CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Ms. [**Known lastname 931**] is a 78 year-old woman with h/o HTN, hyperchol,
CHF, ESRD (not yet on HD) who was transfered from [**Hospital **] [**Hospital 2538**] for management of NSTEMI.
.
The patient describes 2 types of pain. The first pain is a R
sternal pain that occurs while eating and is usually relieved
with physical massage. She reports having this pain for years.
.
The second type of pain started 2 days ago, but has not recurred
now for more than 24 hours.   She reports having epigastric
chest pain 2 days prior to admission that lasted for a whole
day.  She also noted pain in her R arm at the same time.  Denies
associated N/V, diaphoresis, or sob.  No recent change in
weight, LE swelling, or PND. Patient did have some mild cough
with yellow productive sputum, but no f/c.  She also c/o chronic
lightheadedness that she attributes to her medication along with
some intermittent vertigo. Patient otherwise denies any
myalgias/arthralgias. She continues to urinate, no
dysuria/hematuria, intermittent constipation.  She also has
chronic insominia.  Her exercise capacity consists of [**12-14**] a
block, limited by fatigue. Patient told her daughter about the
pain, who then contact[**Name (NI) **] patient's PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 2539**].  PCP referred
the patient to [**Hospital1 **] [**Location (un) 620**] ED for evaluation.
.
Upon arrival to the OSH ED, labs revealed Cr 2.7; CK 301; CKMB
59; Trop T 1.46; EKG was unchanged.  Elevated cardiac enzymes
were confirmed with CK of 317, troponin 1.68 with no prior
baseline.  She was started on a heparin gtt, ASA 325, Lopressor
5 mg IV x 1.  Patient was then transferred to [**Hospital1 18**] for further
managment.
.
Currently, patient feels well, denies CP/SOB.

MEDICAL HISTORY: CVA ([**8-16**]; MRI showing left internal capsular defect, little
residual effect)
ESRD still not on HD - Cr 3.0 (1.7-6.0) - followed by Dr. [**Last Name (STitle) **]

MEDICATION ON ADMISSION: Aspirin 325 daily
Plavix 75 daily,
levothyroxine 88 mcg daily
Norvasc 5 mg daily
Zoloft 50 mg daily
simvastatin 10 mg daily
Aranesp 25 mcg every month
benazepril 10 mg daily
PhosLo 667 mg t.i.d.
vitamin C and vitamin E daily.
Zantac prn
Calcitriol 25 mcg qMWF

ALLERGIES: Gemfibrozil

PHYSICAL EXAM: VS: 97.8 - 130/59 - 60 - 16 - 98% 2L
Gen: elderly female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor
or cyanosis of the oral mucosa. No xanthalesma.
Neck: Supple; JVP flat.
CV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NT, ND.
Ext: No c/c/e. No femoral bruits.
Pulses: 2+ femoral, 2+ DP/PT pulses
.

FAMILY HISTORY: Notable for diabetes and renal failure in a brother.

SOCIAL HISTORY: Former light smoker (ages 25-73); quit 4 yrs ago. No history of
Subendocardial infarction, initial episode of care,Syncope and collapse,Other iatrogenic hypotension,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Pulmonary collapse,Dissection of aorta, thoracic,Congestive heart failure, unspecified,Surgical or other procedure not carried out because of contraindication,Coronary atherosclerosis of native coronary artery,Unspecified disease of pericardium,Atherosclerosis of aorta,Other late effects of cerebrovascular disease,Other complications due to renal dialysis device, implant, and graft,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Personal history of tobacco use
Subendo infarct, initial,Syncope and collapse,Iatrogenc hypotnsion NEC,Abn react-cardiac cath,Pneumonia, organism NOS,Hyp kid NOS w cr kid V,End stage renal disease,Pulmonary collapse,Dsct of thoracic aorta,CHF NOS,No proc/contraindication,Crnry athrscl natve vssl,Pericardial disease NOS,Aortic atherosclerosis,Late effect CV dis NEC,Comp-ren dialys dev/grft,Pure hypercholesterolem,Hypothyroidism NOS,Depressive disorder NEC,History of tobacco use
Admission Date:  [**2152-3-16**]              Discharge Date:   [**2152-3-22**]

Date of Birth:  [**2073-11-29**]             Sex:   F

Service: MEDICINE

Allergies:
Gemfibrozil

Attending:[**First Name3 (LF) 443**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
cardiac catheterization

History of Present Illness:
Ms. [**Known lastname 931**] is a 78 year-old woman with h/o HTN, hyperchol,
CHF, ESRD (not yet on HD) who was transfered from [**Hospital **] [**Hospital 2538**] for management of NSTEMI.
.
The patient describes 2 types of pain. The first pain is a R
sternal pain that occurs while eating and is usually relieved
with physical massage. She reports having this pain for years.
.
The second type of pain started 2 days ago, but has not recurred
now for more than 24 hours.   She reports having epigastric
chest pain 2 days prior to admission that lasted for a whole
day.  She also noted pain in her R arm at the same time.  Denies
associated N/V, diaphoresis, or sob.  No recent change in
weight, LE swelling, or PND. Patient did have some mild cough
with yellow productive sputum, but no f/c.  She also c/o chronic
lightheadedness that she attributes to her medication along with
some intermittent vertigo. Patient otherwise denies any
myalgias/arthralgias. She continues to urinate, no
dysuria/hematuria, intermittent constipation.  She also has
chronic insominia.  Her exercise capacity consists of [**12-14**] a
block, limited by fatigue. Patient told her daughter about the
pain, who then contact[**Name (NI) **] patient's PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 2539**].  PCP referred
the patient to [**Hospital1 **] [**Location (un) 620**] ED for evaluation.
.
Upon arrival to the OSH ED, labs revealed Cr 2.7; CK 301; CKMB
59; Trop T 1.46; EKG was unchanged.  Elevated cardiac enzymes
were confirmed with CK of 317, troponin 1.68 with no prior
baseline.  She was started on a heparin gtt, ASA 325, Lopressor
5 mg IV x 1.  Patient was then transferred to [**Hospital1 18**] for further
managment.
.
Currently, patient feels well, denies CP/SOB.


Past Medical History:
CVA ([**8-16**]; MRI showing left internal capsular defect, little
residual effect)
ESRD still not on HD - Cr 3.0 (1.7-6.0) - followed by Dr. [**Last Name (STitle) **]

Congestive Heart Failure (ECHO [**9-27**] [**Hospital1 1474**], technically
limited showed mild concentric LVH with EF at 60%, ?pericardial

effusion (size unspecified)
s/p right renal artery stent ([**9-15**]) by Dr. [**Last Name (STitle) 911**]
Hypertension
Hypercholesterolemia,
Hypothyroidism
Depression
Degenerative Joint Disease
TAH-BSO/repair of umbilical hernia for benign ovarian mass
(path=fibroma [**4-14**])


Social History:
Former light smoker (ages 25-73); quit 4 yrs ago. No history of

EtOH or other drugs. Formerly worked as a paralegal. Now living

in public senior housing in [**Hospital1 1474**]. Mother of two--one
daughter lives nearby.

Family History:
Notable for diabetes and renal failure in a brother.


Physical Exam:
VS: 97.8 - 130/59 - 60 - 16 - 98% 2L
Gen: elderly female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor
or cyanosis of the oral mucosa. No xanthalesma.
Neck: Supple; JVP flat.
CV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NT, ND.
Ext: No c/c/e. No femoral bruits.
Pulses: 2+ femoral, 2+ DP/PT pulses
.


Pertinent Results:
LABS ON ADMISSION:
[**2152-3-16**] 09:30PM BLOOD WBC-8.3 RBC-4.00* Hgb-13.0 Hct-36.3
MCV-91 MCH-32.5* MCHC-35.8* RDW-13.8 Plt Ct-186
[**2152-3-16**] 09:30PM BLOOD Neuts-64.2 Lymphs-21.7 Monos-6.2 Eos-7.4*
Baso-0.5
[**2152-3-16**] 09:30PM BLOOD PT-13.1 PTT-127.1* INR(PT)-1.1
[**2152-3-16**] 09:30PM BLOOD Plt Ct-186
[**2152-3-16**] 09:30PM BLOOD Glucose-87 UreaN-30* Creat-2.5* Na-142
K-3.4 Cl-109* HCO3-21* AnGap-15
[**2152-3-16**] 09:30PM BLOOD ALT-18 AST-49* CK(CPK)-317*
[**2152-3-16**] 09:30PM BLOOD CK-MB-54* MB Indx-17.0* cTropnT-1.68*
[**2152-3-17**] 06:42AM BLOOD ALT-13 AST-40 CK(CPK)-239*
[**2152-3-17**] 06:42AM BLOOD CK-MB-38* MB Indx-15.9* cTropnT-1.88*
[**2152-3-18**] 05:05AM BLOOD CK(CPK)-518*
[**2152-3-18**] 05:05AM BLOOD CK-MB-58* MB Indx-11.2* cTropnT-3.53*
[**2152-3-19**] 07:15AM BLOOD CK(CPK)-351*
[**2152-3-20**] 05:25AM BLOOD CK(CPK)-152*
[**2152-3-16**] 09:30PM BLOOD Calcium-9.9 Phos-2.4* Mg-2.5
[**2152-3-17**] 02:45PM BLOOD %HbA1c-5.6
.
CARDIAC CATHETERIZATION [**2152-3-17**] (PRELIMINARY REPORT)
1.  Selective coronary angiography revealed two vessel coronary
artery disease.  The left main coronary artery was short with no
angiographically apparent flow limiting stenoses.  The LAD had
moderate diffuse disease with a 70% stenosis in the mid vessel
and a 70% stenosis at the origin of the first diagonal.  The LCX
had an OM1 upper pole with a 99% stenosis and slow flow.  The
LCX had a 70% stenosis in the mid vessel.  The RCA was small in
caliber and had no angiographically apparent flow limiting
stenoses.
2.  Limited resting hemodynamics were performed upon entry.
Systemic arterial pressure was moderately elevated (aortic
pressure was 160/73mmHg).
FINAL DIAGNOSIS:
1. Two vessel coronary artery disease.
.
CT ABDOMEN [**2152-3-17**] (PRELIMINARY REPORT)
1. Small hemorrhagic pericardial effusion.
2. Small bilateral pleural effusion.
3. No evidence of reteroperitoneal bleed.
4. Diffuse atherosclerotic disease.
5. Atrophic kidneys. Not significantly changed form CT from [**4-14**], [**2148**].
.
ECHO [**2152-3-17**]
The left ventricular cavity size is normal. LV systolic function
appears depressed with lateral hypokinesis (regional wall motion
not fully assessed). Right ventricular chamber size is normal.
Right ventricular systolic function is normal. There is a small
pericardial effusion. There are no echocardiographic signs of
tamponade.
.
CXR [**2152-3-20**]: (PRELIMINARY REPORT)
2 views of the chest compared to a single view done 4 days
earlier. There are no focal infiltrates or definite effusions.
Mediastinum and bony structures are unchanged including findings
consistent with rotator cuff disease involving the right
shoulder. There is also marked aortic tortuosity and prominence,
this is also unchanged. Over the cervical prevertebral area,
there is a superimposed air which likely represents the trachea
as well as the piriform sinuses. Please correlate clinically in
this patient with fever.
.
CT chest (non-contrast): 1. Extensive aortic and coronary
atherosclerosis with suspected descending thoracic aorta
dissection and intraluminal thrombus, stable. This study is not
dedicated to evaluation of the vascular system and additional
examination might be considered.

2. Right lower lobe atelectasis and small pleural effusions.

Brief Hospital Course:
Mrs. [**Known lastname 931**] is a 78 year-old woman with a history of
hypertension, hypercholesterolemia, congestive heart failure,
end stage renal disease (not yet on hemodialysis) who was
transfered from [**Hospital **] [**Hospital3 628**] for management of NSTEMI.
.
# NSTEMI: The patient was diagnosed with a non-ST elevation MI
at the outside hospital. She underwent cardiac catheterization
on [**2152-3-17**] showing 2 vessel disease(LAD 70%, D1 70%; LCx 70%, OM1
99%).  During cath, the cardiologists were unable to cross the
LCx/OM1 lesion with the wire.  CT surgery was called for
evaluation of possible surgical revascularization given the
inability to perform PCI.  Plavix was held given this
consideration of surgical revascularization in the future.  She
was continued on aspirin and statin.  The patient was not on a
betablocker as an outpatient; however, this was not started
initially after cath due to hypotension (see below). Her
hypotension resolved, and a beta blocker was started.  Because
of ongoing fevers and clinical pneumonia, CABG was deferred and
the pt was discharged home with instructions to follow-up with
CT surgery for CABG in several weeks.
.
# HYPOTENSION:  Approximately 2 hours after catheterization, the
patient was noted to have an asymptomatic low blood pressure of
74/47.  IV fluid bolus was started immediately with some
response and her SBP rose to the mid-80's.  The cardiology team,
including the interventional cardiology attending, and the
attending of record were present to evaluate the patient.  A
stat bedside echo was done given concern for
dissection/perforation since there was difficulty attempting to
cross LCx/OM lesion during cath.  This echo revealed a small
amount of fluid in pericardial space; however, there was no
evidence of tamponade.  The patient was given Atropine given due
to concern for vagal response since she still had a femoral
sheath in place.  She responded to this medication with good
response in her blood pressure (SBP rose from the 80's to
100's); however, this was only a transient response.  A stat
hematocrit was sent given concern for retroperitoneal bleeding.
This value was stable was stable.  She was given a total 1.5L
bolus of normal saline.  The patient was then transferred to the
CCU for further management.
.
On arrival to the CCU, her BP continued to fall, and more
atropine was given (total 1.2mg) along with a dopamine infusion
for augmentation of blood pressure. A triple lumen catheter was
placed in her right femoral vein, and 2 units of PRBCs were
transfused.  She was taken for an emergent CT abdomen once her
MAP was consistently above 65 while on dopamine drip.
Neosynephrine was added for a short period en route to CT, but
was titrated off during the scan.  This CT scan of the abdomen
and pelvis was negative for a retroperitoneal bleed.  On return
to the CCU, an arterial line was placed. The pt. became somewhat
delerious and agitated and was given Haldol 1mg x2 and 0.25 mg
lorazepam x2 for sedation.
.
She did well overnight with improvement in her blood pressure.
Dopamine was titrated off at 12am (total duration approximately
4 hours).   After weaning dopamine, the patient maintained her
blood pressure well in the range of 104-143/50-76.
.
The etiology of her hypotension was thought to be secondary to a
vagal response due to her femoral sheath.  Once her blood
pressure stabilized, she was started on a low dose betablocker.
She remained with normal blood pressure throughout the remainder
of her stay.
.
# FEVER: The patient spiked temperature overnight on [**2152-3-19**]. She
denied all infectious symptoms.  Her WBC count was normal.  UA
was negative, blood cultures show no growth to date.  CXR did
not show evidence of pneumonia, however pt had adventitious lung
sounds on exam. She continued to spike fevers for several days,
and then became mildly hypoxic, so she was started on
levofloxacin for presumed pneumonia.
.
# END STAGE RENAL DISEASE: The patient is not yet on
hemodialysis.  During this admission, her creatinine bumped
slightly from 2.4 to 2.8.  Her FeNa was less than 1%.  She was
likely prerenal with a component of contrast nephropathy from
the catheterization. Her creatinine promptly improved from 2.8
back to her baseline of 2.4.
.
# HYPERLIPIDEMIA: She was placed on lipitor 80mg daily given her
NSTEMI.
.
# HTN: She is on norvasc as an outpatient.  This was held
initially due to her hypotension.  She was later started on a
low dose of metoprolol given her NSTEMI, and her norvasc was
discontinued. Her ACEI was also held both during the admission
and upon discharge due to her renal dysfunction and upcoming
CABG.
.
# DEPRESSION: She was continued on Zoloft.
.
# HYPOTHYROIDISM: She was continued on her outpatient dose of
levothyroxine.
.
# CODE: she was originally DNR/DNI, however after further
discussion with the pt, she decided to be Full Code.
.


Medications on Admission:
Aspirin 325 daily
Plavix 75 daily,
levothyroxine 88 mcg daily
Norvasc 5 mg daily
Zoloft 50 mg daily
simvastatin 10 mg daily
Aranesp 25 mcg every month
benazepril 10 mg daily
PhosLo 667 mg t.i.d.
vitamin C and vitamin E daily.
Zantac prn
Calcitriol 25 mcg qMWF


Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Aranesp 25 mcg/mL Solution Sig: Twenty Five (25) mcg
Injection once a month.
6. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
8. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO EVERY
OTHER DAY (Every Other Day).
9. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3
times a day).
Disp:*45 Tablet(s)* Refills:*2*
10. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q48H
(every 48 hours) for 10 days.
Disp:*5 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Community VNA

Discharge Diagnosis:
Primary diagnosis: Non-ST Elevation Myocardial Infarction

Secondary diagnoses:
Hypotension
End Stage Renal Disease
Stable small aortic dissection


Discharge Condition:
Stable. No chest pain.


Discharge Instructions:
Please call your doctor or return to the emergency room if you
experience chest pain, difficulty breathing, palpitations,
dizziness, weight gain, leg swelling, or any other concern.
.
Take your medications as prescribed. The following changes were
made to your medications:  you should stop taking plavix, you
should take lipitor instead of simvastatin, you should stop
taking your benazepril, and you were started on metoprolol. You
should complete a 10 day course of levofloxacin for pneumonia.
.
Please attend all follow-up appointments.

Followup Instructions:
You have an appointment with Dr. [**Last Name (STitle) 914**] (Cardiac surgery) on
Wednesday [**2152-3-29**] @ 2:30. [**Hospital **] Medical Office Building [**Hospital Unit Name **]
[**Telephone/Fax (1) 170**]. Please also follow-up with your PCP in the next 7
days, as some of your medications may need to be adjusted.  You
also have the following appointments scheduled:

Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 39**], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 41**]
Date/Time:[**2152-4-5**] 11:15
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2540**], RN Phone:[**Telephone/Fax (1) 435**]
Date/Time:[**2152-5-3**] 11:30
Provider: [**First Name11 (Name Pattern1) 177**] [**Last Name (NamePattern4) 720**], M.D. Phone:[**Telephone/Fax (1) 435**]
Date/Time:[**2152-7-19**] 11:30



Completed by:[**2152-3-22**]
{'Subendocardial infarction, initial episode of care,Syncope and collapse,Other iatrogenic hypotension,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Pulmonary collapse,Dissection of aorta, thoracic,Congestive heart failure, unspecified,Surgical or other procedure not carried out because of contraindication,Coronary atherosclerosis of native coronary artery,Unspecified disease of pericardium,Atherosclerosis of aorta,Other late effects of cerebrovascular disease,Other complications due to renal dialysis device, implant, and graft,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Personal history of tobacco use'}


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: chest pain

PRESENT ILLNESS: Ms. [**Known lastname 931**] is a 78 year-old woman with h/o HTN, hyperchol,
CHF, ESRD (not yet on HD) who was transfered from [**Hospital **] [**Hospital 2538**] for management of NSTEMI.
.
The patient describes 2 types of pain. The first pain is a R
sternal pain that occurs while eating and is usually relieved
with physical massage. She reports having this pain for years.
.
The second type of pain started 2 days ago, but has not recurred
now for more than 24 hours.   She reports having epigastric
chest pain 2 days prior to admission that lasted for a whole
day.  She also noted pain in her R arm at the same time.  Denies
associated N/V, diaphoresis, or sob.  No recent change in
weight, LE swelling, or PND. Patient did have some mild cough
with yellow productive sputum, but no f/c.  She also c/o chronic
lightheadedness that she attributes to her medication along with
some intermittent vertigo. Patient otherwise denies any
myalgias/arthralgias. She continues to urinate, no
dysuria/hematuria, intermittent constipation.  She also has
chronic insominia.  Her exercise capacity consists of [**12-14**] a
block, limited by fatigue. Patient told her daughter about the
pain, who then contact[**Name (NI) **] patient's PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 2539**].  PCP referred
the patient to [**Hospital1 **] [**Location (un) 620**] ED for evaluation.
.
Upon arrival to the OSH ED, labs revealed Cr 2.7; CK 301; CKMB
59; Trop T 1.46; EKG was unchanged.  Elevated cardiac enzymes
were confirmed with CK of 317, troponin 1.68 with no prior
baseline.  She was started on a heparin gtt, ASA 325, Lopressor
5 mg IV x 1.  Patient was then transferred to [**Hospital1 18**] for further
managment.
.
Currently, patient feels well, denies CP/SOB.

MEDICAL HISTORY: CVA ([**8-16**]; MRI showing left internal capsular defect, little
residual effect)
ESRD still not on HD - Cr 3.0 (1.7-6.0) - followed by Dr. [**Last Name (STitle) **]

MEDICATION ON ADMISSION: Aspirin 325 daily
Plavix 75 daily,
levothyroxine 88 mcg daily
Norvasc 5 mg daily
Zoloft 50 mg daily
simvastatin 10 mg daily
Aranesp 25 mcg every month
benazepril 10 mg daily
PhosLo 667 mg t.i.d.
vitamin C and vitamin E daily.
Zantac prn
Calcitriol 25 mcg qMWF

ALLERGIES: Gemfibrozil

PHYSICAL EXAM: VS: 97.8 - 130/59 - 60 - 16 - 98% 2L
Gen: elderly female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor
or cyanosis of the oral mucosa. No xanthalesma.
Neck: Supple; JVP flat.
CV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NT, ND.
Ext: No c/c/e. No femoral bruits.
Pulses: 2+ femoral, 2+ DP/PT pulses
.

FAMILY HISTORY: Notable for diabetes and renal failure in a brother.

SOCIAL HISTORY: Former light smoker (ages 25-73); quit 4 yrs ago. No history of 

### Response:
{'Subendocardial infarction, initial episode of care,Syncope and collapse,Other iatrogenic hypotension,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Pulmonary collapse,Dissection of aorta, thoracic,Congestive heart failure, unspecified,Surgical or other procedure not carried out because of contraindication,Coronary atherosclerosis of native coronary artery,Unspecified disease of pericardium,Atherosclerosis of aorta,Other late effects of cerebrovascular disease,Other complications due to renal dialysis device, implant, and graft,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Personal history of tobacco use'}
