CHIEF COMPLAINT: SOB; V-tach

PRESENT ILLNESS: This 64 year old male has a history of ischemic cardiomyopathy
with an EF of [**9-3**]%. He is s/p CABG in [**2086**] with SVG to PLA,
LIMA to LAD. He was evaluated for a biventricular ICD at [**Hospital1 **] in [**2098**], but did not qualify at that time, based on
his QRS duration and tissue Doppler imaging. He has been
medically managed since then.
.
He has a h/o ?COPD and c/o cough productive of clear sputum, and
worsening wheezing and SOB. He thought he had the flu but denies
fevers, chills, HA, myalgia, or night sweats. He reports stable
2-pillow orthopnea, denies PND. He was treated presumptively for
?bronchitis vs PNA? with a week-long course of azithromycin
without improvement. He also reports eating almost nothing in
the past 2 weeks and drinking very little. He has been compliant
with all meds including diuretics. He denies chest pain and
endorses light headedness only with coughing. He has felt his
ICD go into ATP but denies any shocks.
.
This AM he presented to [**Hospital6 **] for this
worsened shortness of breath where his VSS were 112/70 P 95 rr20
92% on RA. He was given levoquin 750, CTX, albuterol. He was
found to have intermittent SVT that was terminated by ATP. He
was given amiodarone 150mg IV x1 and started on a drip which
decreased the rate of his VT such that his AICD did not fire; he
was therefore transferred to [**Hospital1 18**] emergency department.
.
In [**Hospital1 18**] ED given ASA, plavix, nebs, CXR?RML pna? 100mg
lidocaine and drip at 3mg/hr. EP service interrogated his pacer
and found frequent episodes of VT terminated by ATP beginning
[**11-22**]. They changed the thesholds of his AICD and it did
appropriately respond to several more runs of VT. He had
approximately 10 runs SVT that were pace-terminated in the [**Hospital1 18**]
emergency department. He was started on a lidocaine drip at 3mg,
given nebs, bolused 800cc and admitted to the CCU.
.
In the CCU on transfer he felt well other than fatigue and SOB.
He denied CP, nausea, vomiting, myalgias. He was alert and
oriented x 3 and appropriately conversant. His vital signs were
T 97.2 BP 68/44, HR 71, 100% 3L n/c with PE significant for loud
wheezes, mild respiratory distress and neck veins elevated to
ear lobe while sitting up at 45 degrees. He was bolused 250 cc
without improvement in his BP. He was oliguric to about 5-10cc
in his first hour. Over that hour he became progressively
hypotensive with SBP in the 60's-90 range in both arms (mainly
60's'-70's) with HR in the 70's. He was asymptomatic with these
pressures and mentating well. He then began feeling more
fatigued/generally poor with SBPs consistently in the 60's. He
was started on levophed via peripheral IV, and while attempting
arterial placement the patient became apneic and unresponsive.
CPR was initiated for PEA arrest and he was intubated. He
received 3 rounds epi and within about 45 minutes, he regained a
pulse. Bedside echo showed a severely depressed EF and no
pericardial effusion.

MEDICAL HISTORY: Significant vascular disease:
bilateral renal artery stenosis s/p stenting [**2097**]
T.O right internal carotid
left internal carotid stenosis s/p left endarterectomy
AAA
chronic renal insufficency, baseline creat 2.9
remote gastric ulcer
ankle arthritis treated with steroid injections
COPD
past ETOH abuse, currently drinks socially
CABG
appy
hernia repair

MEDICATION ON ADMISSION: hctz 25mg tues-fri
lasix 80mg qAM; 40mg qPM
isordil 10mg [**Hospital1 **]
Coreg 15mg [**Hospital1 **]?
lipitor 40mg
plavix 75 qod
ASA
KCl 20mEa
folate 1mg [**Hospital1 **]
flomax 0.4mg qAM
trental 100mg qAM
singulair 10mg
tiotropium qday
albuterol qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE prior to cardiac arrest:
Ht: 5'6
Wt: 170 lbs
T 97.2 BP 68/44, HR 71, 100% 3L n/c
Gen: elderly male, appearing tired but NAD. alert and oriented x
2
CV: RRR no m/r/g; JVD to level of ear
Pulm: loud wheezes throughout, no accessory muscle use.
Abd: s/nd/nt + BS
extremities: cool, absent pulses

FAMILY HISTORY: NC

SOCIAL HISTORY: married
Acute respiratory failure,Congestive heart failure, unspecified,Paroxysmal ventricular tachycardia,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Hypovolemia,Obstructive chronic bronchitis with acute bronchitis,Cardiogenic shock,Fitting and adjustment of automatic implantable cardiac defibrillator,Aortocoronary bypass status,Other specified forms of chronic ischemic heart disease,Chronic passive congestion of liver,Anemia of other chronic disease,Foreign body in esophagus,Foreign body accidentally entering other orifice
Acute respiratry failure,CHF NOS,Parox ventric tachycard,Acute kidney failure NOS,Chronic kidney dis NOS,Hypovolemia,Obs chr bronc w ac bronc,Cardiogenic shock,Ftng autmtc dfibrillator,Aortocoronary bypass,Chr ischemic hrt dis NEC,Chr passiv congest liver,Anemia-other chronic dis,Foreign body esophagus,FB entering oth orifice
Admission Date:  [**2102-11-25**]              Discharge Date:   [**2102-12-13**]

Date of Birth:  [**2036-5-10**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2387**]
Chief Complaint:
SOB; V-tach

Major Surgical or Invasive Procedure:
CPR
Swan Ganz catheter insertion
Intubation


History of Present Illness:
This 64 year old male has a history of ischemic cardiomyopathy
with an EF of [**9-3**]%. He is s/p CABG in [**2086**] with SVG to PLA,
LIMA to LAD. He was evaluated for a biventricular ICD at [**Hospital1 **] in [**2098**], but did not qualify at that time, based on
his QRS duration and tissue Doppler imaging. He has been
medically managed since then.
.
He has a h/o ?COPD and c/o cough productive of clear sputum, and
worsening wheezing and SOB. He thought he had the flu but denies
fevers, chills, HA, myalgia, or night sweats. He reports stable
2-pillow orthopnea, denies PND. He was treated presumptively for
?bronchitis vs PNA? with a week-long course of azithromycin
without improvement. He also reports eating almost nothing in
the past 2 weeks and drinking very little. He has been compliant
with all meds including diuretics. He denies chest pain and
endorses light headedness only with coughing. He has felt his
ICD go into ATP but denies any shocks.
.
This AM he presented to [**Hospital6 **] for this
worsened shortness of breath where his VSS were 112/70 P 95 rr20
92% on RA. He was given levoquin 750, CTX, albuterol. He was
found to have intermittent SVT that was terminated by ATP. He
was given amiodarone 150mg IV x1 and started on a drip which
decreased the rate of his VT such that his AICD did not fire; he
was therefore transferred to [**Hospital1 18**] emergency department.
.
In [**Hospital1 18**] ED given ASA, plavix, nebs, CXR?RML pna? 100mg
lidocaine and drip at 3mg/hr. EP service interrogated his pacer
and found frequent episodes of VT terminated by ATP beginning
[**11-22**]. They changed the thesholds of his AICD and it did
appropriately respond to several more runs of VT. He had
approximately 10 runs SVT that were pace-terminated in the [**Hospital1 18**]
emergency department. He was started on a lidocaine drip at 3mg,
given nebs, bolused 800cc and admitted to the CCU.
.
In the CCU on transfer he felt well other than fatigue and SOB.
He denied CP, nausea, vomiting, myalgias. He was alert and
oriented x 3 and appropriately conversant. His vital signs were
T 97.2 BP 68/44, HR 71, 100% 3L n/c with PE significant for loud
wheezes, mild respiratory distress and neck veins elevated to
ear lobe while sitting up at 45 degrees. He was bolused 250 cc
without improvement in his BP. He was oliguric to about 5-10cc
in his first hour. Over that hour he became progressively
hypotensive with SBP in the 60's-90 range in both arms (mainly
60's'-70's) with HR in the 70's. He was asymptomatic with these
pressures and mentating well. He then began feeling more
fatigued/generally poor with SBPs consistently in the 60's. He
was started on levophed via peripheral IV, and while attempting
arterial placement the patient became apneic and unresponsive.
CPR was initiated for PEA arrest and he was intubated. He
received 3 rounds epi and within about 45 minutes, he regained a
pulse. Bedside echo showed a severely depressed EF and no
pericardial effusion.


Past Medical History:
Significant vascular disease:
bilateral renal artery stenosis s/p stenting [**2097**]
T.O right internal carotid
left internal carotid stenosis s/p left endarterectomy
AAA
chronic renal insufficency, baseline creat 2.9
remote gastric ulcer
ankle arthritis treated with steroid injections
COPD
past ETOH abuse, currently drinks socially
CABG
appy
hernia repair


Social History:
married

Family History:
NC

Physical Exam:
PE prior to cardiac arrest:
Ht: 5'6
Wt: 170 lbs
T 97.2 BP 68/44, HR 71, 100% 3L n/c
Gen: elderly male, appearing tired but NAD. alert and oriented x
2
CV: RRR no m/r/g; JVD to level of ear
Pulm: loud wheezes throughout, no accessory muscle use.
Abd: s/nd/nt + BS
extremities: cool, absent pulses


Pertinent Results:
[**2102-11-25**] CXR: Mild congestive heart failure has developed with
perihilar haziness, peribronchial cuffing and septal thickening
as well as a small right pleural effusion.
.
[**2102-11-27**] ECHO:  LVEF <20% The left atrium is mildly dilated. Left
ventricular wall thicknesses are normal. The left ventricular
cavity is moderately dilated with severe global hypokinesis. No
masses or thrombi are seen in the left ventricle. Tissue Doppler
imaging suggests an increased left ventricular filling pressure
(PCWP>18mmHg). The right ventricular cavity is mildly dilated
wtih severe global free wall hypokinesis.The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. The mitral valve leaflets
are structurally normal. Moderate (2+) mitral regurgitation is
seen. There is moderate pulmonary artery systolic hypertension.
Significant pulmonic regurgitation is seen. The end-diastolic
pulmonic regurgitation velocity is increased suggesting
pulmonary artery diastolic hypertension. There is no pericardial
effusion.
.
[**2102-12-1**] Renal dopplers: IMPRESSION:
1. Left main and intrarenal arteries demonstrate abnormal parvus
waveforms. There is associated cortical thinning of the left
kidney. Findings suggest chronic left renal artery stenosis or
intrinsic renal disease. Conventional or MR angiography of the
renal arteries is recommended for further evaluation.
.
2. Mildly elevated right-sided renal resistive indices.
.
[**2102-12-5**] RUQ U/S:  CONCLUSION: Small volume ascites, small left
effusion, splenomegaly and dilatation of the hepatic veins and
inferior vena cava. Pulsatile nature of portal vein flow is also
noted and the findings are suggestive of right heart failure
with passive hepatic congestion as a possible explanation for
elevated LFTs.
.
Gallbladder sludge also noted, but no evidence of cholecystitis,
cholelithiasis, or bile duct abnormalities.
.


Brief Hospital Course:
Mr. [**Known lastname **] is a 66 year old man with a history of coronary
artery disease, ischemic cardiomyopathy with EF 10-15%, s/p [**Hospital1 **]-V
ICD, presenting with SOB and found to have multiple episodes of
VT. s/p intubation for respiratory failure and PEA arrest x 2.
.
# hypotension/shock/PEA arrest on admission:  Was likely
cardiogenic shock [**12-22**] extremely low baseline EF (10-15%) +
decompensation from hypovolemia and bradycardia with coronary
hypoperfusion. It was unlikely ACS is underlying etiology given
lack of chest pain, EKG unchanged, negative CE's. and an eccho
that was grossly unchanged. Pt again PEA arrested AM
post-admission (resolved with epi/atropine x2) with telemetry
findings sinus brady rate 54, concerning for failure of LV
capture.  He developed VT developed post arrest which was
associated with normotension and was pace-terminated.
Electrophysiology was consulted who changed his pace-maker's
back-up rate to 70; he subsuquently had no further episodes of
PEA arrest or of hypotension.
.
#) CARDIAC:
a) RHYTHM: Mr [**Known lastname **] presented after having multiple episodes
of VT at home [**2102-11-22**], per interrogation by EP. At an OSH he was
initially managed with amio boluses, causing VT to slow down
which was not recognized by his pacemaker. EP adjusted the
parameters on his pacemaker and then he was managed with
lidocaine gtt. Mr [**Known lastname **] had one witnessed episode of VT upon
coming out of his PEA arrest; this broke with lidocaine drip
(which was stopped shortly thereafter). Other than this, he had
one short episode of VT found on telemetry which was ATP
terminated on teh 2nd cycle.  He was subsuquently started on
amiodarone; he should have q6 month LFTs, thyroid tests; yearly
PFTs and eye exam while on this drug
.
With regards to his [**Hospital1 **]-V pacer; it was theorized that his BP was
unable to tolerate bradycardia and his back-up ventricular rate
was increased rate to 70. He had no other hypotensive episodes
after this change.
.
b) PUMP: severe, ischemic cardiomyopathy. EF likely <10%. He was
initially hypovolemic due to continued diuretic use and poor PO
intake. He was given IVF which improved his BP as did increasing
his back-up [**Hospital1 **]-V pacer rate to 70.  He was resumed on carvedilol
12.5 [**Hospital1 **] which he tolerated.  ACE inhibitor was held [**12-22**] ARF.
Aldactone was attempted but d/c'd [**12-22**] hyperkalemia.  He may need
a standing diuretic at a later date, but he has taken in very
poor po and may not need this.
.
c) ISCHEMIA: EKG does not show any changes suggestive of
ischemia. Cardiac enzymes were flat on admission and post-code.
Doubtful that ACS is involved.  he was continued ASA, plavix,
statin.
.
#) ID: pt w/ cough x1wk unresponsive to azithro. He may have had
a viral URI vs. COPD exacerbation. He was treated with 4d CTX
for bronchitis/COPD.  He was treated with 2d vancomycin to
prophylax lines placed during code situation.
.
#) hyperbilirubinemia: Mr [**Known lastname **] had slight elevation of
transaminases with a normal RUQ US.  It was thought to be [**12-22**]
congestive hepatopathy vs shock liver.  He should have LFTs
followed on amiodarone.
.
#) Dyspnea/resp failure: clinical picture (pre-decompensated)
very suspicious for COPD exacerbaton. Pt was intubated for
several days for cardiac arrest.  He did well post extubation
and was given a prednisone taper; he was treated x4d with CTX
for ?infection.  He has standing nebs and his home COPD regimen
of montelukast, combivent, he was vaccinated for influenza and
pneumococcus.  He should also take guaifenessin.
.
#) Renal: CKD with Cr max at 2.7, baseline ~2.  His ACE
inhibitor was held; he has had poor po intake and appears dry;
he should be encouraged to drink 2L/day.  he developed
hyperkalemia on aldactone; this should not be restarted.
.
#) Anemia: He was transfused 2U pRBCs for hct<30; this has been
stable
.
#) F/E/N: cardiac/low-salt diet.  Experienced hyperkalemia
requiring kayexalate on aldactone; this should not be resumed.
.
# Swallowed teeth: Mr [**Known lastname **] dentures were evidently knocked
loose during emergent intubation and during mouth care one day
they were swallowed.  An incident report filed; the teeth were
retrieved from the esophagus by endoscopy.  This should be fixed
as an outpatient; he needs prophylaxis with amoxicillin 2g x 1
30minutes prior to dental procedure.
.
#) code: full
.
#) PPX: PPI, pneumoboots

Medications on Admission:
hctz 25mg tues-fri
lasix 80mg qAM; 40mg qPM
isordil 10mg [**Hospital1 **]
Coreg 15mg [**Hospital1 **]?
lipitor 40mg
plavix 75 qod
ASA
KCl 20mEa
folate 1mg [**Hospital1 **]
flomax 0.4mg qAM
trental 100mg qAM
singulair 10mg
tiotropium qday
albuterol qday


Discharge Medications:
1. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
5. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q3-4H (Every 3 to 4 Hours) as needed.
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed.
7. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed.
8. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
9. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
11. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
12. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day.

13. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed.
14. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] House Nursing Home - [**Location 9583**]

Discharge Diagnosis:
PEA arrest
Ventricular tachycardia
CHF with EF 10%
COPD exacerbation
acute renal failure
hyperkalemia on aldactone


Discharge Condition:
fair,
AFVSS


Discharge Instructions:
You were admitted because of frequent ventricular tachycardia;
we have changed your pacemaker settings to be able to stop this
irregular rhythm.  If you feel your pacemaker defibrillate
(feels like a shock), you need to go to the emergency
department.  We have also started an antiarrhythmic medication
called amiodarone.  Because of this your cardiologist will need
to obtain yearly pulmonary tests, eye exam, and [**Hospital1 **]-annual
thyroid studies and liver studies.
.
Please take all medications as prescribed; we have made several
changes to these medications including decreasing your
carvedilol dose.  We have also added a new medication called
amiodarone to help decrease the amount of ventricular
tachycardia you have been experiencing.
.
We are finishing a prednisone taper because you came in with
some breathing troubles.  We will give you instructions on how
to taper this.
.
Please come to the emergency department if you have any chest
pain, shortness of breath, light-headedness, fevers, chills, or
for any other concerns.

Followup Instructions:
With Dr. [**Last Name (STitle) **] (you will be contact[**Name (NI) **] with an appt time)
[**Telephone/Fax (1) 14525**]
{'Acute respiratory failure,Congestive heart failure, unspecified,Paroxysmal ventricular tachycardia,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Hypovolemia,Obstructive chronic bronchitis with acute bronchitis,Cardiogenic shock,Fitting and adjustment of automatic implantable cardiac defibrillator,Aortocoronary bypass status,Other specified forms of chronic ischemic heart disease,Chronic passive congestion of liver,Anemia of other chronic disease,Foreign body in esophagus,Foreign body accidentally entering other orifice'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: SOB; V-tach

PRESENT ILLNESS: This 64 year old male has a history of ischemic cardiomyopathy
with an EF of [**9-3**]%. He is s/p CABG in [**2086**] with SVG to PLA,
LIMA to LAD. He was evaluated for a biventricular ICD at [**Hospital1 **] in [**2098**], but did not qualify at that time, based on
his QRS duration and tissue Doppler imaging. He has been
medically managed since then.
.
He has a h/o ?COPD and c/o cough productive of clear sputum, and
worsening wheezing and SOB. He thought he had the flu but denies
fevers, chills, HA, myalgia, or night sweats. He reports stable
2-pillow orthopnea, denies PND. He was treated presumptively for
?bronchitis vs PNA? with a week-long course of azithromycin
without improvement. He also reports eating almost nothing in
the past 2 weeks and drinking very little. He has been compliant
with all meds including diuretics. He denies chest pain and
endorses light headedness only with coughing. He has felt his
ICD go into ATP but denies any shocks.
.
This AM he presented to [**Hospital6 **] for this
worsened shortness of breath where his VSS were 112/70 P 95 rr20
92% on RA. He was given levoquin 750, CTX, albuterol. He was
found to have intermittent SVT that was terminated by ATP. He
was given amiodarone 150mg IV x1 and started on a drip which
decreased the rate of his VT such that his AICD did not fire; he
was therefore transferred to [**Hospital1 18**] emergency department.
.
In [**Hospital1 18**] ED given ASA, plavix, nebs, CXR?RML pna? 100mg
lidocaine and drip at 3mg/hr. EP service interrogated his pacer
and found frequent episodes of VT terminated by ATP beginning
[**11-22**]. They changed the thesholds of his AICD and it did
appropriately respond to several more runs of VT. He had
approximately 10 runs SVT that were pace-terminated in the [**Hospital1 18**]
emergency department. He was started on a lidocaine drip at 3mg,
given nebs, bolused 800cc and admitted to the CCU.
.
In the CCU on transfer he felt well other than fatigue and SOB.
He denied CP, nausea, vomiting, myalgias. He was alert and
oriented x 3 and appropriately conversant. His vital signs were
T 97.2 BP 68/44, HR 71, 100% 3L n/c with PE significant for loud
wheezes, mild respiratory distress and neck veins elevated to
ear lobe while sitting up at 45 degrees. He was bolused 250 cc
without improvement in his BP. He was oliguric to about 5-10cc
in his first hour. Over that hour he became progressively
hypotensive with SBP in the 60's-90 range in both arms (mainly
60's'-70's) with HR in the 70's. He was asymptomatic with these
pressures and mentating well. He then began feeling more
fatigued/generally poor with SBPs consistently in the 60's. He
was started on levophed via peripheral IV, and while attempting
arterial placement the patient became apneic and unresponsive.
CPR was initiated for PEA arrest and he was intubated. He
received 3 rounds epi and within about 45 minutes, he regained a
pulse. Bedside echo showed a severely depressed EF and no
pericardial effusion.

MEDICAL HISTORY: Significant vascular disease:
bilateral renal artery stenosis s/p stenting [**2097**]
T.O right internal carotid
left internal carotid stenosis s/p left endarterectomy
AAA
chronic renal insufficency, baseline creat 2.9
remote gastric ulcer
ankle arthritis treated with steroid injections
COPD
past ETOH abuse, currently drinks socially
CABG
appy
hernia repair

MEDICATION ON ADMISSION: hctz 25mg tues-fri
lasix 80mg qAM; 40mg qPM
isordil 10mg [**Hospital1 **]
Coreg 15mg [**Hospital1 **]?
lipitor 40mg
plavix 75 qod
ASA
KCl 20mEa
folate 1mg [**Hospital1 **]
flomax 0.4mg qAM
trental 100mg qAM
singulair 10mg
tiotropium qday
albuterol qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE prior to cardiac arrest:
Ht: 5'6
Wt: 170 lbs
T 97.2 BP 68/44, HR 71, 100% 3L n/c
Gen: elderly male, appearing tired but NAD. alert and oriented x
2
CV: RRR no m/r/g; JVD to level of ear
Pulm: loud wheezes throughout, no accessory muscle use.
Abd: s/nd/nt + BS
extremities: cool, absent pulses

FAMILY HISTORY: NC

SOCIAL HISTORY: married 

### Response:
{'Acute respiratory failure,Congestive heart failure, unspecified,Paroxysmal ventricular tachycardia,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Hypovolemia,Obstructive chronic bronchitis with acute bronchitis,Cardiogenic shock,Fitting and adjustment of automatic implantable cardiac defibrillator,Aortocoronary bypass status,Other specified forms of chronic ischemic heart disease,Chronic passive congestion of liver,Anemia of other chronic disease,Foreign body in esophagus,Foreign body accidentally entering other orifice'}
