CHIEF COMPLAINT: Transfer from OSH for acute MI.

PRESENT ILLNESS: 71 year-old Portuguese speaking man with history of HTN, DM who
noted indigestion/GI upset [**3-15**] with acute onset of dyspnea. EMS
as called and the patient was found to be saturating 70% on RA.
On arrival at [**Hospital3 **], VS BP 180/110, HR 92, sat to 89% on
6L then 97% on 100% NRB. Labs significant for CK 484, MB 31.9,
Index 6.6, trop 4.34, glucose 328, creatinine 2.1, WBC 22 (77%
PMN). He received lasix 40 mg IV x1 (700cc of urine in foley on
arrival) and combivent neb x1. He then received SLNGx1, aspirin,
plavix, heparin gtt, nitro gtt. ECG concerning for down-sloping
ST depressions (V4-V6); I and aVL; II, III, and aVF with ST
elevations in V1, V2, Q wave in III, TWI in V5, V6, II, III, aVF
(no old for comparison); axis and intervals WNL. He was
transferred to [**Hospital1 18**] for concern for STEMI.
.
On arrival he denied fevers, chills, cough, dyspnea, chest pain
or pressure, abdominal pain, nausea, vomiting. His family notes
that he complained of chills a few days prior, but otherwise has
been in his usual state of health. No known angina or dyspnea on
exertion.

MEDICAL HISTORY: 1. Hypertension
2. Type II diabetes
3. Legally blind
4. History of burn requiring skin grafts

MEDICATION ON ADMISSION: Ratenolol/chlorthal 100/25 mg po qd
Fluoxetine 20 mg po qhs
Avandia 4 mg po qd
Clonazepam 1 mg po qam
Metformin 1000 mg po bid
Simvastatin 40 mg po qd
Enalapril 20 mg po qd
Prednisolone Acetate 1 % drops
Brimonidine 0.15 % drops
.
Medications on transfer:
heparin gtt
plavix 300mg
aspirin 162mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 96.5 BP 153/102 HR 90 RR 27 SpO2 92% on 0.60% NRB
Gen: Pale, anxious appearing man breathing rapidly
HEENT: PERRLA, OP clear
Neck: No LAD, JVP to jaw
Resp: Diffusely rhonchorus with poor air movement and expiratory
wheezes, no distinct rales
CV: RRR, S1 S2 present but muffled, no distinct
murmurs/rubs/gallops
Abdomen: Obese, distended, NT, +BS, no masses
Extremities: No cyanosis, clubbing, edema, hyperpigmented skin
with decreased hair growth, 2+ DP/PT bilaterally, 2+ femoral
bilaterally, no femoral bruits
Skin: Scar tissue bilateral lower extremities

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Lives with wife at home. Ex smoker, quit 20 years ago, 1 PPD x
aprox 30 years, occ. etoh, denies illicit drug use.
Acute myocardial infarction of inferolateral wall, initial episode of care,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other chronic pulmonary heart diseases,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Dysthymic disorder
AMI inferolateral, init,CHF NOS,Pneumonia, organism NOS,Acute kidney failure NOS,Chronic kidney dis NOS,Crnry athrscl natve vssl,Hy kid NOS w cr kid I-IV,Chr pulmon heart dis NEC,DMII renl nt st uncntrld,Dysthymic disorder
Admission Date:  [**2110-3-16**]              Discharge Date:   [**2110-3-25**]

Date of Birth:  [**2038-4-22**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 425**]
Chief Complaint:
Transfer from OSH for acute MI.

Major Surgical or Invasive Procedure:
Cardiac catherization.
Bare metal stent placement.


History of Present Illness:
71 year-old Portuguese speaking man with history of HTN, DM who
noted indigestion/GI upset [**3-15**] with acute onset of dyspnea. EMS
as called and the patient was found to be saturating 70% on RA.
On arrival at [**Hospital3 **], VS BP 180/110, HR 92, sat to 89% on
6L then 97% on 100% NRB. Labs significant for CK 484, MB 31.9,
Index 6.6, trop 4.34, glucose 328, creatinine 2.1, WBC 22 (77%
PMN). He received lasix 40 mg IV x1 (700cc of urine in foley on
arrival) and combivent neb x1. He then received SLNGx1, aspirin,
plavix, heparin gtt, nitro gtt. ECG concerning for down-sloping
ST depressions (V4-V6); I and aVL; II, III, and aVF with ST
elevations in V1, V2, Q wave in III, TWI in V5, V6, II, III, aVF
(no old for comparison); axis and intervals WNL. He was
transferred to [**Hospital1 18**] for concern for STEMI.
.
On arrival he denied fevers, chills, cough, dyspnea, chest pain
or pressure, abdominal pain, nausea, vomiting. His family notes
that he complained of chills a few days prior, but otherwise has
been in his usual state of health. No known angina or dyspnea on
exertion.

Past Medical History:
1. Hypertension
2. Type II diabetes
3. Legally blind
4. History of burn requiring skin grafts

Social History:
Lives with wife at home. Ex smoker, quit 20 years ago, 1 PPD x
aprox 30 years, occ. etoh, denies illicit drug use.

Family History:
Unknown

Physical Exam:
VS: T 96.5 BP 153/102 HR 90 RR 27 SpO2 92% on 0.60% NRB
Gen: Pale, anxious appearing man breathing rapidly
HEENT: PERRLA, OP clear
Neck: No LAD, JVP to jaw
Resp: Diffusely rhonchorus with poor air movement and expiratory
wheezes, no distinct rales
CV: RRR, S1 S2 present but muffled, no distinct
murmurs/rubs/gallops
Abdomen: Obese, distended, NT, +BS, no masses
Extremities: No cyanosis, clubbing, edema, hyperpigmented skin
with decreased hair growth, 2+ DP/PT bilaterally, 2+ femoral
bilaterally, no femoral bruits
Skin: Scar tissue bilateral lower extremities


Pertinent Results:
[**2110-3-16**] 04:31AM   PT-14.9* PTT-93.9* INR(PT)-1.3*
[**2110-3-16**] 04:31AM   PLT SMR-NORMAL PLT COUNT-368
[**2110-3-16**] 04:31AM   NEUTS-83.2* LYMPHS-9.3* MONOS-7.5 EOS-0
BASOS-0
[**2110-3-16**] 04:31AM   WBC-23.3* RBC-4.34* HGB-12.6* HCT-37.8*
MCV-87 MCH-29.1 MCHC-33.3 RDW-13.4
[**2110-3-16**] 04:31AM   CALCIUM-9.4 PHOSPHATE-4.5 MAGNESIUM-2.0
[**2110-3-16**] 04:31AM   CK-MB-28* MB INDX-5.8
[**2110-3-16**] 04:31AM   cTropnT-0.93*
[**2110-3-16**] 04:31AM   ALT(SGPT)-47* AST(SGOT)-87* LD(LDH)-335*
CK(CPK)-485* ALK PHOS-74 TOT BILI-0.4
[**2110-3-16**] 04:31AM   GLUCOSE-311* UREA N-46* CREAT-2.0*
SODIUM-129* POTASSIUM-4.0 CHLORIDE-90* TOTAL CO2-21* ANION
GAP-22*
[**2110-3-16**] 04:45AM   LACTATE-5.2*
[**2110-3-16**] 04:53AM   %HbA1c-7.6* [Hgb]-DONE [A1c]-DONE
[**2110-3-16**] 09:31AM   LACTATE-3.0*
[**2110-3-16**] 09:31AM   TYPE-ART PO2-79* PCO2-40 PH-7.43 TOTAL CO2-27
BASE XS-1
[**2110-3-16**] 11:14AM   PLT COUNT-280
[**2110-3-16**] 01:00PM   PLT COUNT-269
[**2110-3-16**] 01:00PM   CK-MB-43* MB INDX-4.8 cTropnT-4.02*
[**2110-3-16**] 01:00PM   CK(CPK)-900*
[**2110-3-16**] 01:00PM   POTASSIUM-3.9
[**2110-3-16**] 05:55PM   WBC-15.4* RBC-3.29* HGB-9.6* HCT-27.7*#
MCV-84 MCH-29.3 MCHC-34.7 RDW-13.1
[**2110-3-16**] 05:55PM   PLT COUNT-255
[**2110-3-16**] 05:55PM   CALCIUM-8.6 PHOSPHATE-4.3 MAGNESIUM-1.8
[**2110-3-16**] 05:55PM   CK-MB-35* MB INDX-4.1 cTropnT-4.61*
[**2110-3-16**] 05:55PM   CK(CPK)-854*
[**2110-3-16**] 06:47PM URINE  RBC-6* WBC-4 BACTERIA-FEW YEAST-NONE
EPI-[**3-24**]
[**2110-3-16**] 06:47PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-30
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-SM
[**2110-3-16**] 06:47PM URINE  COLOR-Yellow APPEAR-Cloudy SP [**Last Name (un) 155**]-1.022
[**2110-3-16**] 08:17PM   CK-MB-24* MB INDX-3.5 cTropnT-4.56*
[**2110-3-16**] 08:17PM   CK(CPK)-692*
.
ECG Study Date of [**2110-3-16**]  4:28:02 AM
Sinus rhythm. Left ventricular hypertrophy with repolarization
abnormality.
Probable left atrial abnormality. Extensive ST-T wave
abnormalities may be due
to left ventricular hypertrophy, but may also be due to
ischemia. Clinical
correlation is suggested. No previous tracing available for
comparison.
.
C.CATH Study Date of [**2110-3-16**]
1.  Selective coronary angiography of this right dominant system
shows
severe 2 vessel coronary artery disease.  The LMCA is without
angiographically apparent disease.  The pLAD has a long 70%
stenosis.
The LCx system is without obstructive coronary artery disease.
The mRCA
has a discrete 95% stenosis.
2.  Resting hemodynamic study shows severely elevated left sided
filling
pressure with a PCWP of 29mmHg and pulmonary arterial
hypertension with
PAP of 54/28mmHg.  The cardiac output was maintianed on dopamine
drip
with a cardiac index of 2.5.
3.  Left ventriculography was not obtained as the LV filling
pressure
was quite high and the patient has chronic renal insufficiency.

FINAL DIAGNOSIS:
1. Two vessel coronary artery disease.
2. Severely elevated left sided filling pressure
3. Severe pulmonary hypertension
.
CT ABDOMEN W/O CONTRAST  [**2110-3-16**]:

1. No evidence of retroperitoneal hematoma.
2. Moderate bilateral pleural effusions with associated
atelectasis.
3. Coronary artery calcifications.
4. Bilateral renal cysts. 1.5-cm relatively hyperattenuating
rounded lesion in the mid pole of the left kidney likely
represents a hyperdense cyst; however, this could be confirmed
with ultrasound.
5. Small hypodensity seen at the liver dome, possibly
representing a cyst versus partial voluming artifact. This could
also be confirmed with ultrasound.
6. Coronary artery calcifications.
7. Vascular calcifications and calcification of the vas
deferens, suggesting a history of diabetes.
8. Enlargement of the prostate.
.
ECHO Study Date of [**2110-3-17**]
Left Ventricle - Ejection Fraction: 20% to 25% (nl >=55%)
Conclusions:
The left atrium is mildly dilated. Left ventricular wall
thicknesses and
cavity size are normal. A left ventricular mass/thrombus cannot
be excluded.  Overall left ventricular systolic function is
severely depressed with global hypokinesis and near akinesis of
the distal LV and apex. There is no ventricular septal defect.
Right ventricular chamber size and free wall motion are normal.
The aortic root is mildly dilated at the sinus level. The aortic
valve leaflets (3) are mildly thickened but aortic stenosis is
not present. No aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened.  Mild to moderate ([**1-21**]+) mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened. There is mild pulmonary artery systolic hypertension.
There is a trivial/physiologic pericardial effusion.
.
COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2110-3-24**] 07:35AM    13.4* 4.53* 12.9* 38.6* 85 28.5 33.5 13.0
420
BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Smr Plt Ct
INR(PT)
[**2110-3-25**] 11:28AM    25.5* 30.3     2.6*

Brief Hospital Course:
71 year old Portugese speaking man with hypertension, diabetes
mellitus admitted with STEMI. He was taken to cardiac cath
shortly after arrival and found to have diffuse LAD disease and
a tight right coronary lesion which was stented. He was very
clear that he did not want CABG.  His hospital course was
complicated by acute pulmonary edema and respiratory distress.
.
1. Cardiac:
a. Coronary artery disease: Cardiac cath showed LAD 70%
long-diffuse stenosis and RCA 95% mid-distal. Patient status
post bare metal stent to RCA. The patient was started on
aspirin, plavix, and high-dose statin. Metoprolol and enalapril
were initially held for hypotension but restarted one week prior
to discharge. The patient was started on a long-acting nitrate
for prevention of angina. The patient should have a resting MIBI
study as an outpatient to assess for reversible ischemia in the
LAD territory which was not re-perfused.  The patient and his
family are adamantly against CABG and revascularization would
only be performed if amenable to stenting.  The patient will
follow-up with Dr. [**Last Name (STitle) **] from cardiology.
.
b. Pump: EF 20% to 25%. The patient was given lasix for fluid
overload with good diuresis. The patient was restarted on
metoprolol and enalapril when blood pressure resolved. The
patient was started on coumadin for wall akinesis.  The patient
should have a repeat echocardiogram in three months to evaluate
for need for ICD placement.  The patient will follow-up with his
primary care doctor regarding his INR and coumadin dosing.
.
c. Rhythm: The patient remained in normal sinus rhythm. The
patient was restarted on metoprolol as above.
.
2. Shortness of breath: Secondary to pulmonary edema and then
pneumonia.  The patient was intubated initially but weaned off
the ventilator.  He was extubated without difficulty.  The
patient was given lasix with good diuresis.  He completed a
7-day course of levofloxacin for pneumonia after he developed
low-grade fever and leukocytosis. The patient was given
supplemental oxygen as needed.
.
3. Diabetes mellitus: The patient's metformin and avandia were
initially held for renal failure and cardiac cath.  The
patient's renal failure did not improve to a level that
metformin could be restarted.  The patient's hemoglobin A1C < 8,
almost goal.  The patient's enalapril was restarted prior to
discharge.  The patient's avandia was restarted prior to
discharge.  The patient will follow-up at [**Last Name (un) **] for further
diabetes care.
.
4. Renal failure: The patient's baseline creatinine was unknown;
no labs available from the patient's primary care physician.
[**Name10 (NameIs) **] patient's likely has underlying chronic kidney disease
secondary to hypertension and diabetes.  During admission, the
patient had acute renal failure likely secondary to
contrast-induced nephropathy with FeUrea 240%.  Creatinine
improved to 1.8 prior to discharge.
.
5. Hyperlipidemia: Lipid profile at goal with LDL < 100.  The
patient was continued on atorvastatin 80 po QD.
.
6. Psychiatric: Patient has history of depression and anxiety.
The patient's fluoxetine and klonapin were initially held but
restarted prior to discharge.
.
7. Legally blind: The patient was continued on his outpatient
regimen of eye drops.
.
8. Code: Full, but family reports patient would not want to be
kept alive by artificial means if no hope for recovery.
.
9. Disposition: Home with PT

Medications on Admission:
Ratenolol/chlorthal 100/25 mg po qd
Fluoxetine 20 mg po qhs
Avandia 4 mg po qd
Clonazepam 1 mg po qam
Metformin 1000 mg po bid
Simvastatin 40 mg po qd
Enalapril 20 mg po qd
Prednisolone Acetate 1 % drops
Brimonidine 0.15 % drops
.
Medications on transfer:
heparin gtt
plavix 300mg
aspirin 162mg


Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
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. Prednisolone Acetate 1 % Drops, Suspension Sig: One (1) Drop
Ophthalmic [**Hospital1 **] (2 times a day).
5. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic Q8H
(every 8 hours).
6. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
7. Clonazepam 1 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for anxiety.
8. Enalapril Maleate 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
9. Metoprolol Tartrate 50 mg Tablet Sig: 2.5 Tablets PO BID (2
times a day).
Disp:*150 Tablet(s)* Refills:*2*
10. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
11. Warfarin 1 mg Tablet Sig: Five (5) Tablet PO once a day.
Disp:*150 Tablet(s)* Refills:*2*
12. Imdur 30 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
13. Outpatient Lab Work
Basic metabolic panel, INR.
Thursday, [**3-27**].
14. Avandia 4 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home With Service

Facility:
Multicultural VNA

Discharge Diagnosis:
Primary:
1. STEMI s/p bare metal stent to RCA
2. Congestive heart failure
3. Pneumonia
.
Secondary:
1. Hypertension
2. Type II diabetes
3. Legally blind
4. History of burn requiring skin grafts


Discharge Condition:
Afebrile, vital signs stable.


Discharge Instructions:
You were hospitalized with a heart attack and fluid in your
lungs from heart failure. You should take all your medications
as directed. You should restrict your salt intake to 2 grams per
day. You should restrict your fluid intake to 1 liter per day.
You should weigh yourself every day and call your doctor if your
weight is increased by more than two pounds. You should follow
the activity guidelines provided to you and work with physical
therapy.
.
Please contact a physician if you experience fevers, chills,
chest pain, shortness of breath, or any other concerning
symptoms.
.
Please take your medications as prescribed.
Your heart medications were changed as follows:
- Stop taking Tenoretic (atenolol/hydrochlorothiazide).
- Stop taking Simvastatin.
- Take Aspirin 325 mg once daily.
- Take Plavix 75 mg once daily.
- Take Metoprolol 125 mg twice daily.
- Continue Enalopril 20 mg once daily.
- Take Lipitor 80 mg once daily.
- Take Imdur 30 mg once daily.
- Take Lasix 40 mg twice daily. You will need blood levels of
electrolytes checked at your primary care appointment.
- Take Coumadin 5 mg once daily. You will need blood levels
checked in two days and usually once to twice a week per your
primary care doctor.
- You will follow-up with Dr. [**Last Name (STitle) **] regarding your heart care.
.
Your diabetes medications were changed as following:
- Stop taking Metformin.
- Continue taking Avandia 4 mg once daily.
- You will follow-up with Dr. [**First Name (STitle) 1557**] at the [**Last Name (un) **] Institute
regarding your diabetes care.
.
No change were made to your eye drops or psychiatric
medications.
.
Please keep your follow-up appointments as below.

Followup Instructions:
Follow-up with in primary care doctor, Dr. [**Last Name (STitle) 11791**]: Thursday,
[**3-27**] at 1:30pm. Please call [**Telephone/Fax (1) 72506**] with any questions
or concerns. You will have blood work checked at this time for
levels of your blood thinner, coumadin.
.
Follow-up with your new diabetes doctor: [**4-1**] at 8:30am at
the [**Last Name (un) **] Institute with Dr. [**First Name (STitle) 1557**]. Please call [**Telephone/Fax (1) 2378**]
with any questions or concerns.
.
Follow-up with your new heart doctor: Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 2386**] Date/Time:[**2110-4-21**] 8:00. [**Hospital Ward Name 23**]
building, [**Location (un) 436**].
{'Acute myocardial infarction of inferolateral wall, initial episode of care,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other chronic pulmonary heart diseases,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Dysthymic disorder'}


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: Transfer from OSH for acute MI.

PRESENT ILLNESS: 71 year-old Portuguese speaking man with history of HTN, DM who
noted indigestion/GI upset [**3-15**] with acute onset of dyspnea. EMS
as called and the patient was found to be saturating 70% on RA.
On arrival at [**Hospital3 **], VS BP 180/110, HR 92, sat to 89% on
6L then 97% on 100% NRB. Labs significant for CK 484, MB 31.9,
Index 6.6, trop 4.34, glucose 328, creatinine 2.1, WBC 22 (77%
PMN). He received lasix 40 mg IV x1 (700cc of urine in foley on
arrival) and combivent neb x1. He then received SLNGx1, aspirin,
plavix, heparin gtt, nitro gtt. ECG concerning for down-sloping
ST depressions (V4-V6); I and aVL; II, III, and aVF with ST
elevations in V1, V2, Q wave in III, TWI in V5, V6, II, III, aVF
(no old for comparison); axis and intervals WNL. He was
transferred to [**Hospital1 18**] for concern for STEMI.
.
On arrival he denied fevers, chills, cough, dyspnea, chest pain
or pressure, abdominal pain, nausea, vomiting. His family notes
that he complained of chills a few days prior, but otherwise has
been in his usual state of health. No known angina or dyspnea on
exertion.

MEDICAL HISTORY: 1. Hypertension
2. Type II diabetes
3. Legally blind
4. History of burn requiring skin grafts

MEDICATION ON ADMISSION: Ratenolol/chlorthal 100/25 mg po qd
Fluoxetine 20 mg po qhs
Avandia 4 mg po qd
Clonazepam 1 mg po qam
Metformin 1000 mg po bid
Simvastatin 40 mg po qd
Enalapril 20 mg po qd
Prednisolone Acetate 1 % drops
Brimonidine 0.15 % drops
.
Medications on transfer:
heparin gtt
plavix 300mg
aspirin 162mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 96.5 BP 153/102 HR 90 RR 27 SpO2 92% on 0.60% NRB
Gen: Pale, anxious appearing man breathing rapidly
HEENT: PERRLA, OP clear
Neck: No LAD, JVP to jaw
Resp: Diffusely rhonchorus with poor air movement and expiratory
wheezes, no distinct rales
CV: RRR, S1 S2 present but muffled, no distinct
murmurs/rubs/gallops
Abdomen: Obese, distended, NT, +BS, no masses
Extremities: No cyanosis, clubbing, edema, hyperpigmented skin
with decreased hair growth, 2+ DP/PT bilaterally, 2+ femoral
bilaterally, no femoral bruits
Skin: Scar tissue bilateral lower extremities

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Lives with wife at home. Ex smoker, quit 20 years ago, 1 PPD x
aprox 30 years, occ. etoh, denies illicit drug use. 

### Response:
{'Acute myocardial infarction of inferolateral wall, initial episode of care,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other chronic pulmonary heart diseases,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Dysthymic disorder'}
