CHIEF COMPLAINT: Syncope

PRESENT ILLNESS: This is a 68-year-old male patient known to [**Hospital1 18**] with a history
of severe AS; CAD, s/p CABG in [**2160**] (LIMA-LAD, SVG-LAD, SVG-OM);
stent to LMCA and stent to Diag 1 in [**2160**]; PCI to SCG-LAD; ISR
of D1 stent in [**2161**]; and s/p Cypher stent to LMCA in [**2162**]. He is
also a diabetic, has PVD, HTN, CRI, hypothyroidism, CHF, EF
40-50%, Gout, sleep apnea, and a history of GI bleed from AVMs.
He presented OSH today with two episodes of syncope. He reports
walking to the door to let out his dog at 5 am and passed out.
Woke up on the floor. + LOC. Then, syncopized a second time,
witnessed by son, about 2-3 hours later. This occurred when
walking to the car. Felt "clammy", also had N/V once at the
hospital. No post fall confusion. No jerking movements, no
incontinence. He hit head posteriorly ?anteriorly also.
He has lacerations on his forehead but required no stitches. CT
head at OSH reportedly normal per patient (report not available
at this time). His blood sugar was greater than 400 on arrival.
He was give Lantus and regular insulin, Zofran and because his
lungs were diminished at the bases and he is chronically short
of breath he was given a nebulizer treatment. He also underwent
an echocardiogram with the results still pending. He was given
Morphine for chest pain with relief.
He reports chronic "congestive" chest pain; with questioning
this did not seem to be any worse than his baseline today. Also
dyspneic with exertion chronically. Also reports heaviness in
his calves and legs that limit his exercise tolerance.
The few days PTA he attended a day program at [**Last Name (un) **] for
improvement in his glucose control. He felt well until one day
PTA when he began to feel lightheaded and fatigues despite
normal glucose. Also recently had vitrectomy/eye surgery (1.5
weeks ago). Also thought he was starting a gout flare of R foot;
took PO prednisone last night to start a taper. ROS negative
other than listed above.

MEDICAL HISTORY: -- CABG '[**48**] (LIMA-LAD, SVG LAD, SVG OM)
-- Cath [**10/2162**]: Three vessel native coronary artery disease,
patent grafts, moderate aortic stenosis, patent previously
placed stents, elevated left sided filling pressure.
-- Stress test [**2162-5-24**]: Poor functional status. 3.5 minutes of
exercise on [**Doctor Last Name 4001**] protocol. EF 30% and multiple fixed
perfusion defects and minor inferior defect.
-- multiple coronary stents in [**2160**], [**2161**], and [**2162**]
-- Aortic stenosis: [**Location (un) 109**] 1.09 cm2 [**10-8**] cath.
-- Ischemic CM/CHF - diastolic, systolic EF 45%, multiple admits

MEDICATION ON ADMISSION: CURRENT MEDICATIONS (somewhat unclear; multiple sources with a
lot of disagreement - pharmacy, [**Last Name (un) **] note, past D/C summaries,
OMR):
Levothyroxine 200 mcg daily
Metoprolol XL 100 mg daily
Ezetimibe 10 mg daily
Sertraline 100 mg daily
Imdur 60 mg daily
Sucralfate 1 g QID
Ambien 5 mg QHS prn
Bumex 1 mg daily
Metolazone 2.5 mg daily or prn daily for weight gain?
Insulin (NPH or glargine) patient reports 50 QAM, 50 QPM
Novolog: patient reports 20 units with each meal
Allopurinol 100 TID
ASA 325 daily
Colchicine 0.6 mg daily
eye gtts (Xibrom, Zymar)
Simvastatin 80 mg daily (but not recently filled at pharm)
Lisinopril 2.5 mg daily (but not recently filled at pharm)
Spironolactone 25 mg daily
mvi
Pantoprazole 40 mg daily
Calcitriol 0.25 daily (but not according to pharm)
oxycodone prn pain
Plavix ([**First Name8 (NamePattern2) **] [**Last Name (un) **] notes but not listed anywhere else)
Prednisone taper prn gout flare

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - T97.5, BP 128/56, P97, R20, 96% on 2L
Gen: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL. Conjunctiva pink, MMM, OP
clear.
Neck: Supple, no noted JVP elevation. Murmur radiation into
carotids.
CV: RR, normal S1, S2. Loud AS murmur heard throughout the
precordium with radiation to the carotids.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored. + bibasilar crackles.
Abd: Soft, NTND. No HSM or tenderness.
Ext: Trace edema bilat.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. Retired [**Doctor Last Name **].
Widowed in [**2163-1-3**].
Aortic valve disorders,Acute on chronic systolic heart failure,Acute kidney failure, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hyperpotassemia,Unspecified acquired hypothyroidism,Chronic kidney disease, unspecified
Aortic valve disorder,Ac on chr syst hrt fail,Acute kidney failure NOS,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hyperpotassemia,Hypothyroidism NOS,Chronic kidney dis NOS
Admission Date:  [**2163-9-30**]              [**Month/Day/Year **] Date:   [**2163-10-18**]

Date of Birth:  [**2094-10-7**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Syncope

Major Surgical or Invasive Procedure:
[**2163-10-7**] Redo-Sternotomy, Aortic Valve Replacement, Coronary
Artery Bypass Graft x 2 (SVG to PDA, SVG to LIMA)

History of Present Illness:
This is a 68-year-old male patient known to [**Hospital1 18**] with a history
of severe AS; CAD, s/p CABG in [**2160**] (LIMA-LAD, SVG-LAD, SVG-OM);
stent to LMCA and stent to Diag 1 in [**2160**]; PCI to SCG-LAD; ISR
of D1 stent in [**2161**]; and s/p Cypher stent to LMCA in [**2162**]. He is
also a diabetic, has PVD, HTN, CRI, hypothyroidism, CHF, EF
40-50%, Gout, sleep apnea, and a history of GI bleed from AVMs.
He presented OSH today with two episodes of syncope. He reports
walking to the door to let out his dog at 5 am and passed out.
Woke up on the floor. + LOC. Then, syncopized a second time,
witnessed by son, about 2-3 hours later. This occurred when
walking to the car. Felt "clammy", also had N/V once at the
hospital. No post fall confusion. No jerking movements, no
incontinence. He hit head posteriorly ?anteriorly also.
He has lacerations on his forehead but required no stitches. CT
head at OSH reportedly normal per patient (report not available
at this time). His blood sugar was greater than 400 on arrival.
He was give Lantus and regular insulin, Zofran and because his
lungs were diminished at the bases and he is chronically short
of breath he was given a nebulizer treatment. He also underwent
an echocardiogram with the results still pending. He was given
Morphine for chest pain with relief.
He reports chronic "congestive" chest pain; with questioning
this did not seem to be any worse than his baseline today. Also
dyspneic with exertion chronically. Also reports heaviness in
his calves and legs that limit his exercise tolerance.
The few days PTA he attended a day program at [**Last Name (un) **] for
improvement in his glucose control. He felt well until one day
PTA when he began to feel lightheaded and fatigues despite
normal glucose. Also recently had vitrectomy/eye surgery (1.5
weeks ago). Also thought he was starting a gout flare of R foot;
took PO prednisone last night to start a taper. ROS negative
other than listed above.

Past Medical History:
-- CABG '[**48**] (LIMA-LAD, SVG LAD, SVG OM)
-- Cath [**10/2162**]: Three vessel native coronary artery disease,
patent grafts, moderate aortic stenosis, patent previously
placed stents, elevated left sided filling pressure.
-- Stress test [**2162-5-24**]: Poor functional status. 3.5 minutes of
exercise on [**Doctor Last Name 4001**] protocol. EF 30% and multiple fixed
perfusion defects and minor inferior defect.
-- multiple coronary stents in [**2160**], [**2161**], and [**2162**]
-- Aortic stenosis: [**Location (un) 109**] 1.09 cm2 [**10-8**] cath.
-- Ischemic CM/CHF - diastolic, systolic EF 45%, multiple admits

for diuresis, last [**1-9**], [**6-8**].
-- DM2, last HgA1c in [**2162-10-3**] of 7.1
-- Anemia: baseline HCT 31-33
-- Hypothyroidism
-- OSA on CPAP
-- Depression
-- CKD- with baseline Cr 1.5-2.0
-- hypercholesterolemia
-- OA
-- Gout
-- IBS-diarrhea predominant
-- Obesity
-- PVD
-- UGI and LGI bleeding secondary to AVMs


Social History:
Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. Retired [**Doctor Last Name **].
Widowed in [**2163-1-3**].

Family History:
There is no family history of premature coronary artery disease
or sudden death.

Physical Exam:
VS - T97.5, BP 128/56, P97, R20, 96% on 2L
Gen: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL. Conjunctiva pink, MMM, OP
clear.
Neck: Supple, no noted JVP elevation. Murmur radiation into
carotids.
CV: RR, normal S1, S2. Loud AS murmur heard throughout the
precordium with radiation to the carotids.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored. + bibasilar crackles.
Abd: Soft, NTND. No HSM or tenderness.
Ext: Trace edema bilat.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas

Pertinent Results:
[**10-4**] CNIS: There is less than 40% right ICA stenosis and there
is 40-59 left ICA stenosis. There is a greater than 50% left ECA
stenosis as well, and both vertebral arteries are unable to be
visualized.
[**10-7**] Echo: PRE-CPB: The left atrium is mildly dilated. No
spontaneous echo contrast is seen in the body of the left
atrium. No spontaneous echo contrast is seen in the left atrial
appendage. No thrombus is seen in the left atrial appendage. No
atrial septal defect is seen by 2D or color Doppler. There is
mild symmetric left ventricular hypertrophy. The left
ventricular cavity size is normal. There is moderate regional
left ventricular systolic dysfunction with severe inferior
hypokinesis. Overall left ventricular systolic function is
moderately depressed (LVEF= 35 %). Transmitral Doppler and
tissue velocity imaging are consistent with Grade II (moderate)
LV diastolic dysfunction. Right ventricular chamber size and
free wall motion are normal. There are simple atheroma in the
aortic root. There are simple atheroma in the ascending aorta.
There are simple atheroma in the aortic arch. There are simple
atheroma in the descending thoracic aorta. There are three
aortic valve leaflets. The aortic valve leaflets are moderately
thickened. No masses or vegetations are seen on the aortic
valve. There is severe aortic valve stenosis (area <0.8cm2).
Mild (1+) aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. Mild (1+) mitral regurgitation is
seen. Addendum: Episode of increased PA pressures during
exposure of coronary bypass grafts with apical akinesis. No
change in bp, CO or mixed venous. Nitroglycerine started and
patient put on cardiopulmonary bypass within minutes. POST-CPB:
On infusions of epi, levo, milrinone, amiodarone, insulin.
Well-seated bioprosthetic valve in the aortic position. No
paravalvular leak. MR is 3+ with ventricular dilation, improved
with IABP insertion. LVEF now 35%. Inferoseptal, apical and
inferior hypokinesis. IABP in good position 3 cm below LSCA.
Aortic contour is normal post decannulation.
RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2163-10-12**] 1:33 PM

CHEST (PA & LAT)

Reason: evaluate for effusion with sternal drainage

[**Hospital 93**] MEDICAL CONDITION:
68 year old man s/p avr cabg x2
REASON FOR THIS EXAMINATION:
evaluate for effusion with sternal drainage
INDICATION: Evaluate for effusion, with sternal drainage.

COMPARISONS: Chest radiograph dated [**2163-10-10**].

FINDINGS: Frontal and lateral views of the chest were obtained.
Sternotomy wires and mediastinal clips remain. A cardiac valve
prosthesis is noted. A right internal jugular catheter
terminates at the cavoatrial junction. There is mild blunting of
both posterior costophrenic angles, with associated decreased
retrocardiac opacity. There is no pneumothorax. The cardiac
silhouette is stable and enlarged. There is no pulmonary
vascular congestion.

IMPRESSION: Small bilateral pleural effusions with decreased
retrocardiac atelectasis.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name (STitle) 7805**] [**Name (STitle) **]
DR. [**First Name8 (NamePattern2) 4075**] [**Last Name (NamePattern1) 5999**]
Hematology
  COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2163-10-13**] 05:44AM    8.7 3.20* 10.0* 29.0* 91 31.3 34.5 16.4*
207
Chemistry
  RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2163-10-13**] 05:44AM    135* 36* 1.4* 135 3.9 99 29 11




Brief Hospital Course:
As mentioned in the HPI, Mr. [**Known lastname 21147**] was transferred to OSH
following two syncopal episodes. Upon admission he was
appropriately worked up and medically managed until cleared for
surgery. Finally on [**10-7**] he was brought to the operating room
where he underwent a redo-sternotomy, aortic valve replacement
and coronary artery bypass graft x 2. Please see operative
report for surgical details. Following surgery he was
transferred to the CVICU for invasive monitoring and was on Epi,
Levo, Milrinone, and Pitressin and an IABP.   His drips were
slowly weaned and on POD#2 his IABP was d/c'd and he was
extubated.  ON POD#3 his chest tubes were d/c'd and he was
transferred to the floor in stable condition.  His epicardial
pacing wires were d/c'd on POD#4.  He developed serosanguineous
sternal drainage on POD#4. He also had a gout flare up that was
treated while sternal drainage was monitored. Cleared for
[**Month/Day (1) **] to home with VNA services on POD #11. Pt. is to make
all followup appts. as per [**Month/Day (1) **] instructions.

Medications on Admission:
CURRENT MEDICATIONS (somewhat unclear; multiple sources with a
lot of disagreement - pharmacy, [**Last Name (un) **] note, past D/C summaries,
OMR):
Levothyroxine 200 mcg daily
Metoprolol XL 100 mg daily
Ezetimibe 10 mg daily
Sertraline 100 mg daily
Imdur 60 mg daily
Sucralfate 1 g QID
Ambien 5 mg QHS prn
Bumex 1 mg daily
Metolazone 2.5 mg daily or prn daily for weight gain?
Insulin (NPH or glargine) patient reports 50 QAM, 50 QPM
Novolog: patient reports 20 units with each meal
Allopurinol 100 TID
ASA 325 daily
Colchicine 0.6 mg daily
eye gtts (Xibrom, Zymar)
Simvastatin 80 mg daily (but not recently filled at pharm)
Lisinopril 2.5 mg daily (but not recently filled at pharm)
Spironolactone 25 mg daily
mvi
Pantoprazole 40 mg daily
Calcitriol 0.25 daily (but not according to pharm)
oxycodone prn pain
Plavix ([**First Name8 (NamePattern2) **] [**Last Name (un) **] notes but not listed anywhere else)
Prednisone taper prn gout flare

[**Last Name (un) **] Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
3. Levothyroxine 100 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. 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:*1*
6. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
7. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
10. Zinc Sulfate 220 (50) mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
Disp:*30 Capsule(s)* Refills:*1*
11. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*1*
12. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
13. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
14. Colchicine 0.6 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
15. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO once
a day for 7 days.
Disp:*7 Packet(s)* Refills:*0*
16. Bumex 1 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days: twice a day for 7 days, then 1 mg daily ongoing.
Disp:*30 Tablet(s)* Refills:*1*
17. Keflex 250 mg Capsule Sig: One (1) Capsule PO four times a
day for 7 days.
Disp:*28 Capsule(s)* Refills:*0*
18. Insulin Glargine 100 unit/mL Solution Sig: Thirty Five (35)
units Subcutaneous twice a day.
Disp:*2100 units* Refills:*2*
19. Ferrous sulfate 325 mg po daily
20. Humalog insulin per printed copy sliding scale


[**Last Name (un) **] Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

[**Hospital3 **] Diagnosis:
Aortic Stenosis/Coronary Artery Disease s/p Aortic Valve
Replacement, Coronary Artery Bypass Graft x 2
PMH: s/p Coronary Artery Bypass x 3 and multiple PCI, Congestive
Heart Failure, Ischemic Cardiomyopathy, Hyperlipidemia, Diabetes
Mellitus, Hypothyroid, Gout, h/o Upper GI Bleed, chronic renal
insufficiency, Obstructive Sleep Apnea, Anemia ?etiology,
Depression, Osteoarthritis, Peripheral Vascular Disease

[**Hospital3 **] Condition:
Good

[**Hospital3 **] Instructions:
1)Please shower daily. No baths. Pat dry incisions, do not rub.
2)Avoid creams and lotions to surgical incisions.
3)Call cardiac surgeon if there is concern for wound infection.
4)No lifting more than 10 lbs for at least 10 weeks from
surgical date.
5)No driving for at least one month.

Followup Instructions:
Dr. [**First Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**]
Dr. [**Last Name (STitle) 911**] in [**2-5**] weeks
Dr. [**Last Name (STitle) **] in [**1-4**] weeks
You have two appointments with your eye doctors [**First Name8 (NamePattern2) **] [**Last Name (Titles) **] on
Friday [**10-28**] starting at 1:00 pm with Drs. [**Last Name (STitle) 17233**] and
[**Name5 (PTitle) **].

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2163-10-18**]
{'Aortic valve disorders,Acute on chronic systolic heart failure,Acute kidney failure, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hyperpotassemia,Unspecified acquired hypothyroidism,Chronic kidney disease, 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: Syncope

PRESENT ILLNESS: This is a 68-year-old male patient known to [**Hospital1 18**] with a history
of severe AS; CAD, s/p CABG in [**2160**] (LIMA-LAD, SVG-LAD, SVG-OM);
stent to LMCA and stent to Diag 1 in [**2160**]; PCI to SCG-LAD; ISR
of D1 stent in [**2161**]; and s/p Cypher stent to LMCA in [**2162**]. He is
also a diabetic, has PVD, HTN, CRI, hypothyroidism, CHF, EF
40-50%, Gout, sleep apnea, and a history of GI bleed from AVMs.
He presented OSH today with two episodes of syncope. He reports
walking to the door to let out his dog at 5 am and passed out.
Woke up on the floor. + LOC. Then, syncopized a second time,
witnessed by son, about 2-3 hours later. This occurred when
walking to the car. Felt "clammy", also had N/V once at the
hospital. No post fall confusion. No jerking movements, no
incontinence. He hit head posteriorly ?anteriorly also.
He has lacerations on his forehead but required no stitches. CT
head at OSH reportedly normal per patient (report not available
at this time). His blood sugar was greater than 400 on arrival.
He was give Lantus and regular insulin, Zofran and because his
lungs were diminished at the bases and he is chronically short
of breath he was given a nebulizer treatment. He also underwent
an echocardiogram with the results still pending. He was given
Morphine for chest pain with relief.
He reports chronic "congestive" chest pain; with questioning
this did not seem to be any worse than his baseline today. Also
dyspneic with exertion chronically. Also reports heaviness in
his calves and legs that limit his exercise tolerance.
The few days PTA he attended a day program at [**Last Name (un) **] for
improvement in his glucose control. He felt well until one day
PTA when he began to feel lightheaded and fatigues despite
normal glucose. Also recently had vitrectomy/eye surgery (1.5
weeks ago). Also thought he was starting a gout flare of R foot;
took PO prednisone last night to start a taper. ROS negative
other than listed above.

MEDICAL HISTORY: -- CABG '[**48**] (LIMA-LAD, SVG LAD, SVG OM)
-- Cath [**10/2162**]: Three vessel native coronary artery disease,
patent grafts, moderate aortic stenosis, patent previously
placed stents, elevated left sided filling pressure.
-- Stress test [**2162-5-24**]: Poor functional status. 3.5 minutes of
exercise on [**Doctor Last Name 4001**] protocol. EF 30% and multiple fixed
perfusion defects and minor inferior defect.
-- multiple coronary stents in [**2160**], [**2161**], and [**2162**]
-- Aortic stenosis: [**Location (un) 109**] 1.09 cm2 [**10-8**] cath.
-- Ischemic CM/CHF - diastolic, systolic EF 45%, multiple admits

MEDICATION ON ADMISSION: CURRENT MEDICATIONS (somewhat unclear; multiple sources with a
lot of disagreement - pharmacy, [**Last Name (un) **] note, past D/C summaries,
OMR):
Levothyroxine 200 mcg daily
Metoprolol XL 100 mg daily
Ezetimibe 10 mg daily
Sertraline 100 mg daily
Imdur 60 mg daily
Sucralfate 1 g QID
Ambien 5 mg QHS prn
Bumex 1 mg daily
Metolazone 2.5 mg daily or prn daily for weight gain?
Insulin (NPH or glargine) patient reports 50 QAM, 50 QPM
Novolog: patient reports 20 units with each meal
Allopurinol 100 TID
ASA 325 daily
Colchicine 0.6 mg daily
eye gtts (Xibrom, Zymar)
Simvastatin 80 mg daily (but not recently filled at pharm)
Lisinopril 2.5 mg daily (but not recently filled at pharm)
Spironolactone 25 mg daily
mvi
Pantoprazole 40 mg daily
Calcitriol 0.25 daily (but not according to pharm)
oxycodone prn pain
Plavix ([**First Name8 (NamePattern2) **] [**Last Name (un) **] notes but not listed anywhere else)
Prednisone taper prn gout flare

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - T97.5, BP 128/56, P97, R20, 96% on 2L
Gen: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL. Conjunctiva pink, MMM, OP
clear.
Neck: Supple, no noted JVP elevation. Murmur radiation into
carotids.
CV: RR, normal S1, S2. Loud AS murmur heard throughout the
precordium with radiation to the carotids.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored. + bibasilar crackles.
Abd: Soft, NTND. No HSM or tenderness.
Ext: Trace edema bilat.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. Retired [**Doctor Last Name **].
Widowed in [**2163-1-3**]. 

### Response:
{'Aortic valve disorders,Acute on chronic systolic heart failure,Acute kidney failure, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hyperpotassemia,Unspecified acquired hypothyroidism,Chronic kidney disease, unspecified'}
