CHIEF COMPLAINT: Shortness of breath and chest discomfort

PRESENT ILLNESS: Mr. [**Known lastname 86418**] is a 78 year-old man with a history of inferior MI,
hypertension, hypercholesterolemia and claudication who was
admitted to the CCU following emergent cardiac catheterization
after presenting with acute onset shortness of breath and chest
discomfort. He is a vague historian although does feel that he
has been more fatigued in general over the last 2-3 weeks with
shortness of breath noticed when it was hot and humid. He
noticed he has felt more short of breath since the evening prior
to admission ([**6-18**]) and first noticed this when he was tryng to
go to sleep. He was restless and felt that his breathing was
labored at rest. He also notes epigastric/lower chest discomfort
which was continuous since the evening of [**6-18**] and was a dull
pain which had no particular radiation and was assocated with
some chest heaviness. He denied significant nausea, no vomiting
although he was diaphoretic.
.
His symptoms were considerably worse by the morning of [**6-19**] and
he called EMS and was admitted to the outside hospital ([**Hospital1 **]) ED and ECG at the time showed a LBBB and inferior Q
waves and CXR showed pulmonary edema and cardiac enzymes were
mildly elevated with Trop 0.12, BNP 3490. Baseline labs at
[**Hospital3 **] showed BUN 41 Cr 1.4.
.
In the [**Hospital 97437**] Hospital ED, he was loaded with clopidogrel 600mg
and 4x81mg aspirin and integrilin infusion at 14ml/hour and a
nitroglycerin 50mcg/min infusion. On arrival at [**Hospital3 **] ED
he received furosemide 40mg IV and taken to cardiac
catheterization. Cardiac cath demonstrated diffuse 3-vessel
disease not amenable to PCI.
.
On review of systems, he denied any recent fever, chills, change
in weight, change to bowel or bladder habbits, arthalgia,
myaglia, dizziness, numbness or weakness. Cardiac review of
systems is notable for absence of typical chest pain, although
he was dyspneic at rest, had no paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, palpitations, syncope or presyncope. He
noted bilateral claudication at 200yrds with no rest pain. Of
note he had dark/black stools for three days and settled two
days ago. He has chronic problems with increased urinary
frequency/urgency.

MEDICAL HISTORY: - History of Inferior MI [**89**] years ago
- Hypertension
- Hypercholesterolemia.
- Previous gastric/DU 10 years ago and had a GI bleed requiring
hospital admission.
- Mild Osteoarthritis
- GERD
- s/p left knee surgeries
- s/p hemorrhoidectomy

MEDICATION ON ADMISSION: Propranolol 80mg qd
Gemfibrozil 600mg [**Hospital1 **]
Hydroxyzine 50mg tid
Nitroglycerin patch 0.2mcg/hr applied daily
Multivitamin 1 tab qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Exam
Gen: Well appearing main with some SOB.
HEENT: PERRL, EOMI. MMM. OP clear. Conjunctiva well pigmented.
Neck: Supple, without adenopathy. Some JVD and JVP elevated at
7-8cm above sternal angle.
Chest: Decreased breath sounds bilaterally to midzones and
crackles to midzones bilaterally worse on the left. Dullness at
bases.
Cor: HS SI+ soft SII + ESM with no radiation. RRR. No deviated
apex.
Abdomen: Obese Soft, non-tender.. +BS, no HSM. R groin cath site
no hematoma no bruit.
Extremity: Femorals 2+ b/l Popliteals 2+ on L 1+ on R, DP
present barely on teh left and absent on the right. PT absent
bilaterally. All foot pulses present on doppler with monophasic
waveforms. No peripheral edema. No clinical evidence of DVT.
Neuro: Alert and oriented. CN 2-12 intact. Motor strength intact
in all extremities. Sensation intact grossly.

FAMILY HISTORY: Mother had MI and pancreatic ca
Father - asthma
Sibs - No cardiac disease. 2 sisters otherwise well

SOCIAL HISTORY: Retired [**Doctor Last Name **] at Stop and Shop and limousine driver.
-Tobacco history: 5 cigars/day since teens
-ETOH: 0-2 units per week. Denies prev alcohol excess.
-Illicit drugs: denies
Normally walks unaided and has ET 1 mile on the flat.
Subendocardial infarction, initial episode of care,Acute on chronic combined systolic and diastolic heart failure,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Aortic valve disorders,Diarrhea,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Esophageal reflux,Other chronic pulmonary heart diseases,Retained dental root,Unspecified disorder of kidney and ureter,Peripheral vascular disease, unspecified
Subendo infarct, initial,Ac/chr syst/dia hrt fail,Parox ventric tachycard,Crnry athrscl natve vssl,Pure hypercholesterolem,Aortic valve disorder,Diarrhea,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Esophageal reflux,Chr pulmon heart dis NEC,Retained dental root,Renal & ureteral dis NOS,Periph vascular dis NOS
Admission Date:  [**2175-6-19**]              Discharge Date:   [**2175-7-3**]

Date of Birth:  [**2097-3-6**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Shortness of breath and chest discomfort

Major Surgical or Invasive Procedure:
[**2175-6-19**] Cardiac Catherization
[**2175-6-26**] Three Vessel Coronary Artery Bypass Grafting(left
internal mammary to left anterior descending artery with
saphenous vein grafts to diagonal and PDA).


History of Present Illness:
Mr. [**Known lastname 86418**] is a 78 year-old man with a history of inferior MI,
hypertension, hypercholesterolemia and claudication who was
admitted to the CCU following emergent cardiac catheterization
after presenting with acute onset shortness of breath and chest
discomfort. He is a vague historian although does feel that he
has been more fatigued in general over the last 2-3 weeks with
shortness of breath noticed when it was hot and humid. He
noticed he has felt more short of breath since the evening prior
to admission ([**6-18**]) and first noticed this when he was tryng to
go to sleep. He was restless and felt that his breathing was
labored at rest. He also notes epigastric/lower chest discomfort
which was continuous since the evening of [**6-18**] and was a dull
pain which had no particular radiation and was assocated with
some chest heaviness. He denied significant nausea, no vomiting
although he was diaphoretic.
.
His symptoms were considerably worse by the morning of [**6-19**] and
he called EMS and was admitted to the outside hospital ([**Hospital1 **]) ED and ECG at the time showed a LBBB and inferior Q
waves and CXR showed pulmonary edema and cardiac enzymes were
mildly elevated with Trop 0.12, BNP 3490. Baseline labs at
[**Hospital3 **] showed BUN 41 Cr 1.4.
.
In the [**Hospital 97437**] Hospital ED, he was loaded with clopidogrel 600mg
and 4x81mg aspirin and integrilin infusion at 14ml/hour and a
nitroglycerin 50mcg/min infusion. On arrival at [**Hospital3 **] ED
he received furosemide 40mg IV and taken to cardiac
catheterization. Cardiac cath demonstrated diffuse 3-vessel
disease not amenable to PCI.
.
On review of systems, he denied any recent fever, chills, change
in weight, change to bowel or bladder habbits, arthalgia,
myaglia, dizziness, numbness or weakness. Cardiac review of
systems is notable for absence of typical chest pain, although
he was dyspneic at rest, had no paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, palpitations, syncope or presyncope. He
noted bilateral claudication at 200yrds with no rest pain. Of
note he had dark/black stools for three days and settled two
days ago. He has chronic problems with increased urinary
frequency/urgency.


Past Medical History:
- History of Inferior MI [**89**] years ago
- Hypertension
- Hypercholesterolemia.
- Previous gastric/DU 10 years ago and had a GI bleed requiring
hospital admission.
- Mild Osteoarthritis
- GERD
- s/p left knee surgeries
- s/p hemorrhoidectomy

Social History:
Retired [**Doctor Last Name **] at Stop and Shop and limousine driver.
-Tobacco history: 5 cigars/day since teens
-ETOH: 0-2 units per week. Denies prev alcohol excess.
-Illicit drugs: denies
Normally walks unaided and has ET 1 mile on the flat.


Family History:
Mother had MI and pancreatic ca
Father - asthma
Sibs - No cardiac disease. 2 sisters otherwise well


Physical Exam:
Admission Exam
Gen: Well appearing main with some SOB.
HEENT: PERRL, EOMI. MMM. OP clear. Conjunctiva well pigmented.
Neck: Supple, without adenopathy. Some JVD and JVP elevated at
7-8cm above sternal angle.
Chest: Decreased breath sounds bilaterally to midzones and
crackles to midzones bilaterally worse on the left. Dullness at
bases.
Cor: HS SI+ soft SII + ESM with no radiation. RRR. No deviated
apex.
Abdomen: Obese Soft, non-tender.. +BS, no HSM. R groin cath site
no hematoma no bruit.
Extremity: Femorals 2+ b/l Popliteals 2+ on L 1+ on R, DP
present barely on teh left and absent on the right. PT absent
bilaterally. All foot pulses present on doppler with monophasic
waveforms. No peripheral edema. No clinical evidence of DVT.
Neuro: Alert and oriented. CN 2-12 intact. Motor strength intact
in all extremities. Sensation intact grossly.


Pertinent Results:
[**2175-6-19**] WBC-12.4* RBC-4.46* Hgb-12.0* Hct-36.6* Plt Ct-296
[**2175-6-19**] PT-12.7 PTT-23.6 INR(PT)-1.1
[**2175-6-19**] Glucose-140* UreaN-44* Creat-1.7* Na-142 K-4.5 Cl-107
HCO3-20*
[**2175-6-19**] ALT-8 AST-14 LD(LDH)-177 CK(CPK)-25* AlkPhos-126
TotBili-0.6
[**2175-6-19**] CK-MB-2 cTropnT-0.16*
[**2175-6-20**] CK-MB-4 cTropnT-0.17*
[**2175-6-20**] CK-MB-3 cTropnT-0.14*
[**2175-6-21**] CK-MB-2 cTropnT-0.13*
[**2175-6-19**] Albumin-4.0 Calcium-9.5 Phos-5.0* Mg-2.3 Cholest-209*
[**2175-6-19**] %HbA1c-5.9 eAG-123
[**2175-6-19**] Triglyc-167* HDL-30 CHOL/HD-7.0 LDLcalc-146*
[**2175-6-19**] Cardiac Cath:
1. Selective coronary angiography of this right dominant system
revealed two vessel coronary artery disease. The LMCA had mild
diffuse disease.
The LAD had serial 90% stenoses, including near the ostium. The
Lcx had
moderate diffuse disease. The RCA (engaged with AL1) was totally

occluded and filled distally via left to right collaterals.
2. Resting hemodyanmics revealed severely elevated filling
pressures
with RVEDP of 23 and LVEDP of 39 mmHg. There was severe
pulmonary
hypertension with PASP of 50/31 mmHg. There was preserved
cardiac index
of 2.7 L/min/m2. There was a 20mmHg gradient across the aortic
valve,
which was confirmed on LV pullback, consistent with aortic
stenosis.
[**2175-6-19**] Echocardiogram:
The left atrium is normal in size. 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. Overall left ventricular systolic function is severely
depressed (LVEF= 25-30 %) with global hypokinesis and regional
inferior, lateral and apical near akinesis. There is no
ventricular septal defect. with borderline normal free wall
function. The aortic root is mildly dilated at the sinus level.
The aortic valve leaflets are moderately thickened. There is
probably moderate to severe aortic valve stenosis (valve area
0.8-1.0cm2) (low output AS). Mild (1+) aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. There is
no mitral valve prolapse. Trivial mitral regurgitation is seen.
The tricuspid valve leaflets are mildly thickened. The pulmonary
artery systolic pressure could not be determined. There is no
pericardial effusion.
[**2175-6-20**] Carotid Ultrasound:
Right ICA stenosis 60-69%. Left ICA stenosis <40%.
[**2175-6-26**] Intraop Echocardiogram:
PREBYPASS
No atrial septal defect is seen by 2D or color Doppler. There is
mild symmetric left ventricular hypertrophy. The left
ventricular cavity is severely dilated. There is severe regional
left ventricular systolic dysfunction with thinning and akinesis
of the inferior, inferoseptal walls. There is hypokinesis of the
inferolateral wall.. Right ventricular chamber size and free
wall motion are normal. The aortic root is mildly dilated at the
sinus level. There are complex (mobile) atheroma in the
ascending aorta as demonstrated by an epiaortic scan. There are
complex (mobile) atheroma in the aortic arch. There are multiple
complex (>4mm) atheroma in the descending thoracic aorta. The
aortic valve leaflets are moderately thickened with decreased
mobility of the left and non coronary cusps.. There is severe
aortic valve stenosis (valve area 0.8- 0.9 cm2). Peak/mean
gradient is 25/15 mm Hg. Given the patients low CI of 1.5, this
may represent pseudo-aortic stenosis. Dobuatmine testing of this
hypothesis was not performed. Mild (1+) aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. Mild to
moderate ([**12-3**]+) mitral regurgitation is seen. Dr. [**Last Name (STitle) **].

POSTBYPASS
The patient is receiving dobutamine 5 ucg/kg/min
LV systolic function appears slightly improved in the setting of
inotropes. There is slight improvement of the anterior and
lateral walls. The AV gradient peak/mean gradient is now 35/20
and the [**Location (un) 109**] is 1.0-1.1 cm2. The MR is now trace/mild. RV
systolic function remains normal

            WBC   Hgb    Hct       Plt Ct
[**2175-7-3**] 12.2*  10.8*  32.9        317
[**2175-7-2**] 12.6*  11.8*  36.0        289
[**2175-7-1**] 11.8*  10.4*  31.7        229
[**2175-6-30**] 13.7*  10.1*  30.6        220

                      UreaN  Creat   Na   K   Cl   HCO3
[**2175-7-3**]             34*    1.7*   136  4.2 102
[**2175-7-2**]             35*    1.7*   142  3.7 106   24
[**2175-7-1**]             39*    1.8*   140  3.7 104   25
[**2175-6-30**]             39*    1.8*   141  3.7 104   26


Brief Hospital Course:
While in the CCU, patient had a pre surgical work up which
included echocardiogram and carotid ultrasound. Given that the
patient was stable on medical therapy, surgery was delayed for
Plavix washout. Echocardiogram was notable for moderate aortic
stenosis and severely depressed LV function (EF 25%-30%).
Carotid ultrasound showed moderate disease of the right internal
carotid artery. See result section for further details. Given
potential for valve replacement, patient underwent several teeth
extractions prior to surgery. On admission, creatinine was
elevated at 1.7. Renal function remained stable prior to
surgery.

On [**6-26**], Dr. [**Last Name (STitle) **] performed coronary artery bypass grafting
surgery. Given intraoperative findings, aortic valve replacement
was not performed. See operative note for further details.
Following the operation, he was brought to the CVICU for
invasive monitoring. Within 24 hours, he awoke neurologically
intact and was extubated. He maintained stable hemodynamics and
weaned from inotropic support. On postoperative day two, he
transferred to the SDU.  He experienced some confusion which
improved with the discontinuation of narcotics.  His chest tubes
and pacing wires were removed without complication.  Heart
failure regimen was resumed postoperatively except for the ACE
inhibitor given his chronic renal insuffiency. Single 7 beat run
of NSVT was noted but otherwise he remained in a normal sinus
rhythm with further atrial or ventricular arrhythmias. Over
several days, he continued to make clinical improvements with
diuresis and was eventually cleared for the [**Hospital **] Rehab in
[**Location (un) 686**] on post-operative day seven.

Of note, he had several days of diarrhea prior to discharge
which was D. difficile negative. Despite negative EIA for C.
diff toxin, he will empirically be treated with Flagyl for seven
days. With the negative EIA, antidiarrheals were given.

Medications on Admission:
Propranolol 80mg qd
Gemfibrozil 600mg [**Hospital1 **]
Hydroxyzine 50mg tid
Nitroglycerin patch 0.2mcg/hr applied daily
Multivitamin 1 tab qd


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
6. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

7. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO Q8H (every
8 hours) for 7 days: Please stop after one week.
8. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day: please
hold if K > 4.5 - dose may need to be titrated accordingly.
9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day:
Please titrate accordingly.
10. Outpatient Lab Work
Please monitor weekly CBC, lytes, BUN/Cr while at rehab and fax
results to cardiac surgery office @ [**Telephone/Fax (1) 5793**]


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 6560**] Care & Rehab Center  - [**Location (un) 86**]

Discharge Diagnosis:
Coronary Artery Disease, s/p CABG
Ischemic Cardiomyopathy
Postop Non Sustained Ventricular Tachycardia
Aortic Stenosis
Chronic Systolic Congestive Heart Failure
Non ST Elevation Myocardial Infarction
Hypertension
Dyslipidemia
Chronic Renal Insufficiency
Carotid Disease
Postop Diarrhea(C. difficile negative)


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage. 1+ Edema
bilaterally

PAGE 1 ?????? for VNA and Rehabs


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
Dr. [**Last Name (STitle) **] on [**2175-7-26**] 1PM, call office with any questions
[**Telephone/Fax (1) 170**]
PCP/Cardiologist, Dr. [**Last Name (STitle) **] - call office for appt



Completed by:[**2175-7-3**]
{'Subendocardial infarction, initial episode of care,Acute on chronic combined systolic and diastolic heart failure,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Aortic valve disorders,Diarrhea,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Esophageal reflux,Other chronic pulmonary heart diseases,Retained dental root,Unspecified disorder of kidney and ureter,Peripheral vascular 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: Shortness of breath and chest discomfort

PRESENT ILLNESS: Mr. [**Known lastname 86418**] is a 78 year-old man with a history of inferior MI,
hypertension, hypercholesterolemia and claudication who was
admitted to the CCU following emergent cardiac catheterization
after presenting with acute onset shortness of breath and chest
discomfort. He is a vague historian although does feel that he
has been more fatigued in general over the last 2-3 weeks with
shortness of breath noticed when it was hot and humid. He
noticed he has felt more short of breath since the evening prior
to admission ([**6-18**]) and first noticed this when he was tryng to
go to sleep. He was restless and felt that his breathing was
labored at rest. He also notes epigastric/lower chest discomfort
which was continuous since the evening of [**6-18**] and was a dull
pain which had no particular radiation and was assocated with
some chest heaviness. He denied significant nausea, no vomiting
although he was diaphoretic.
.
His symptoms were considerably worse by the morning of [**6-19**] and
he called EMS and was admitted to the outside hospital ([**Hospital1 **]) ED and ECG at the time showed a LBBB and inferior Q
waves and CXR showed pulmonary edema and cardiac enzymes were
mildly elevated with Trop 0.12, BNP 3490. Baseline labs at
[**Hospital3 **] showed BUN 41 Cr 1.4.
.
In the [**Hospital 97437**] Hospital ED, he was loaded with clopidogrel 600mg
and 4x81mg aspirin and integrilin infusion at 14ml/hour and a
nitroglycerin 50mcg/min infusion. On arrival at [**Hospital3 **] ED
he received furosemide 40mg IV and taken to cardiac
catheterization. Cardiac cath demonstrated diffuse 3-vessel
disease not amenable to PCI.
.
On review of systems, he denied any recent fever, chills, change
in weight, change to bowel or bladder habbits, arthalgia,
myaglia, dizziness, numbness or weakness. Cardiac review of
systems is notable for absence of typical chest pain, although
he was dyspneic at rest, had no paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, palpitations, syncope or presyncope. He
noted bilateral claudication at 200yrds with no rest pain. Of
note he had dark/black stools for three days and settled two
days ago. He has chronic problems with increased urinary
frequency/urgency.

MEDICAL HISTORY: - History of Inferior MI [**89**] years ago
- Hypertension
- Hypercholesterolemia.
- Previous gastric/DU 10 years ago and had a GI bleed requiring
hospital admission.
- Mild Osteoarthritis
- GERD
- s/p left knee surgeries
- s/p hemorrhoidectomy

MEDICATION ON ADMISSION: Propranolol 80mg qd
Gemfibrozil 600mg [**Hospital1 **]
Hydroxyzine 50mg tid
Nitroglycerin patch 0.2mcg/hr applied daily
Multivitamin 1 tab qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Exam
Gen: Well appearing main with some SOB.
HEENT: PERRL, EOMI. MMM. OP clear. Conjunctiva well pigmented.
Neck: Supple, without adenopathy. Some JVD and JVP elevated at
7-8cm above sternal angle.
Chest: Decreased breath sounds bilaterally to midzones and
crackles to midzones bilaterally worse on the left. Dullness at
bases.
Cor: HS SI+ soft SII + ESM with no radiation. RRR. No deviated
apex.
Abdomen: Obese Soft, non-tender.. +BS, no HSM. R groin cath site
no hematoma no bruit.
Extremity: Femorals 2+ b/l Popliteals 2+ on L 1+ on R, DP
present barely on teh left and absent on the right. PT absent
bilaterally. All foot pulses present on doppler with monophasic
waveforms. No peripheral edema. No clinical evidence of DVT.
Neuro: Alert and oriented. CN 2-12 intact. Motor strength intact
in all extremities. Sensation intact grossly.

FAMILY HISTORY: Mother had MI and pancreatic ca
Father - asthma
Sibs - No cardiac disease. 2 sisters otherwise well

SOCIAL HISTORY: Retired [**Doctor Last Name **] at Stop and Shop and limousine driver.
-Tobacco history: 5 cigars/day since teens
-ETOH: 0-2 units per week. Denies prev alcohol excess.
-Illicit drugs: denies
Normally walks unaided and has ET 1 mile on the flat. 

### Response:
{'Subendocardial infarction, initial episode of care,Acute on chronic combined systolic and diastolic heart failure,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Aortic valve disorders,Diarrhea,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Esophageal reflux,Other chronic pulmonary heart diseases,Retained dental root,Unspecified disorder of kidney and ureter,Peripheral vascular disease, unspecified'}
