CHIEF COMPLAINT: Chest pain and shortness of breath

PRESENT ILLNESS: CHIEF COMPLAINT: Chest pain
.
EVENTS / HISTORY OF PRESENTING ILLNESS: [**Age over 90 **] year old male with
CAD (s/p CABG and multiple stents to the venous grafts),
hypertension, type II diabetes, and chronic renal insufficency
who presented with suddent onset chest pain and respiratory
distress starting at 6a.m. on day of admission. The patient felt
this was the same type of pain as his past myocardial
infarction. The patient did not have nausea or vomiting.
.
In the ED, vital signs were as follows: HR-108-120, BP:
128-254/100-164, RR: 32, O2sat: 93-100% on CPAP at 5cm H20. On
exam, patient was diaphoretic with cool extremities, there was
JVD, bibasilar rales, and bilateral pedal edema. EKG showed ST
elevations in aVR and V1-V3. Cardiac enzymes showed a CPK of
125, MB-8, and Trop T 0.21. The patient was given morphine,
Aspirin 325mg, metoprolol, Plavix 600mg, integrillin, heparin
drip, nitro drip, Lasix 40mg. The patient continued to have
respiratory distress an arterial blood gas showed a ph of 7.15,
pC02 of 54, and a pO2 of 74 and was therefore intubated with an
8.0 ETT with ventilator settings of Assist control mode with a
respiratory rate of 12, tidal volume of 550ml, and PEEP of 7.5,
and FiO2 of 100% and an NG tube was placed. He was then brought
urgently to the catheterization lab.
On review of symptoms, he was intubated/sedated and unable to
obtain history.

MEDICAL HISTORY: 1. CAD s/p CABG with 3 venous grafts(SVG->LAD, SVG->LCx,
SVG->PDA '[**86**].)  Status post stent in [**2099**] (3.5 x 23 mm and 3.5 x
8 mm Cypher in SVG->PDA).  Status post stent in [**2103**](3.5 x 18mm
Vision RX bare metal stent in the SVG-OM with TIMI 3 flow.)

MEDICATION ON ADMISSION: 1. Colchicine 0.6 mg po qod
2. Allopurinol 100 mg po qod
3. Lisinopril 40 mg po daily
4. Atorvastatin 20 mg po daily
5. Aspirin 325 mg po daily
6. Hexavitamin  po daily
7. Glipizide 5 mg po daily
8. Furosemide 20 mg po daily
9. Clopidogrel 75 mg  po daily
10. Nitroglycerin 0.3 mg Tablet sl prn
11. Isosorbide Dinitrate 30mg po tid
12. Metoprolol Tartrate 75 mg po bid
13. Ferrous Sulfate 325mg po daily
14. Docusate Sodium 100 mg PO BID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 99.0 , BP: 135/68 , HR: 65 , RR: 100% O2sat on
AC/16/500/5/50% Wt: 68kg
Gen: Slender elderly male who is intubated and sedated.
HEENT: Normal cephalic and atraumatic. Sclera anicteric. EOMI.
Conjunctiva were pink, no pallor or cyanosis of the oral mucosa.

FAMILY HISTORY: Non contributory.

SOCIAL HISTORY: The patient lives with daughter and wife. [**Name (NI) **] 8 children.
Ambulates at home.
Denies tobacco, alcohol, and illegal drug use.
Acute myocardial infarction of anterolateral wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Congestive heart failure, unspecified,Acute respiratory failure,Acidosis,Chronic kidney disease, unspecified,Other iatrogenic hypotension,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Gout, unspecified,Aortocoronary bypass status
AMI anterolateral, init,Comp-oth cardiac device,CHF NOS,Acute respiratry failure,Acidosis,Chronic kidney dis NOS,Iatrogenc hypotnsion NEC,Crnry athrscl natve vssl,Hy kid NOS w cr kid I-IV,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Gout NOS,Aortocoronary bypass
Admission Date:  [**2103-7-21**]              Discharge Date:   [**2103-7-26**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
Chest pain and shortness of breath

Major Surgical or Invasive Procedure:
1)Cardiac catheterization with thrombectomy and balloon
angioplasty of a bare metal stent in a venous graft to the
obtuse marginal artery.
.
2) Intubation/Ventilation
.
3) Right subclavian central line


History of Present Illness:
CHIEF COMPLAINT: Chest pain
.
EVENTS / HISTORY OF PRESENTING ILLNESS: [**Age over 90 **] year old male with
CAD (s/p CABG and multiple stents to the venous grafts),
hypertension, type II diabetes, and chronic renal insufficency
who presented with suddent onset chest pain and respiratory
distress starting at 6a.m. on day of admission. The patient felt
this was the same type of pain as his past myocardial
infarction. The patient did not have nausea or vomiting.
.
In the ED, vital signs were as follows: HR-108-120, BP:
128-254/100-164, RR: 32, O2sat: 93-100% on CPAP at 5cm H20. On
exam, patient was diaphoretic with cool extremities, there was
JVD, bibasilar rales, and bilateral pedal edema. EKG showed ST
elevations in aVR and V1-V3. Cardiac enzymes showed a CPK of
125, MB-8, and Trop T 0.21. The patient was given morphine,
Aspirin 325mg, metoprolol, Plavix 600mg, integrillin, heparin
drip, nitro drip, Lasix 40mg. The patient continued to have
respiratory distress an arterial blood gas showed a ph of 7.15,
pC02 of 54, and a pO2 of 74 and was therefore intubated with an
8.0 ETT with ventilator settings of Assist control mode with a
respiratory rate of 12, tidal volume of 550ml, and PEEP of 7.5,
and FiO2 of 100% and an NG tube was placed. He was then brought
urgently to the catheterization lab.
On review of symptoms, he was intubated/sedated and unable to
obtain history.


Past Medical History:
1. CAD s/p CABG with 3 venous grafts(SVG->LAD, SVG->LCx,
SVG->PDA '[**86**].)  Status post stent in [**2099**] (3.5 x 23 mm and 3.5 x
8 mm Cypher in SVG->PDA).  Status post stent in [**2103**](3.5 x 18mm
Vision RX bare metal stent in the SVG-OM with TIMI 3 flow.)

Cath [**2-7**] with: Three vessle coronary disease. 90% mid-vessel
stenosis of the SVG to OM with TIMI 2 flow. 40% stenosis of the
SVG to PDA prior to the Taxus stent. Total occlusion of the SVG
to LAD graft. LVEDP of 26mm Hg. Moderate left ventricular
diastolic dysfunction. Successful stention of the SVG-OM graft
with a 3.5x1 8mm bare metal stent.

ECHO ([**2101-12-8**]): Elongated LA. Normal LV wall thickness and
cavity size. LVEF of 50% with mild hypokinesis of the anterior
septum, anterior free wall, and apex. Dilated RA. Normal RV
chamber size and free wall motion. No AS, or AR. 1+ MR and1-2+
TR. There was moderate pulmonary artery systolic hypertension.
2. HTN
3. Hyperlipidemia
4. Peripheral vascular disease status post bypass [**2088**]
5. DM Type II (not on oral hypoglycemics)
6. Chronic renal insufficiency- baseline Cr of 1.7-2.0
7. Gout
8. Status post right cataract surgery


Social History:
The patient lives with daughter and wife. [**Name (NI) **] 8 children.
Ambulates at home.
Denies tobacco, alcohol, and illegal drug use.


Family History:
Non contributory.

Physical Exam:
VS: T: 99.0 , BP: 135/68 , HR: 65 , RR: 100% O2sat on
AC/16/500/5/50% Wt: 68kg
Gen: Slender elderly male who is intubated and sedated.
HEENT: Normal cephalic and atraumatic. Sclera anicteric. EOMI.
Conjunctiva were pink, no pallor or cyanosis of the oral mucosa.

Neck: Supple with JVP of less than 10cm.
CV: PMI located in 5th intercostal space, midclavicular line.
regular rate, normal S1, S2. No S4, no S3. No murmurs.
Chest: No chest wall deformities, scoliosis or kyphosis.
Bibasilar crackles.
Abd: Soft, non-tender and non-distended, No hepatosplenomegally
or tenderness. No abdominal bruits.
Ext: Warm, 2+ pedal edema bilaterally.
Skin: Minimal stasis dermatitis, No ulcers, scars, or xanthomas.

Pulses:
Right: Carotid 1+ without bruit; DP 1+; PT 1+
Left: Carotid 1+ without bruit; DP 1+; PT 1+
Neur: Opens eyes to painful stimulus. Moving all four
extremities.


Pertinent Results:
EKG ([**2103-7-21**]): Sinus Tachycardia with a rate of 117bpm. Nml PR
and QRS intervals. Mildly prolonged QT interval. Nml axis. LVH.
ST elevations in aVR, V1-V3. ST depressions in I, II, aVF,
V5-V6. T wave inversions in I, and aVL. Compared to prior EKG:
Sinus Tachycardia, worsening of ST elevation in aVR and V1-V3.
Though, in the past, minimal ST elevations were present in those
leads.
.
CXR ([**2103-7-21**]): The cardiac silhouette size remains borderline
enlarged but stable. Extensive degenerative changes are noted
throughout the thoracic spine.  There is mild cardiogenic
hydrostatic edema with small bilateral pleural effusions.
.
CARDIAC CATHETERIZATION ([**2103-7-21**])SVG-RCS with 40% stenosis.
SVG-OM with previous stent occluded and thrombus. SVG-OM
thrombectomy with balloon angioplasty (22atms)resulting in
normal flow. LVEDP 25. Right renal artery with no critical
lesions. Left renal artery with mild ostial disease.
.
ECHO ([**2103-7-21**]): Dilated LV with LVEF depressed (20%) Inferior
akinesis/hypokinesis, anterior hypokinesis, septal
akinesis/hypokinesis, and apical akinesis/dyskinesis. Nml RV
size with depressed RV funcion. No AS. No pericardial
effusion/tamponade.
.
ECHO ([**2103-7-23**]):  Mild LA enlargement.  Mild symmetric LVH with
normal cavity size.  There is mild hypokinesis of the distal
septum and distal inferior wall.  Left ventricular ejection
fraction of 30-35%.  Mild RA dilation.  Normal RV chamber size
and mild RV hypokinesis.  Trace AR, ([**1-2**]+) MR, (1+) TR.
Compared to study on [**2103-7-21**], there is improvement in LV
function.
.
[**2103-7-21**] WBC-14.4*# RBC-4.99 Hgb-16.4 Hct-51.2 MCV-103*
MCH-32.9* MCHC-32.0 RDW-16.0* Plt Ct-212
[**2103-7-26**] WBC-7.5 RBC-3.43* Hgb-11.3* Hct-33.3* MCV-97 MCH-32.8*
MCHC-33.8 RDW-15.7* Plt Ct-189
.
[**2103-7-21**] PT-11.4 PTT-26.3 INR(PT)-1.0
[**2103-7-26**] PT-11.8 PTT-27.1 INR(PT)-1.0
.
[**2103-7-21**] Glucose-201* UreaN-28* Creat-2.0* Na-140 K-4.4 Cl-104
HCO3-24 AnGap-16
[**2103-7-26**] Glucose-134* UreaN-35* Creat-2.0* Na-138 K-4.2 Cl-101
HCO3-27 AnGap-14
.
[**2103-7-21**] ALT-53* AST-40 AlkPhos-145* Amylase-29 TotBili-0.8
[**2103-7-22**] ALT-39 AST-57*
.
[**2103-7-21**] CPK-125
[**2103-7-21**] CPK-95
[**2103-7-21**] CPK-773*
[**2103-7-21**] CPK-603*
[**2103-7-22**] CPK-354*
.
[**2103-7-21**] CK-MB-8
[**2103-7-21**] cTropnT-0.21*
[**2103-7-21**] CK-MB-95* MB Indx-12.3* cTropnT-3.10*
[**2103-7-21**] CK-MB-49* MB Indx-8.1*
[**2103-7-22**] CK-MB-23* MB Indx-6.5* cTropnT-1.88*
.
[**2103-7-21**] 08:15AM BLOOD Triglyc-153* HDL-37 CHOL/HD-3.5
LDLcalc-62
.
[**2103-7-21**] Blood gas in ED:  pO2-54* pCO2-74* pH-7.15* calTCO2-27
Base XS--4
[**2103-7-21**] Blood gas before extubation:  pO2-90 pCO2-40 pH-7.45
calTCO2-29 Base XS-3
.
[**2103-7-21**] %HbA1c-5.8
.
[**2103-7-21**]  HIV AB - negative, HCV Ab - negative
.
[**2103-7-21**] Urine Culture.  Enterococcus greater than 100,000
organisms.  Sensitive to ampicilln, nitrofurantoin, and
vancomycin.  Resistant to tetracycline.


Brief Hospital Course:
ASSESSMENT AND PLAN, AS REVIEWED AND DISCUSSED IN MULTI
DISCIPLINARY ROUNDS : Mr. [**Known lastname **] is a [**Age over 90 **] year old man with a
history of CAD (s/p CABG and mult. stent placements), type II
diabetes, hypertension, and hyperlipidemia who presented with
chest pain and shortness of breath and found to have an ST
elevation myocardial infarction based on EKG and cardiac
enzymes.  Status post cardiac catheterization with thrombectomy
and balloon angioplasty of the SBG-OM graft.
.
CAD/STEMI:  Patient is s/p cardiac cath with thrombectomy and
balloon angioplasty of the SBG-OM graft.  Cardiac enzymes were
cycled with a peak CPK of 773 and a peak CK-MB of 95.  The fact
that the patient had thrombosis of a bare metal stent in the
SBG-OM graft while on a home dose aspirin and Plavix is
concerning for some sort of hypercoagulable state.  The patient
was therefore started on Plavix 75mg PO BID.  The patient was
continued on aspirin 325 mg daily, continued on Integrilin for
18 hours after catheterization, atorvastatin 80 mg, and a nitro
drip (which was later weaned.)  Metoprolol was titrated up to 75
mg PO TID.  The patient was also started on isosorbide 30mg TID.
 An ACE inhibitor was held until hospital day 4 because of the
history of chronic renal insufficiency and the recent cardiac
catheterization dye load.  The lisinopril then was started and
titrated up to 20mg Daily.  A lipid panel showed and HDL of 37
and LDL of 62,
.
Pump/CHF: Patient has history of LVEF of 50% with diastolic
dysfunction repeat ECHO showed and an ejection fraction of 20%
with inferior, septal, and anterior hypokinesis. On admission
exam, the patient had bilateral crackles and pedal edema.
Admission chest x-ray showed infiltrates.  Therefore the patient
was given Lasix 20mg IV for three days.  The patient was 4.5
liters negative for the length of stay with decreasing oxygen
requirement (now on room air) and resolved pedal edema.  The
patient will be discharged on his home dose of Lasix 20mg PO
Daily.  The patient was maintained on a beta blocker and an ACE
inhibitor was started on hospital day 4.
.
Rhythm:  Patient stayed in normal sinus rhythm.  Occasional
premature atrial beats.
.
Resp: On admission to the CCU, the patient was
intubated/sedated. The ventilator setting were weaned and the
patient passed a pressure support trial.  An arterial blood gas
before extubation showed a ph of 7.45, pCO2 of 40, and pO2 of
90.  On the evening of admission, the patient was extubated
successfully.  Since that time the patient has had decreasing
oxygen requirement and was discharged on room air.
.
Hypotension: On transport from the cath lab, the patient became
bradycardic and hypotensive (SBP to the 80's.) The patient was
given atropine with good response. The patient was also started
on a neosynephrine drip which was quickly weaned. This episode
was thought to be due to a post-cath vaso-vagal event or recent
administration of propofol. There was concern from a cardiac
tamponade and/or ACS an ECHO was rapidly performed and ruled
this out.  The patient did not have any more hypotensive
episodes.
.
Respiratory Acidosis: ABG on admission showed a ph of 7.20 pCO2
of 58, and pO2 of 314 consistent with respiratory acidosis. The
respiratory rate was increased and repeat ABG showed a pH of
7.47, pCO2 of 29, and pO2 of 193.
.
DM type II:  A HbA1c was 5.8%.  The patient was maintained on an
insulin sliding scale.  The patient was restarted on his home
dose of glipized before discharge.
.
ID/Fever:  On [**2103-7-21**], the patient had rectal temperature to
102.4.  The patient was started on a course of levofloxacin for
possible pneumonia (equivocal infiltrate on CXR).  Blood
cultures were negative and and urine cultures grew enterococcus
sensitive to ampicillin, nitrofuratoin, and vancomycin.  The
patient was started on a 10 day course of amoxicillin on [**2103-7-24**]
and remained afebrile throughout the rest of his stay.
.
Renal Function: Patient has history of chronic renal
insufficiency with a baseline Cr of 1.8-2.0, and received
Acetylcysteine x2 after catheterization.  His renal function
remained stable and he is discharged on lisinopril 20mg.
.
Hematuria: Mr. [**Known lastname **] developed hematura on aspirin, Plavix,
heparin, and Integrilin.   Because of clots, urology was
consulted and a 3 way catheter was placed and irrigated.  The
catheter was removed the next day w/o complication and he was
urinating wihtout difficulty on discharge.
.
Prophy: The patient was maintained on a bowel regimen, proton
pump inhibitor, and Heparin SQ.
.
Access: Right SCV line was placed on [**2103-7-21**] and removed on
[**2103-7-23**].  Patient had peripheral IV access at that time.
.
Code: Full
.
Contact: [**Name (NI) 29880**], [**Telephone/Fax (1) 29881**]. Granddaughter, [**Name (NI) **],
[**Telephone/Fax (1) 29882**].
.
Dispo: The patient was discharged to the floor on [**2103-7-25**].  The
patient was seen by physical therapy and sent home with
services.  The patient will follow up with his cardiologist and
primary care doctor.


Medications on Admission:
1. Colchicine 0.6 mg po qod
2. Allopurinol 100 mg po qod
3. Lisinopril 40 mg po daily
4. Atorvastatin 20 mg po daily
5. Aspirin 325 mg po daily
6. Hexavitamin  po daily
7. Glipizide 5 mg po daily
8. Furosemide 20 mg po daily
9. Clopidogrel 75 mg  po daily
10. Nitroglycerin 0.3 mg Tablet sl prn
11. Isosorbide Dinitrate 30mg po tid
12. Metoprolol Tartrate 75 mg po bid
13. Ferrous Sulfate 325mg po daily
14. Docusate Sodium 100 mg PO BID


Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
5. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID
(3 times a day).
9. Amoxicillin 250 mg Capsule Sig: Two (2) Capsule PO Q12H
(every 12 hours) for 8 days.
Disp:*32 Capsule(s)* Refills:*0*
10. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) tablet
Sublingual once a day as needed for chest pain.
11. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
12. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO once a day.

13. Glipizide 10 mg Tablet Sig: One (1) Tablet PO once a day.
14. Isosorbide Dinitrate 30 mg Tablet Sig: One (1) Tablet PO
three times a day.
Disp:*90 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
1) ST elevation myocardial infarction
2) Congestive heart failure
3) Hypoxic respiratory failure
4) Urinary tract infection


Discharge Condition:
good; stable/normal vital signs, tolerating po, ambulating with
assistance.


Discharge Instructions:
During this hospitalization, you were diagnosed with a heart
attack.  The type of heart attack you had is called an ST
elevation myocardial infarction. You underwent a cardiac
catheterization to help open up the vessels in your heart.
.
It is very important that you take all of your medications.  It
is especially important that you take your Plavix and aspirin.
You should take your aspirin once a day and your Plavix twice a
day.  Under no circumstance should you stop taking these
medications without speaking to your cardiologist.  If you
become sick and vomit and are not able to take your aspirin or
plavix, please contact your cardiologist.
.
If you have chest pain, shortness of breath, dizziness, or feel
hot/sweaty, please call your doctor or go to the nearest
emergency room.  Please call your doctor if you have any other
concerns.

We also found that you have a urinary tract infection for which
you will need to finish about 1 week of antibiotics.

If you develop fevers, chills, nausea, vomiting, abdominal pain
and diarrhea, or any other problems then please seek medical
advice.

Followup Instructions:
Please follow up with your cardiologist.  You have an
appointment with Dr. [**Last Name (STitle) **] on [**2103-8-1**] at 11:30am at [**Hospital3 29818**] [**Apartment Address(1) 29883**].  Please call [**Telephone/Fax (1) 5985**] if you have any
questions.
.
Because you were in the hospital, you should follow up with your
primary care doctor.  You have an appointment with DR. [**First Name (STitle) **] [**Name8 (MD) 29884**], MD on [**2103-7-25**] at 2:15pm.  Please call [**Telephone/Fax (1) 7976**] with
any questions.
.
You also have an appointment with [**First Name5 (NamePattern1) 6811**] [**Last Name (NamePattern1) 29885**] [**Doctor Last Name **] on
[**2103-8-6**] at 11:00am.  Please call [**Telephone/Fax (1) 7976**] with any questions.
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Congestive heart failure, unspecified,Acute respiratory failure,Acidosis,Chronic kidney disease, unspecified,Other iatrogenic hypotension,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Gout, unspecified,Aortocoronary bypass status'}


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 and shortness of breath

PRESENT ILLNESS: CHIEF COMPLAINT: Chest pain
.
EVENTS / HISTORY OF PRESENTING ILLNESS: [**Age over 90 **] year old male with
CAD (s/p CABG and multiple stents to the venous grafts),
hypertension, type II diabetes, and chronic renal insufficency
who presented with suddent onset chest pain and respiratory
distress starting at 6a.m. on day of admission. The patient felt
this was the same type of pain as his past myocardial
infarction. The patient did not have nausea or vomiting.
.
In the ED, vital signs were as follows: HR-108-120, BP:
128-254/100-164, RR: 32, O2sat: 93-100% on CPAP at 5cm H20. On
exam, patient was diaphoretic with cool extremities, there was
JVD, bibasilar rales, and bilateral pedal edema. EKG showed ST
elevations in aVR and V1-V3. Cardiac enzymes showed a CPK of
125, MB-8, and Trop T 0.21. The patient was given morphine,
Aspirin 325mg, metoprolol, Plavix 600mg, integrillin, heparin
drip, nitro drip, Lasix 40mg. The patient continued to have
respiratory distress an arterial blood gas showed a ph of 7.15,
pC02 of 54, and a pO2 of 74 and was therefore intubated with an
8.0 ETT with ventilator settings of Assist control mode with a
respiratory rate of 12, tidal volume of 550ml, and PEEP of 7.5,
and FiO2 of 100% and an NG tube was placed. He was then brought
urgently to the catheterization lab.
On review of symptoms, he was intubated/sedated and unable to
obtain history.

MEDICAL HISTORY: 1. CAD s/p CABG with 3 venous grafts(SVG->LAD, SVG->LCx,
SVG->PDA '[**86**].)  Status post stent in [**2099**] (3.5 x 23 mm and 3.5 x
8 mm Cypher in SVG->PDA).  Status post stent in [**2103**](3.5 x 18mm
Vision RX bare metal stent in the SVG-OM with TIMI 3 flow.)

MEDICATION ON ADMISSION: 1. Colchicine 0.6 mg po qod
2. Allopurinol 100 mg po qod
3. Lisinopril 40 mg po daily
4. Atorvastatin 20 mg po daily
5. Aspirin 325 mg po daily
6. Hexavitamin  po daily
7. Glipizide 5 mg po daily
8. Furosemide 20 mg po daily
9. Clopidogrel 75 mg  po daily
10. Nitroglycerin 0.3 mg Tablet sl prn
11. Isosorbide Dinitrate 30mg po tid
12. Metoprolol Tartrate 75 mg po bid
13. Ferrous Sulfate 325mg po daily
14. Docusate Sodium 100 mg PO BID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 99.0 , BP: 135/68 , HR: 65 , RR: 100% O2sat on
AC/16/500/5/50% Wt: 68kg
Gen: Slender elderly male who is intubated and sedated.
HEENT: Normal cephalic and atraumatic. Sclera anicteric. EOMI.
Conjunctiva were pink, no pallor or cyanosis of the oral mucosa.

FAMILY HISTORY: Non contributory.

SOCIAL HISTORY: The patient lives with daughter and wife. [**Name (NI) **] 8 children.
Ambulates at home.
Denies tobacco, alcohol, and illegal drug use. 

### Response:
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Congestive heart failure, unspecified,Acute respiratory failure,Acidosis,Chronic kidney disease, unspecified,Other iatrogenic hypotension,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Gout, unspecified,Aortocoronary bypass status'}
