CHIEF COMPLAINT: Transfered from an outside hospital with chest pain and anterior
ST elevation MI.

PRESENT ILLNESS: 78 year-old female with significant smoking history, no other
past medical history, who presents from an outside hospital with
acute onset sub-sternal chest pain at rest with radiation to the
left shoulder and diaphoresis. The paitent was in her usual
state of health when the event occurred. Prior to this she
reported 1 episode of chest pain a month prior which resolved on
its own. Her current pain was graded as [**11-15**], sharp, midline
with slight radiation. She denied any shortness of breath or
dyspnea with the pain. The pain did not resolve on its own and
she called EMS. At the outside hospital ED, the patient was
given nitro, morphine with improvement of her pain. EKG
demonstrated ST elevations in V1-V6. Her Trop I was 0.97. She
received ASA 325, Plavix 600mg, heparin bolus, integrillin bolus
x2 plus gtt at 2mcg/kg/min and lopressor 5mg IV x1. She was
taken urgently to the cath lab.
.
In the cath lab, she was found to have 80% prox LAD stenosis,
80-90% LCx stenosis, 80% RCA and 60-70% ramus stenosis. Given
her significant 3 vessel disease, she was transferred to [**Hospital1 18**]
for possible CABG.
.
On arrival to [**Hospital1 18**], the patient felt well and denied chest
pain. She was lying flat comfortably. The cath sheath was in
place and intact.
.
On review of symptoms, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, cough, hemoptysis, black stools or red stools.
She denies recent fevers, chills or rigors. She denies
exertional buttock or calf pain. All of the other review of
systems were negative.
.
Cardiac review of systems is notable for absence paroxysmal
nocturnal dyspnea, orthopnea, palpitations, syncope or
presyncope. Of note, the patient reports chronic LE edema for
which she is taking a "water pill."

MEDICAL HISTORY: 1)Degenerative Joint Disease
2) Left Eye Blindness
3) Varicose veins-s/p bilateral lower extermity vein stripping

MEDICATION ON ADMISSION: Tylenol prn
Triamterene (unsure of dose)
Tramadol (unsure of dose)
Ibuprofen prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.7, BP 108/55, HR 78, RR 24, O2 96% on RA
Gen: Alert, talkative elderly female in no distress
HEENT: Normal cephalic and atraumatic. Sclera anicteric,
extra-occular movements intact, asymmetric pupils L>R.
Conjunctiva were pink, no pallor or cyanosis of the oral mucosa.

FAMILY HISTORY: Her Father had a heart attack at age 64. There is no family
history of premature coronary artery disease or sudden death.

SOCIAL HISTORY: Social history is significant for the current tobacco use of 4
cigs/day. She has a 50 pack year history.  There is no history
of alcohol abuse. She is a retired office worker who lives with
her husband. She has 2 children. She is functional and
independent with her activities of daily life.
Acute myocardial infarction of other anterior wall, initial episode of care,Acute posthemorrhagic anemia,Diverticulosis of colon with hemorrhage,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Coronary atherosclerosis of native coronary artery,External hemorrhoids with other complication,Benign neoplasm of rectum and anal canal,Stricture of artery,Other specified hypotension,Arthropathy, unspecified, multiple sites,Tobacco use disorder,Macular degeneration (senile), unspecified
AMI anterior wall, init,Ac posthemorrhag anemia,Dvrtclo colon w hmrhg,Ocl mlt bi art wo infrct,Crnry athrscl natve vssl,Ext hemrrhoid w comp NEC,Benign neopl rectum/anus,Stricture of artery,Hypotension NEC,Arthropathy NOS-mult,Tobacco use disorder,Macular degeneration NOS
Admission Date:  [**2113-8-21**]              Discharge Date:   [**2113-8-29**]

Date of Birth:  [**2035-6-1**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
Transfered from an outside hospital with chest pain and anterior
ST elevation MI.

Major Surgical or Invasive Procedure:
1) Cardiac catheterization with left anterior descending
coronary artery thrombectomy and drug eluting stent placement.
2) Left Internal Carotid Artery Stenting
3) Colonoscopy
4) Upper endoscopy


History of Present Illness:
78 year-old female with significant smoking history, no other
past medical history, who presents from an outside hospital with
acute onset sub-sternal chest pain at rest with radiation to the
left shoulder and diaphoresis. The paitent was in her usual
state of health when the event occurred. Prior to this she
reported 1 episode of chest pain a month prior which resolved on
its own. Her current pain was graded as [**11-15**], sharp, midline
with slight radiation. She denied any shortness of breath or
dyspnea with the pain. The pain did not resolve on its own and
she called EMS. At the outside hospital ED, the patient was
given nitro, morphine with improvement of her pain. EKG
demonstrated ST elevations in V1-V6. Her Trop I was 0.97. She
received ASA 325, Plavix 600mg, heparin bolus, integrillin bolus
x2 plus gtt at 2mcg/kg/min and lopressor 5mg IV x1. She was
taken urgently to the cath lab.
.
In the cath lab, she was found to have 80% prox LAD stenosis,
80-90% LCx stenosis, 80% RCA and 60-70% ramus stenosis. Given
her significant 3 vessel disease, she was transferred to [**Hospital1 18**]
for possible CABG.
.
On arrival to [**Hospital1 18**], the patient felt well and denied chest
pain. She was lying flat comfortably. The cath sheath was in
place and intact.
.
On review of symptoms, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, cough, hemoptysis, black stools or red stools.
She denies recent fevers, chills or rigors. She denies
exertional buttock or calf pain. All of the other review of
systems were negative.
.
Cardiac review of systems is notable for absence paroxysmal
nocturnal dyspnea, orthopnea, palpitations, syncope or
presyncope. Of note, the patient reports chronic LE edema for
which she is taking a "water pill."


Past Medical History:
1)Degenerative Joint Disease
2) Left Eye Blindness
3) Varicose veins-s/p bilateral lower extermity vein stripping

Social History:
Social history is significant for the current tobacco use of 4
cigs/day. She has a 50 pack year history.  There is no history
of alcohol abuse. She is a retired office worker who lives with
her husband. She has 2 children. She is functional and
independent with her activities of daily life.

Family History:
Her Father had a heart attack at age 64. There is no family
history of premature coronary artery disease or sudden death.

Physical Exam:
VS: T 97.7, BP 108/55, HR 78, RR 24, O2 96% on RA
Gen: Alert, talkative elderly female in no distress
HEENT: Normal cephalic and atraumatic. Sclera anicteric,
extra-occular movements intact, asymmetric pupils L>R.
Conjunctiva were pink, no pallor or cyanosis of the oral mucosa.

Neck: Supple with JVP of ~ 10cm. No bruits
CV: PMI located in 5th intercostal space, midclavicular line.
regular rate, normal S1, S2, no murmurs, rubs, or gallops
Chest: Clear anteriorly with decreased BS and scattered rales
postero-laterally
Abd: Obese, soft, non-tender and non-distended, No
hepato-splenomegally or tenderness
Ext: Bilat. 2+ edema with diffuse varicosities. Dopplerable
pulses
Skin: No stasis dermatitis, venous insufficiency changes
Pulses:
Right: Carotid 2+ without bruit; Femoral with sheath in place;
Left: Carotid 2+ without bruit; Femoral 2+ without bruit;
Dopplerable pulses bilat


Pertinent Results:
FROM OSH:
EKG FROM OSH: Sinus at 85bpm, nl axis with occ PVC, ST
elevations V1-V5
.
CARDIAC CATH at OSH ([**2113-8-21**]):  80% prox LAD stenosis, 80-90%
LCx stenosis, 80% RCA and 60-70% ramus stenosis
.
.
EKG on arrival: NSR at 70bpm, nl axis, near resolution of ST
elevations in the precordium with biphasic T waves in V2-V5
.
CXR ([**2113-8-22**]):  Low lung volumes.  Normal sized heart.  No
evidence of pulmonary edema or CHF.
.
CAROTID US ([**2113-8-22**].)  80% proximal stenosis of the right
proximal internal carotid artery.  ICA/CCA ratio of 2.64.
80-99% left internal carotid artery stenosis.  ICA/CCA ratio of
4.72.  There is decreased flow in the right vertebral artery,
suggesting inflow stenosis.
.
2D ECHO ([**2113-8-22**]):  Ejection fraction of 60-70%.  LVH.  Normal
left ventricular size.  LV inflow patter consisten with impaired
relaxation.  Focal wall motion abnormality not able to be fully
excluded.  Dialted left atrium.  Normal right ventricle size and
function.  Normal right atrial size.  Mildly dilated arotic
sinus.  No AS or MS.  Borderline pulmonary artery systolic
hypertension.
.
CARDIAC CATH at [**Hospital1 18**] ([**2113-8-23**]):  Right dominant circulation.
80% stenosis of the proximal LAD.  Mid-LAD diffuse disease.  90%
stenosis of the mid-LCX.  60% stenosis of the prox-ramus.  LAD
thrombectomy was performed and A Cyhper drug eluting stent (2.5
x 18mm) was placed in the LAD.  TIMI 3 flow was obtained.
Subclavian angiogram was normal.  Carotid angiogram showed
bilateral high grade focal disease.
.
PERIPHERAL (CAROTID)CATH at [**Hospital1 18**] ([**2113-8-24**]):  Right subclavian
artery with 80% stenosis.  Left subclavian artery with minimal
disease.  Right Common Carotid Artery was patent.  Right
Internal Carotid Artery with 60% stenosis.  Left Common Carotid
Artery was patent.  Left Internal Carotid Artery with 99%
stenosis.  Left Internal Carotid was stented with a [**7-14**] x 30
Acculink stent.  This resulted in normal flow with filling of
the ipsilateral Middle Carotid Artery.
.
ABDOMINAO/PELVIC CT:  NO retroperitoneal bleed.  Bilateral
pleural effusions, sigmoid diverticula, degenerative changes in
the right ischial bone.  Mult. other degenerative changes.
Exophytic lesion of the lower pole of right kidney measuring
42mm. Comparison to old studies is recommended to ensure
stablity.

COLONOSCOPY ([**2113-8-28**]):  The patient was found to have
Diverticulosis of the whole colon, external hemorrhoids, Polyps
in the rectum (these were not removed as the patient was on
Plavix.)  There was no active bleeding during the colonoscopy.
Recommendations: Repeat colonoscopy in 6 months to examine the
colon and remove rectal polyps. Patient will have to stop Plavix
5 days before and after the procedure. This is to be scheduled
by the patient's primary care physician.
.
UPPER ENDOSCOPY ([**2113-8-28**]):  Normal EGD to second part of the
duodenum
Recommendations.  No obvious upper GI source of bleeding.
.
Labs from OSH: [**2113-8-21**] 20:28 - Trop I 0.97 CK 66
BUN/Cr ?????? 22/0.96
Na 141 K 4.2 Cl 105 Co2 26 Glu 106
H/H 15.1/45.9
INR 0.92 PTT 23.5
.
Labs at [**Hospital1 18**]:
.
Cardiac enzymes ([**8-22**]):
CK 173-->84 --->124--->151-->191
CK-MB-20 --> 20-->4-->4--->4
MB Indx-11.6
cTropnT-0.67 --> 0.82
.
[**2113-8-22**] WBC-8.6 RBC-4.29 Hgb-12.9 Hct-36.9 MCV-86 MCH-30.0
MCHC-34.9 RDW-14.5 Plt Ct-183
.
[**2113-8-22**] PT-11.7 PTT-26.8 INR(PT)-1.0
.
[**2113-8-22**] Glucose-113* UreaN-20 Creat-0.7 Na-139 K-3.8 Cl-109*
HCO3-23 AnGap-11
[**2113-8-22**] Albumin-3.2* Calcium-9.3 Phos-3.7 Mg-2.3
.
[**2113-8-22**] ALT-11 AST-17 LD(LDH)-173 AlkPhos-67 TotBili-0.3
.
[**2113-8-22**] Triglyc-131 HDL-42 CHOL/HD-4.3 LDLcalc-111 Cholest-179
.
[**2113-8-22**] %HbA1c-5.6%
.
[**2113-8-23**] TSH-0.49
.
UA ([**8-22**]): > 50 RBCs, 0-2 WBCs, [**7-16**] epis




Brief Hospital Course:
Ms. [**Known lastname 15499**] is a 78 year-old female with a 50 pack year smoking
history admitted to OSH for antero-septal ST elevation
myocardial infarction with three vessel disease and was
transferred to the [**Hospital1 18**].  She was treated with cardiac
catheterization with LAD thrombectomy and placement of drug
eluting stent in the LAD.
.
Anterior ST elevation MI. Patient with severe 3 vessel disease
with smoking as an only known risk factor for coronary artery
disease.  Percutaneous cardiac intervention at the outside
hospital revealed:  80% prox LAD, 80-90% LCx, 80% RCA, 60-70%
ramus stenosis.  On admission to the [**Hospital1 18**], the patient was
chest pain free with improvement in ST elevations on EKG.  Peak
CPK was 191 and peak CK-MG was 20.  The patient was started on
aspirin, Statin, heparin drip, Integrilin, and metoprolol 12.5mg
TID.  Plavix was held because of the possibility of CABG. The
patient was initially evaluated for a CABG by CT surgery.
Pre-op carotid US showed a  80-90% bilateral carotid stenosis,
making her a poor surgical candidate for CABG.  Therefore, in
the setting of the patient's recent anterior myocardial
infarction and proximal LAD lesion, the patient was taken for a
cardiac catheterization ([**2113-8-23**]) with LAD thrombectomy and drug
eluting stent placement in the LAD.  Plavix was started before
cardiac catheterization.  A lipid profile was found to be within
normal limits.  A HbAlc was found to be 5.6%.  The patient will
follow up with a cardiologist, Dr. [**Last Name (STitle) 1295**], at the [**Hospital1 **]
cardiology group on [**2113-9-7**] for the possibility of stenting of
the LCx and RCA.  Her blood pressure was too low on discharge to
add an ACEI, but she may benefit from Lisinopril in the future.
.
Carotid Stenosis:  Carotid US showed bilateral 80-90% carotid
stenosis.  Peripheral catheterization on [**2113-8-24**] showed a 60%
Right Internal Carotid Artery stenosis and a 99% Left Internal
Carotid Artery stenosis.  An Acculink stent was placed in the
Left Internal Carotid Artery with subsequent robust flow through
this artery into the Middle Cerebral Artery.  After the
procedure, the patient's blood pressure was monitored so that
the systolic blood pressure ranged from 100's-140's.
Additionally, the patient's neurologic exam was unchanged after
the catheterization.  The patient will continue on Plavix for at
least one year and may need Plavix as a life-long medication.
The patient will follow up with Dr. [**First Name (STitle) **] in on [**2113-9-26**].
.
PUMP:  Echocardiogram on [**2113-8-22**] showed an left ventricular
ejection fraction of 60-70% with mild LVH and impaired
ventricular relaxation.  She has no know history of heart
dysfunction or congestive heart failure.  The patient was
treated with metoprolol 12.5mg TID to maintain a low heart rate
and allow left ventricular filling.  Due to her low-normal blood
pressure, an ACEI could not be started in the hospital, but she
may benefit from one in the future.
.
Hypotension: On [**8-23**], the patient presented with MAPs in 50s
overnight.  She was completely asymptomatic at that time,
without tachycardia, chest pain or shortness of breath.
Etiology of hypotension unclear, but on questioning pt reports
"always having very low blood pressure."  There was no evidence
of bleeding post cath, and HCT was stable. She was given 2 fluid
boluses with slight elevation of blood pressure and good urine
output, but continued to have MAPs lower than 60. At his point,
she was initiated on neo-synephrine with good response.  When
the patient went to cardiac catheterization on [**2113-8-23**], an
arterial line did show normal blood pressures (117-159/49-113)
that were 30 points higher than cuff measurements.
Additionally, peripheral catheterization showed an  80% Right
Subclavian Artery Stenosis, causing even lower pressure readings
by cuff measurements taken in her right arm.  When the patient's
blood pressure was taken from the left arm, it normalized.

.
Rhythm: The patient was placed on telemetry and remained in
normal sinus rhythm with occasional PVC's.
.
GI Bleed.  On [**2113-8-25**], the patient's Hct dropped from 28.8 to
25.2 to 23.5.  The patient was stable with good urine output and
no change in mental status.  A abdomino-pelvic CT was performed
to rule out an retroperitoneal bleed. Although her HCT rose to
27.0 on [**2113-8-26**], she reported that she had multiple loose,
bloody stools.  On [**2113-8-27**], a NG lavage showed no blood and the
bleed was assumed be from a lower GI source.  The patient was
seen by GI.  The patient's SQ heparin was discontinued, she was
placed on a proton pump inhibitor [**Hospital1 **], two large bore IV's were
placed, she was typed an crossed, and then given two unit of
packed red blood cells with a Hct bump from 24.6 to 29.1.  The
patient tolerated the blood transfusion well.  On [**2113-8-28**], the
patient was taken to colonoscopy and upper endoscopy.  The upper
endoscopy was normal.  The colonoscopy showed external
hemorrhoids, diverticulosis of the entire colon, and rectal
polyps (not removed because the patient was on Plavix.)  There
was no active bleeding during these studies.  The patient was
kept in the hospital overnight with HCT checks.  The patient
will follow up with a colonoscopy in 6 months.  She will not be
able to stop Plavix under any cirmcumstances for at least a
year, so if plans are made for polyp removal, these must be done
while the patient is on Plavix.
.
Arthritis: The patient reports a history of degenerative joint
disease.  When the patient describes the pain, she states that
it does not stay confined to the joints and that the pain shoots
down her arms and legs.  The patient was treated with Tylenol,
tramadol, and oxycodone PRN.
.
Smoking: Significant smoking history. Question underlying lung
disease.  The patient was maintained on Ipratropium and
Albuterol.  Social work spoke with the patient about smoking
cessation.
.
FEN: The patient was started on a cardiac diet.  Electrolytes
were repleated as needed.
.
Prophy: Bowel regimen, Heparin/Integrilin/Sub-Q heparin, [**Male First Name (un) **]
Stockings
.
Access: PIV x 1
.
Code: FULL code on this admission.  Patient would like to resume
DNR after this hospitalization.
.
Dispo: The patient was seen by physical therapy and discharged
to home with services.  Follow up appointments scheduled with
Dr. [**First Name (STitle) **], Dr. [**Last Name (STitle) 1295**], and DR. [**Last Name (STitle) **].  The patient will also
need a follow up colonoscopy at 6 months.

Medications on Admission:
Tylenol prn
Triamterene (unsure of dose)
Tramadol (unsure of dose)
Ibuprofen prn


Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
5. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
6. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic [**Hospital1 **] (2 times a day).
7. Atenolol 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
1) Anterior ST elevation myocardial infarction
2) Bilateral carotid stenosis
3) Right Subclavian Artery Stenosis
4) GI Bleed
5) Rectal polyps


Discharge Condition:
Stable, ambulating

Discharge Instructions:
  During this hospitalization, you were diagnosed a myocardial
infarction or a heart attack.  The type of heart attack that you
had is called an anterior ST elevation myocardial infarction.
We treated this with a cardiac catheterization and a stent in
one of the coronary arteries.  Additionally, during this
hospitalization, you were found to have narrowing of the
arteries in your neck.  This is called carotid artery stenosis.
This was treated with left carotid artery stent placement.
Finally, you had a GI bleed during this hospitalization.  This
was evaluated with a colonoscopy and an upper endoscopy.  Even
though you had a GI bleed, you need to stay on your aspirin and
plavix.
.
During this hospitalization, you were started on several new
medications to treat your heart and the arteries in your neck.
It is very important that you take all of your medications.  It
is especially important that you take your aspirin and plavix
everyday.  Under no circumstance should you stop taking your
aspirin or plavix- unless you have spoken to your cardiologist.
If you become sick and are vomiting and cannot take your aspirin
or plavix you should contact your cardiologist.
.
If you have any chest pain, shortness of breath, dizziness, feel
hot and/or sweaty, feel confused, are not able to speak, have a
change in your vision,or are suddenly are not able to move or
feel a part of your body-please contact your doctor or go to the
nearest emergency room.  Please feel free to contact your doctor
with any other concerns.

Followup Instructions:
1) Please follow up with Dr. [**First Name (STitle) **] to evaluate your left
carotid stent on [**2113-9-26**] at 3:20pm.  The office is located on
the [**Location (un) 436**] in the [**Hospital Ward Name 23**] Building of the [**Hospital1 771**].  Please call the office coordinator,
Dauwn, at [**Telephone/Fax (1) 73427**] if you have any questions.
.
2)Because you have had a heart attack, it is important for you
to follow up with a cardiologist.  You have an appointment with
Dr. [**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 1295**] on [**2113-9-7**] at 10:30am.  Dr.[**Name (NI) 39613**] office
is at the [**Hospital3 1280**] Heart Center on [**Last Name (NamePattern1) 26916**].  It is next
to the [**Hospital 47**] [**Hospital 1281**] Hospital.  Please call [**Telephone/Fax (1) 6256**] with
any questions.  Please discuss with Dr. [**Last Name (STitle) 1295**] if you need to
start Lisinopril as an outpatient.
.
3) Due to your hospitalization, you should follow up with your
primary care doctor.  You are scheduled for an appointment with
Dr. [**Last Name (STitle) **] on [**2113-9-6**] at 11:00am.  Please call [**Telephone/Fax (1) 7401**] if
you have any questions.
.
4) You should have a follow up colonoscopy in 6 months.  Please
speak to your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) 51794**] this study.
{'Acute myocardial infarction of other anterior wall, initial episode of care,Acute posthemorrhagic anemia,Diverticulosis of colon with hemorrhage,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Coronary atherosclerosis of native coronary artery,External hemorrhoids with other complication,Benign neoplasm of rectum and anal canal,Stricture of artery,Other specified hypotension,Arthropathy, unspecified, multiple sites,Tobacco use disorder,Macular degeneration (senile), unspecified'}


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: Transfered from an outside hospital with chest pain and anterior
ST elevation MI.

PRESENT ILLNESS: 78 year-old female with significant smoking history, no other
past medical history, who presents from an outside hospital with
acute onset sub-sternal chest pain at rest with radiation to the
left shoulder and diaphoresis. The paitent was in her usual
state of health when the event occurred. Prior to this she
reported 1 episode of chest pain a month prior which resolved on
its own. Her current pain was graded as [**11-15**], sharp, midline
with slight radiation. She denied any shortness of breath or
dyspnea with the pain. The pain did not resolve on its own and
she called EMS. At the outside hospital ED, the patient was
given nitro, morphine with improvement of her pain. EKG
demonstrated ST elevations in V1-V6. Her Trop I was 0.97. She
received ASA 325, Plavix 600mg, heparin bolus, integrillin bolus
x2 plus gtt at 2mcg/kg/min and lopressor 5mg IV x1. She was
taken urgently to the cath lab.
.
In the cath lab, she was found to have 80% prox LAD stenosis,
80-90% LCx stenosis, 80% RCA and 60-70% ramus stenosis. Given
her significant 3 vessel disease, she was transferred to [**Hospital1 18**]
for possible CABG.
.
On arrival to [**Hospital1 18**], the patient felt well and denied chest
pain. She was lying flat comfortably. The cath sheath was in
place and intact.
.
On review of symptoms, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, cough, hemoptysis, black stools or red stools.
She denies recent fevers, chills or rigors. She denies
exertional buttock or calf pain. All of the other review of
systems were negative.
.
Cardiac review of systems is notable for absence paroxysmal
nocturnal dyspnea, orthopnea, palpitations, syncope or
presyncope. Of note, the patient reports chronic LE edema for
which she is taking a "water pill."

MEDICAL HISTORY: 1)Degenerative Joint Disease
2) Left Eye Blindness
3) Varicose veins-s/p bilateral lower extermity vein stripping

MEDICATION ON ADMISSION: Tylenol prn
Triamterene (unsure of dose)
Tramadol (unsure of dose)
Ibuprofen prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.7, BP 108/55, HR 78, RR 24, O2 96% on RA
Gen: Alert, talkative elderly female in no distress
HEENT: Normal cephalic and atraumatic. Sclera anicteric,
extra-occular movements intact, asymmetric pupils L>R.
Conjunctiva were pink, no pallor or cyanosis of the oral mucosa.

FAMILY HISTORY: Her Father had a heart attack at age 64. There is no family
history of premature coronary artery disease or sudden death.

SOCIAL HISTORY: Social history is significant for the current tobacco use of 4
cigs/day. She has a 50 pack year history.  There is no history
of alcohol abuse. She is a retired office worker who lives with
her husband. She has 2 children. She is functional and
independent with her activities of daily life. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Acute posthemorrhagic anemia,Diverticulosis of colon with hemorrhage,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Coronary atherosclerosis of native coronary artery,External hemorrhoids with other complication,Benign neoplasm of rectum and anal canal,Stricture of artery,Other specified hypotension,Arthropathy, unspecified, multiple sites,Tobacco use disorder,Macular degeneration (senile), unspecified'}
