CHIEF COMPLAINT: GIB, hypercarbic respiratory failure

PRESENT ILLNESS: Mrs. [**Known lastname **] is an 82 year old female with a history of coronary
artery disease s/p CABG, aortic valve replacement, atrial
fibrillation and COPD on home oxygen who presented to [**Hospital **] on [**2154-11-4**] after being found down in a shelter
unresponsive. Per notes, she had been staying at a shelter
because her power was out in her home. She was found
unresponsive and was bradycardic to the 20s and hypotensive. She
was taken to [**Hospital3 7569**] where she had an emergent
temporary transvenous pacer placed. She also was intubated for
hypercarbic respiratory failure. The initial cause of her
bradycardiac was unclear but felt possibly to be related to
digoxin toxicity for which she received digibind. She was
subsequently treated for a COPD exacerbation with high dose
solumedrol, zosyn and azithromycin. She also was noted to have
acute renal failure thought by nephrology to be consistent with
acute tubular necrosis in the setting of profound hypotension
and was treated with lasix for decreased urine ouput. There was
also concern for gastrointestinal bleeding as her hematocrit on
presentation was 19.4 and she received two units of packed red
blood cells. She was extubated on hospital day two without
difficulty. She had an echocardiogram which showed preserved
systolic function but pulmonary hypertension with a pulmonary
artery pressure of 50 mm. The Zosyn was discontinued when the
patient began to experience a drop in her platelet count to as
low as 56k. On hospital day three she underwent a thoracentesis
for a left sided pleural effusion which was consistent with a
transudate with LDH 88, ratio 0.3, Prot 3.0. She continued to
have loose black guaiac positive stools. She was started on IV
flagyl and PO vancomycin out of concern for clostridium
difficile although c. diff samples were negative x 1. Renal
function has improved from a creatinine of 2.6 on admission to
1.7. She also suffered from a burn to her back from a heating
pad used while she had the transvenous pacer placed and
developed a stage II decubitous ulcer. The temporary pacer was
removed prior to transfer.

MEDICAL HISTORY: Coronary Artery Disease s/p CABG (LIMA to LAD and SVG to RCA)
Aortic Valve Replacement (bioprosthetic)
Atrial Fibrillation (not currently anticoagulated)
Hypertension
Hyperlipidemia
COPD (FEV1 less than one liter)
Diastolic Congestive Heart Failure
Depression
Left phrenic nerve paralysis
Admission to [**Location (un) **] in [**2-26**] for gastrointestinal bleeding

MEDICATION ON ADMISSION: Simvastatin 20 mg daily
Diltiazem 240 mg daily
Tikosyn 62.5 mg [**Hospital1 **]
Lasix 20 mg daily
Digoxin 0.125 mg daily
Hydralazine 25 mg PO BID
Toprol XL 25 mg daily
Enalapril 10 mg PO daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Presentation:

FAMILY HISTORY: Father had coronary artery disease, mother had [**Name (NI) 2481**]
disease.

SOCIAL HISTORY: She does not actively drink or smoke, 100-pack-year history of
smoking. Son in the area acts as health care proxy.
Hemorrhage of gastrointestinal tract, unspecified,Acute on chronic diastolic heart failure,Acute and chronic respiratory failure,Ventilator associated pneumonia,Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Obstructive chronic bronchitis with (acute) exacerbation,Hyperosmolality and/or hypernatremia,Thrombocytopenia, unspecified,Pressure ulcer, upper back,Atrial fibrillation,Anemia of other chronic disease,Aortocoronary bypass status,Other chronic pulmonary heart diseases,Heart valve replaced by transplant,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other mononeuritis of upper limb,Other dependence on machines, supplemental oxygen
Gastrointest hemorr NOS,Ac on chr diast hrt fail,Acute & chronc resp fail,Ventltr assoc pneumonia,Ac kidny fail, tubr necr,Urin tract infection NOS,Obs chr bronc w(ac) exac,Hyperosmolality,Thrombocytopenia NOS,Pressure ulcer, upr back,Atrial fibrillation,Anemia-other chronic dis,Aortocoronary bypass,Chr pulmon heart dis NEC,Heart valve transplant,Hypertension NOS,Hyperlipidemia NEC/NOS,Mononeuritis arm NEC,Depend-supplement oxygen
Admission Date:  [**2154-11-9**]              Discharge Date:   [**2154-12-2**]

Date of Birth:  [**2072-3-30**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 398**]
Chief Complaint:
GIB, hypercarbic respiratory failure

Major Surgical or Invasive Procedure:
Intubation and extubation three times
Central line placement and removal
PEG placement
Tracheostomy placement
PICC placement
Bone Marrow Biopsy

History of Present Illness:
Mrs. [**Known lastname **] is an 82 year old female with a history of coronary
artery disease s/p CABG, aortic valve replacement, atrial
fibrillation and COPD on home oxygen who presented to [**Hospital **] on [**2154-11-4**] after being found down in a shelter
unresponsive. Per notes, she had been staying at a shelter
because her power was out in her home. She was found
unresponsive and was bradycardic to the 20s and hypotensive. She
was taken to [**Hospital3 7569**] where she had an emergent
temporary transvenous pacer placed. She also was intubated for
hypercarbic respiratory failure. The initial cause of her
bradycardiac was unclear but felt possibly to be related to
digoxin toxicity for which she received digibind. She was
subsequently treated for a COPD exacerbation with high dose
solumedrol, zosyn and azithromycin. She also was noted to have
acute renal failure thought by nephrology to be consistent with
acute tubular necrosis in the setting of profound hypotension
and was treated with lasix for decreased urine ouput. There was
also concern for gastrointestinal bleeding as her hematocrit on
presentation was 19.4 and she received two units of packed red
blood cells. She was extubated on hospital day two without
difficulty. She had an echocardiogram which showed preserved
systolic function but pulmonary hypertension with a pulmonary
artery pressure of 50 mm. The Zosyn was discontinued when the
patient began to experience a drop in her platelet count to as
low as 56k. On hospital day three she underwent a thoracentesis
for a left sided pleural effusion which was consistent with a
transudate with LDH 88, ratio 0.3, Prot 3.0. She continued to
have loose black guaiac positive stools. She was started on IV
flagyl and PO vancomycin out of concern for clostridium
difficile although c. diff samples were negative x 1. Renal
function has improved from a creatinine of 2.6 on admission to
1.7. She also suffered from a burn to her back from a heating
pad used while she had the transvenous pacer placed and
developed a stage II decubitous ulcer. The temporary pacer was
removed prior to transfer.

On arrival here the patient noted that she has been experiencing
chest tightness since her endotracheal tube was removed. On
arrival her heart rate was in the 140s in atrial fibrillation
with blood pressures in the 160s systolic. She had a
nitroglycerin patch on and it was unclear whether this was being
used for chest pain or for blood pressure control. She received
5 mg IV metoprolol x 2 with good control of her heart rate.

She currently denies lightheadedness or dizziness. She continues
to experience chest tightness. Her breathing feels at baseline
to her. She endorses mild nausea but no vomiting. She denies
abdominal pain but endorses dark stools with diarrhea. She
denies dysuria, hematuria or decreased urine output. She denies
leg pain or swelling. She does note that she was admitted to
[**Location (un) **] in [**Month (only) 547**] of this year with gastrointestinal bleeding and
had a procedure but she does not recall what was found. All
other review of systems negative in detail.


Past Medical History:
Coronary Artery Disease s/p CABG (LIMA to LAD and SVG to RCA)
Aortic Valve Replacement (bioprosthetic)
Atrial Fibrillation (not currently anticoagulated)
Hypertension
Hyperlipidemia
COPD (FEV1 less than one liter)
Diastolic Congestive Heart Failure
Depression
Left phrenic nerve paralysis
Admission to [**Location (un) **] in [**2-26**] for gastrointestinal bleeding


Social History:
She does not actively drink or smoke, 100-pack-year history of
smoking. Son in the area acts as health care proxy.

Family History:
Father had coronary artery disease, mother had [**Name (NI) 2481**]
disease.

Physical Exam:
On Presentation:

Vitals: T: 97.5 BP: 169/84 HR: 106 RR: 16 O2: 96% on 4L NC
General: Awake, alert, oriented x 3, no distress
HEENT: Sclera anicteric, MM dry, oropharynx clear
Neck: JVP elevated at jaw, no LAD
CV: irregularly irregular, s1 + s2, III/VI SEM at LLSB, HSM at
apex, no rubs or gallops
Lungs: Poor air movement throughout, scarce expiratory wheezes,
no rales or ronchi
GI: soft, non-tender, non-distended, +BS, no organomegaly
appreciated
GU: foley draining clear yellow urine
Ext: WWP, 1+ pulses, no clubbing, cyanosis or edema
Back: stage II decubitous ulcer on back, faint 3 mm erythematous
lesions throughout buttocks and upper thighs, non raised
Rectal: Flexiseal with dark guaiac positive stool


Pertinent Results:
IMAGING:
CARDIAC ECHO [**2154-11-12**]:
The left atrium is moderately dilated. There is mild symmetric
left ventricular hypertrophy. The left ventricular cavity size
is normal. Overall left ventricular systolic function is low
normal (LVEF 50%). Tissue Doppler imaging suggests an increased
left ventricular filling pressure (PCWP>18mmHg). There is no
ventricular septal defect. The right ventricular cavity is
dilated with depressed free wall contractility. There are focal
calcifications in the aortic arch. There are three aortic valve
leaflets. The aortic valve leaflets are moderately thickened.
There is a minimally increased gradient consistent with minimal
aortic valve stenosis. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. There is severe
mitral annular calcification. Mild (1+) mitral regurgitation is
seen. [Due to acoustic shadowing, the severity of mitral
regurgitation may be significantly UNDERestimated.] The
tricuspid valve leaflets are mildly thickened. The supporting
structures of the tricuspid valve are thickened/fibrotic. There
is mild pulmonary artery systolic hypertension. The pulmonic
valve leaflets are thickened. Significant pulmonic regurgitation
is seen. There is no pericardial effusion.

BONE MARROW BIOPSY:  Results pending

DISCHARGE LABS:
-[**2154-12-2**] WBC-3.2* Hgb-8.8* Hct-27.3* Plt Ct-79*
-[**2154-12-2**] Glucose-151* UreaN-33* Creat-1.1 Na-133 K-4.9 Cl-100
HCO3-32
-[**2154-11-19**] calTIBC-195* VitB12-343 Folate-11.1 Ferritn-238*
TRF-150*

Brief Hospital Course:
82 year old female with a history of coronary artery disease s/p
CABG, aortic valve replacement, atrial fibrillation and COPD on
home oxygen who presented to OSH on [**2154-11-4**] with hypotension,
bradycardia and hypercarbic respiratory failure transferred for
management of gastrointestinal bleeding which resolved; also
with failure to extubate s/p trach and thrombocytopenia.
Patient was discharged to a respiratory rehab facility in fair
condition.

# Hypercarbic Respiratory Failure: The patient was transiently
intubated at the OSH prior to transfer for hypercarbic
respiratory failure.  She had been extubated since [**2154-11-5**] and
doing well.  She is on 3L nasal cannula at home.  Here her ABG
[**Last Name (un) **] worsening hypercarbia and she was felt to have pulmonary
edema and possibly and aspiration event so was reintubated and
started on vanc and meropenem.  Reinitated solumedrol at 40mg
[**Hospital1 **] which were eventually tapered (her last dose of steroids was
[**11-20**]).  Continued on atrovent q4h.  She was extubated on [**11-10**]
and placed on noninvasive ventilation for hypoxemia in setting
of pulmonary edema, however she had to be reintubated.  She was
found to have a VAP and was treated with Vanc/[**Last Name (un) **] for an 8-day
course (end date [**11-17**]).  After failing multiple extubation
attempts a trachestomy was placed and patient was discharged to
a [**Hospital 38763**] rehab facility.

# Gastrointestinal Bleeding: Patient had been having dark guaiac
positive stools since admission to [**Location (un) **]. Her hematocrit on
admission was 19.4 and per reports she received 2 units of
packed red blood cells at the OSH. Her hematocrit on admission
here was 26.0.  She recieved 2 units of blood with minimal
improvement in hct (23.7-->24.1-->25.5).  She was started on an
IV PPI [**Hospital1 **].  GI evaluated her, but felt she was too unstable
from a cardiorespiratory status to scope.  GI thought her guaiac
positve stools may have been from stress gastritis.  Her Hcts
continued to be monitored, however they remained stable.  She
received one more unit of PRBC after she had PEG/trach placement
and her Hct decreased to the 24's and bumped appropriately to
the unit.  After that time ([**11-21**]) she did not require further
blood transfusions.  Later on in the hospital course after her
PEG was placed she had a little bit of blood from the PEG and
vomit with blood in it, however this quickly resolved and as her
Hct remained stable GI did not feel it was necessary to scope
her.  The PPI was changed to daily prior to discharge.  During
her hospital stay her vitamin B12 was found to be low and she
was given a vitmain B12 shot x 1.  Folate was WNL and Fe studies
revealed anemia of chronic disease.

# Thrombocytopenia: Unclear etiology. Thought at outside
hospital to be secondary to Zosyn. Platelet count increasing
from nadir of 56.  She had anti-heparin antibiodies sent x 2
which were negative.  Heparin products were held.  She received
one platlet transfusion with transient improvement in her
platets, however they continued to trend downwards.  Heme/onc
was consulted and felt that her thrombocytopenia was chronic as
there were labs from [**2147**] which showed a plt count int he 60's,
although it did improve in [**Hospital3 **].  They recommended
stopping her simvastatin (which was stopped), and also her PPI
and dilt (these were continued given her strong indications for
them including recent GI bleed and a.fib).  SPEP and UPEP were
negative.  She underwent a bone marrow biopsy to rule out a
production problem and the results of the biopsy are pending at
the time of discharge.  She has outpatient follow up scheduled
with hematology.

# Atrial Fibrillation: The patient was in a-fib with rapid
ventricular response on admission and remained in atrial
fibrillation throughout her hospital stay. Has been off digoxin
and tykosyn since admission to outside hospital.  She was
initally treated with IV metoprolol with good response.  Given
her labile SBP's her home medications were stopped and
medications were titrated throughout her stay.  On discharge she
was on carvedilol 25 mg po bid and diltiazem 15 mg po qid for
rate control.  Per her son, the patient had been taken off
coumadin as an outpatient several months prior to admission by
her PCP so anticoagulation was not restarted here even though
she is at risk for stroke.

# Coronary Artery Disease s/p CABG (LIMA to LAD and SVG to RCA).
On admission she was complaining of chest tightness in the
setting of rapid ventricular rates. Troponins were slightly
elevated at 0.2. Trend not available from [**Location (un) **]. EKG without
ischemic changes.  She was initally continued on simvastatin
(although this was later stopped due to thrombocytopenia, as
above) and metoprolol (although this was changed to carvedilol,
as above).

# Acute Renal Failure: Her baseline creatinine 1.0. Was 1.5 on
admission down from 2.6 on presentation to [**Location (un) **] on [**2154-11-4**].
Her Cr trended down to her baseline of 0.8 to 1.0 during the end
of her hospital stay.

# Aortic Valve Replacement (bioprosthetic): Not anticoagulated
as an outpatient. Performed in [**2147**]. Echocardiogram with EF of
50% and a well placed valve.

# Hypertension:  The patient's antihypertensives were held
initally given her hypotension.  She very labile BP during her
early hospital course and intermittently would become
hypertensive requiring IV medication and then would have
decreased mental status if her SBP was brought below 120.  By
discharge her BP medications consisted of carvedilol 25 mg po
bid and lisinopril 5 mg po daily.  Lisinopril can be up-titrated
for blood pressure control.

# Hyperlipidemia:  The patient was initally continued on her
outpatient simvastatin, however this was stopped per heme/onc
recs as it could be a cause of her thrombocytopenia.

# Diastolic Congestive Heart Failure: She had volume overload on
her admission CXR with left sided effusion s/p thoracentesis
with transudate.  A TTE showed an EF 50%, severe Pulm regurg,
mild pulm HTN.  She was intermittently treated with IV lasix for
diuresis, but given her labile SBP earlier in her hospital stay
she ended up over 20 L positive for the hospital stay and will
need continued diuresis as an outpatient.  Her goal currently is
500 cc to 1 L negative daily.

# Back Wound: Patient with stage II ulcer on back from burn
injury at [**Location (un) **].   A wound care consult was obtained and she
was treated with Silvadene 1% cream to coccyx [**Hospital1 **].  This
treatment was completed by discharge.

# FEN: She had a PEG placed as well as her tracheostomy and was
started on tube feeds.  Reglan qid was started as she was
initally nausea with residuals when tube feeding was started.

# Prophylaxis: pneumoboots

# Code: DNR/DNI, this was discussed with the patient and her
family, however they did wish to proceed with trach placement
and PEG placement so this was done.

# Communication: Son [**Name (NI) **] [**Name (NI) **] [**Telephone/Fax (1) 38764**]


Medications on Admission:
Simvastatin 20 mg daily
Diltiazem 240 mg daily
Tikosyn 62.5 mg [**Hospital1 **]
Lasix 20 mg daily
Digoxin 0.125 mg daily
Hydralazine 25 mg PO BID
Toprol XL 25 mg daily
Enalapril 10 mg PO daily


Discharge Medications:
1. Lisinopril 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

2. Metoclopramide 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO QIDACHS (4
times a day (before meals and at bedtime)).
3. Lactulose 10 gram/15 mL Syrup [**Hospital1 **]: Thirty (30) ML PO Q8H
(every 8 hours) as needed.
4. Furosemide 20 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

5. Fluticasone 110 mcg/Actuation Aerosol [**Hospital1 **]: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
6. Heparin (Porcine) 5,000 unit/mL Solution [**Hospital1 **]: One (1)
Injection TID (3 times a day).
7. Trazodone 50 mg Tablet [**Hospital1 **]: 0.25 Tablet PO HS (at bedtime) as
needed for insomnia.
8. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
9. Carvedilol 12.5 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO BID (2 times
a day).
10. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Last Name (STitle) **]: Six (6)
Puff Inhalation Q4H (every 4 hours).
11. Simethicone 80 mg Tablet, Chewable [**Last Name (STitle) **]: 1.5 Tablet,
Chewables PO QID (4 times a day) as needed for gaseous pain.
12. Ciprofloxacin 250 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q12H
(every 12 hours) for 5 doses: Your last dose will be on
[**2154-12-4**].
13. Chlorhexidine Gluconate 0.12 % Mouthwash [**Date Range **]: Five (5) ML
Mucous membrane [**Hospital1 **] (2 times a day).
14. Ondansetron HCl (PF) 4 mg/2 mL Solution [**Hospital1 **]: 4-8 mg
Injection Q8H (every 8 hours) as needed for Nausea.
15. Prochlorperazine 10 mg IV Q6H:PRN


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] Northeast - [**Location (un) 1110**]

Discharge Diagnosis:
Respiratory Failure
Urinary Tract Infection
Low platelets (Thrombocytopenia)


Discharge Condition:
Stable, afebrile


Discharge Instructions:
You were admitted to the hospital after being found unconcious
in the shelter. You were found to have a slow heart rate thought
to be due to your digoxin medication. You were also intubated as
you had difficulty breathing. Whilst in the hospital we tried
several times to have you breath without the tube, unfortunately
you were not able to breathe on your own so you underwent a
tracheostomy. Prior to your transfer to the rehab facility you
were breathing comfortably with minimal support from the
ventilator.

Your platelet levels were also found to be low so we performed a
bone marrow biopsy. You have an appointment with the
hematology/oncology doctors [**Last Name (NamePattern4) **] [**2154-12-18**] at 0900 to discuss the
results.

During your hospitalization we also noticed you had a urinary
tract infection and we started you on an antibiotic called
Ciprofloxacin. You will be taking 250mg twice a day your last
dose of this medication will be on [**2154-12-4**].

Several other medication changes were made for your high blood
pressure which may be changed at the rehab facility.


Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 3749**], MD Phone:[**Telephone/Fax (1) 3241**]
Date/Time:[**2154-12-18**] 9:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 10921**], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2154-12-18**] 9:00
{'Hemorrhage of gastrointestinal tract, unspecified,Acute on chronic diastolic heart failure,Acute and chronic respiratory failure,Ventilator associated pneumonia,Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Obstructive chronic bronchitis with (acute) exacerbation,Hyperosmolality and/or hypernatremia,Thrombocytopenia, unspecified,Pressure ulcer, upper back,Atrial fibrillation,Anemia of other chronic disease,Aortocoronary bypass status,Other chronic pulmonary heart diseases,Heart valve replaced by transplant,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other mononeuritis of upper limb,Other dependence on machines, supplemental oxygen'}


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: GIB, hypercarbic respiratory failure

PRESENT ILLNESS: Mrs. [**Known lastname **] is an 82 year old female with a history of coronary
artery disease s/p CABG, aortic valve replacement, atrial
fibrillation and COPD on home oxygen who presented to [**Hospital **] on [**2154-11-4**] after being found down in a shelter
unresponsive. Per notes, she had been staying at a shelter
because her power was out in her home. She was found
unresponsive and was bradycardic to the 20s and hypotensive. She
was taken to [**Hospital3 7569**] where she had an emergent
temporary transvenous pacer placed. She also was intubated for
hypercarbic respiratory failure. The initial cause of her
bradycardiac was unclear but felt possibly to be related to
digoxin toxicity for which she received digibind. She was
subsequently treated for a COPD exacerbation with high dose
solumedrol, zosyn and azithromycin. She also was noted to have
acute renal failure thought by nephrology to be consistent with
acute tubular necrosis in the setting of profound hypotension
and was treated with lasix for decreased urine ouput. There was
also concern for gastrointestinal bleeding as her hematocrit on
presentation was 19.4 and she received two units of packed red
blood cells. She was extubated on hospital day two without
difficulty. She had an echocardiogram which showed preserved
systolic function but pulmonary hypertension with a pulmonary
artery pressure of 50 mm. The Zosyn was discontinued when the
patient began to experience a drop in her platelet count to as
low as 56k. On hospital day three she underwent a thoracentesis
for a left sided pleural effusion which was consistent with a
transudate with LDH 88, ratio 0.3, Prot 3.0. She continued to
have loose black guaiac positive stools. She was started on IV
flagyl and PO vancomycin out of concern for clostridium
difficile although c. diff samples were negative x 1. Renal
function has improved from a creatinine of 2.6 on admission to
1.7. She also suffered from a burn to her back from a heating
pad used while she had the transvenous pacer placed and
developed a stage II decubitous ulcer. The temporary pacer was
removed prior to transfer.

MEDICAL HISTORY: Coronary Artery Disease s/p CABG (LIMA to LAD and SVG to RCA)
Aortic Valve Replacement (bioprosthetic)
Atrial Fibrillation (not currently anticoagulated)
Hypertension
Hyperlipidemia
COPD (FEV1 less than one liter)
Diastolic Congestive Heart Failure
Depression
Left phrenic nerve paralysis
Admission to [**Location (un) **] in [**2-26**] for gastrointestinal bleeding

MEDICATION ON ADMISSION: Simvastatin 20 mg daily
Diltiazem 240 mg daily
Tikosyn 62.5 mg [**Hospital1 **]
Lasix 20 mg daily
Digoxin 0.125 mg daily
Hydralazine 25 mg PO BID
Toprol XL 25 mg daily
Enalapril 10 mg PO daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Presentation:

FAMILY HISTORY: Father had coronary artery disease, mother had [**Name (NI) 2481**]
disease.

SOCIAL HISTORY: She does not actively drink or smoke, 100-pack-year history of
smoking. Son in the area acts as health care proxy. 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Acute on chronic diastolic heart failure,Acute and chronic respiratory failure,Ventilator associated pneumonia,Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Obstructive chronic bronchitis with (acute) exacerbation,Hyperosmolality and/or hypernatremia,Thrombocytopenia, unspecified,Pressure ulcer, upper back,Atrial fibrillation,Anemia of other chronic disease,Aortocoronary bypass status,Other chronic pulmonary heart diseases,Heart valve replaced by transplant,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other mononeuritis of upper limb,Other dependence on machines, supplemental oxygen'}
