CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: Ms [**Known lastname 5448**] is an 89yo pt with h/o CAD s/p RCA stent in [**2124**],
a-fib on warfarin and dofetilide, who presented to OSH on
[**2132-12-7**] with CHF exacerbation. BNP was 326 (1-100). CT ruled
out PE but showed extensive metastatic disease to pleura.
Initial tropI was negative but the 2nd tropI was positive at
1.43 at 7AM and 1.79 at 12:30PM. EKG showed e/o possible prior
septal infarct, no acute ST changes. Cardiology saw her and felt
that, given her age and comorbidity (breast cancer w/mets), she
is not suitable for further intervention and recommended medical
management. Pt was started on nitro patch. However, her primary
cardiologist (Dr. [**Last Name (STitle) **] felt otherwise and was willing to cath
her, so she was transferred to [**Hospital1 18**] for catheterization. Per
report, she had an episode of chest pain that responded to nitro
this afternoon. Also, after speaking with medical team at OSH,
the discussion was had about her code status and decision was
made DNR.
.
At home, pt reports passing out 5 days ago. She was getting into
bed, felt SOB, lost consciousness for a couple of minutes. She
reports hitting her head on the left side of her forehead on a
thick rug. Her sons were with her. Episode of SOB while watching
TV as well as +Substernal pressure, rating [**7-13**], no radiation.
No assoc lightheaded, diaphrosis, SOB, n/v, palpitations. No
orthopnea, pedal edema, wt gain. +PND 5 days ago.  She denies
headaches, dyarthia, vision changes, numbness/tingling, focal
muscle weakness, gait disturbance.
.
On arrival to [**Hospital Ward Name 121**] 5, patient denied any chest pain. However,
she had frequent runs of polymorphic VT, 5-30 seconds each.
Patient was transferred to CCU emergently, given Mg infusion,
started on isoproterenol gtt, which broke the torsades.
Throughout this episode, her BP was stable with SBP in the 110s,
and she remained asymptomatic except for some brief nausea.
.
On review of systems, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery. Pt denies fever, chills, cough, hemoptysis,
abdominal pain, diarrhea, constipation, BRBPR, melena, myalgias,
joint pains. All of the other review of systems were negative.

MEDICAL HISTORY: -Breast Cancer with mets to pleura: On hormonal therapy for
breast ca, no chemo or xrt.
-CAD s/p PCI and stent placed 3 years ago
-CHF
-HTN
-HL
-PAF
-s/p hysterectomy
-s/p knee replacement

MEDICATION ON ADMISSION: Pt does not remember, pharmacy: Rite Aide ([**Location (un) 5450**], NH) -
[**Telephone/Fax (1) 5451**]
.
Warfarin 2mg PO daily
Dofetilide 500 mg [**Hospital1 **]
Metoprolol tartrate 50 mg daily (checked w pharmacist)
Lipitor 10 mg daily
Diovan 160 mg daily
Lasix 40 mg daily
Aromasin 25 mg daily
Percocet 1 pill a day  PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T98.2, 134/79, 89, 18, 95% on 5L
GENERAL: elderly female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink. MMM.
NECK: Supple without LAD, JVP of 9 cm.
CARDIAC: Irregularly irregular. Normal S1, S2. No m/r/g. No
thrills, lifts. No S3 or S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Bibasilar crackles
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

FAMILY HISTORY: Father with MI at 58 yo.

SOCIAL HISTORY: Pt lives with her son. She quit smoking 40 years ago, 1ppd x 2
years. Glass of wine once in awhile.
Subendocardial infarction, initial episode of care,Acute on chronic systolic heart failure,Paroxysmal ventricular tachycardia,Secondary malignant neoplasm of pleura,Cardiac rhythm regulators causing adverse effects in therapeutic use,Unspecified essential hypertension,Malignant neoplasm of breast (female), unspecified,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia
Subendo infarct, initial,Ac on chr syst hrt fail,Parox ventric tachycard,Second malig neo pleura,Adv eff card rhyth regul,Hypertension NOS,Malign neopl breast NOS,Long-term use anticoagul,Hyperlipidemia NEC/NOS
Admission Date:  [**2132-12-8**]              Discharge Date:   [**2132-12-14**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2387**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
cardiac catheterization

History of Present Illness:
Ms [**Known lastname 5448**] is an 89yo pt with h/o CAD s/p RCA stent in [**2124**],
a-fib on warfarin and dofetilide, who presented to OSH on
[**2132-12-7**] with CHF exacerbation. BNP was 326 (1-100). CT ruled
out PE but showed extensive metastatic disease to pleura.
Initial tropI was negative but the 2nd tropI was positive at
1.43 at 7AM and 1.79 at 12:30PM. EKG showed e/o possible prior
septal infarct, no acute ST changes. Cardiology saw her and felt
that, given her age and comorbidity (breast cancer w/mets), she
is not suitable for further intervention and recommended medical
management. Pt was started on nitro patch. However, her primary
cardiologist (Dr. [**Last Name (STitle) **] felt otherwise and was willing to cath
her, so she was transferred to [**Hospital1 18**] for catheterization. Per
report, she had an episode of chest pain that responded to nitro
this afternoon. Also, after speaking with medical team at OSH,
the discussion was had about her code status and decision was
made DNR.
.
At home, pt reports passing out 5 days ago. She was getting into
bed, felt SOB, lost consciousness for a couple of minutes. She
reports hitting her head on the left side of her forehead on a
thick rug. Her sons were with her. Episode of SOB while watching
TV as well as +Substernal pressure, rating [**7-13**], no radiation.
No assoc lightheaded, diaphrosis, SOB, n/v, palpitations. No
orthopnea, pedal edema, wt gain. +PND 5 days ago.  She denies
headaches, dyarthia, vision changes, numbness/tingling, focal
muscle weakness, gait disturbance.
.
On arrival to [**Hospital Ward Name 121**] 5, patient denied any chest pain. However,
she had frequent runs of polymorphic VT, 5-30 seconds each.
Patient was transferred to CCU emergently, given Mg infusion,
started on isoproterenol gtt, which broke the torsades.
Throughout this episode, her BP was stable with SBP in the 110s,
and she remained asymptomatic except for some brief nausea.
.
On review of systems, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery. Pt denies fever, chills, cough, hemoptysis,
abdominal pain, diarrhea, constipation, BRBPR, melena, myalgias,
joint pains. All of the other review of systems were negative.


Past Medical History:
-Breast Cancer with mets to pleura: On hormonal therapy for
breast ca, no chemo or xrt.
-CAD s/p PCI and stent placed 3 years ago
-CHF
-HTN
-HL
-PAF
-s/p hysterectomy
-s/p knee replacement


Social History:
Pt lives with her son. She quit smoking 40 years ago, 1ppd x 2
years. Glass of wine once in awhile.

Family History:
Father with MI at 58 yo.

Physical Exam:
VS: T98.2, 134/79, 89, 18, 95% on 5L
GENERAL: elderly female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink. MMM.
NECK: Supple without LAD, JVP of 9 cm.
CARDIAC: Irregularly irregular. Normal S1, S2. No m/r/g. No
thrills, lifts. No S3 or S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Bibasilar crackles
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+


Pertinent Results:
LABS ON ADMISSION ([**2132-12-8**]):
.
HEMATOLOGY:
[**2132-12-9**] 12:44AM BLOOD WBC-10.0# RBC-3.59* Hgb-10.5* Hct-29.7*
MCV-83 MCH-29.1 MCHC-35.2* RDW-14.0 Plt Ct-322
.
[**2132-12-9**] 12:44AM BLOOD PT-14.7* PTT-22.5 INR(PT)-1.3*
.
CHEMISTRY:
[**2132-12-9**] 12:44AM BLOOD Glucose-145* UreaN-32* Creat-1.1 Na-139
K-3.8 Cl-102 HCO3-26 AnGap-15
[**2132-12-9**] 12:44AM BLOOD Calcium-9.1 Phos-3.9 Mg-1.9
.
[**2132-12-10**] 05:32AM BLOOD ALT-17 AST-37 LD(LDH)-407* CK(CPK)-185*
AlkPhos-62 TotBili-1.0
.
[**2132-12-9**] 12:44AM BLOOD CK-MB-7 cTropnT-0.21* CK-147
[**2132-12-9**] 09:48AM BLOOD CK-MB-8 cTropnT-0.22* CK-156
[**2132-12-9**] 09:54PM BLOOD CK(CPK)-167*
[**2132-12-10**] 05:32AM BLOOD CK(CPK)-185*
.
[**2132-12-9**] 09:48AM BLOOD Triglyc-128 HDL-68 CHOL/HD-2.5 LDLcalc-73
[**2132-12-10**] 05:32AM BLOOD TSH-0.32
.
LABS ON DISCHARGE:
.
HEMATOLOGY:
[**2132-12-14**] 07:40AM BLOOD WBC-5.6 RBC-3.53* Hgb-10.0* Hct-29.8*
MCV-85 MCH-28.3 MCHC-33.6 RDW-13.4 Plt Ct-328
[**2132-12-14**] 07:40AM BLOOD PT-24.7* PTT-70.8* INR(PT)-2.4*
.
CHEMISTRY:
[**2132-12-14**] 07:40AM BLOOD Glucose-96 UreaN-25* Creat-0.8 Na-140
K-4.1 Cl-103 HCO3-27 AnGap-14
[**2132-12-14**] 07:40AM BLOOD Calcium-9.1 Phos-3.4 Mg-2.0
.
MICROBIOLOGY:
C.diff negative
.
RADIOLOGY:
CXR ([**2132-12-9**]):
IMPRESSION:
1. Right upper lobe 3.6 x 4.6 cm opacity and right suprahilar
3.5 x 3.8 cm
opacity that still could represent pneumonia, however are
concerning for
possible malignancy.
2. Right pleural effusion.
3. Mild congestive heart failure.
.
.
CARDIOLOGY:
.
Cardiac Cath ([**2132-12-9**])
BMS placed to R-PDA
.
TTE ([**2132-12-10**]):
The left atrium is elongated. The interatrial septum is
aneurysmal. 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. No masses or thrombi
are seen in the left ventricle. Overall left ventricular
systolic function is mildly depressed (LVEF= 40-45 %) with mid
to distal septal and inferior/infero-lateral hypokinesis. There
is no ventricular septal defect. Right ventricular chamber size
and free wall motion are normal. The ascending aorta is mildly
dilated. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. Mild (1+) aortic regurgitation
is seen. The mitral valve leaflets are mildly thickened. Mild
(1+) mitral regurgitation is seen. The tricuspid valve leaflets
are mildly thickened. There is moderate pulmonary artery
systolic hypertension. There is a trivial/physiologic
pericardial effusion.
.

Brief Hospital Course:
In summary, Ms [**Known lastname 5448**] is an 89yo w CAD and a-fib (formerly on
warfarin and dofetilide), who presented originally to OSH w SOB,
was transferred to [**Hospital1 18**] for cath for NSTEMI, course complicated
by polymorphic VT.
.
# CORONARIES: Pt w known CAD and prior stenting, now p/w NSTEMI
at OSH, s/p cath at [**Hospital1 18**] with bare metal stent to R-PDA. Pt
denies CP/SOB. On heparin drip for NSTEMI at first, then on
heparin to coumadin bridge for a-fb. TTE shows reduced EF. On
discharge, hemodynamically stable, on aspirin, clopidogrel,
beta-blocker, valsartan and atorvastatin.
.
# RHYTHM: History of afib, on coumadin and on dofetilide at
home. Had frequent runs of polymorphic VT with no symptoms on
floor, broke with isoproterenol gtt. Likely induced by
dofetilide in setting of cardiac ischemia and reduced renal
clearance (Cr 1.1, unclear baseline).  Now off dofetilide and
isoproterenol, s/p run of afib with RVR after cath. Metoprolol
used as rate control. Though bradycardia might increase the risk
of ectopic ventricular arrhythmias, it is likely not the cause
of the VT on this admission (VT caused by ischemia/dofetilide).
For afib, pt rate-controlled w metoprolol and anticoagulated w
warfarin w INR goal of [**1-6**]. Therapeutic on discharge, regular
followup recommended. Pt monitored on tele, electrolytes
repleted as needed - K>4.0, Mg >2.0.
.
# PUMP: Likely new diagnosis of systolic CHF, though unclear
whether h/o chronic CHF, unknown EF. Pt does not appear
overloaded on exam. Echo with EF 40-45% with mid to distal
septal and inferior/lateral hypokinesis s/p cath. Beta blocker,
[**Last Name (un) **], furosemide 40mg po daily.
.
# Breast cancer: with mets to pleura. On hormonal therapy; no
chemo or xrt.  Per conversation with oncologist coverage, OK to
not restart aromatase inhibitor (side effect of cardiac
ischemia) as inpatient. Per Dr [**Last Name (STitle) **], restarted aromatase on
discharge. Followup w oncologist recommended.
.
# HTN: stable BP, valsartan held while inpatient, restarted on
discharge.
.
# CODE: FULL, confirmed with patient
.
# Contact: [**Name (NI) **] [**Name (NI) **] [**Telephone/Fax (1) 5449**]


Medications on Admission:
Pt does not remember, pharmacy: Rite Aide ([**Location (un) 5450**], NH) -
[**Telephone/Fax (1) 5451**]
.
Warfarin 2mg PO daily
Dofetilide 500 mg [**Hospital1 **]
Metoprolol tartrate 50 mg daily (checked w pharmacist)
Lipitor 10 mg daily
Diovan 160 mg daily
Lasix 40 mg daily
Aromasin 25 mg daily
Percocet 1 pill a day  PRN


Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): to keep your heart stent open.
Disp:*30 Tablet(s)* Refills:*0*
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): for your cholesterol.
Disp:*30 Tablet(s)* Refills:*2*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO once a day as needed for pain: do not take if sedated or if
driving.
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
for your heart failure.
Disp:*30 Tablet(s)* Refills:*2*
6. Valsartan 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
for your heart and blood pressure.
Disp:*30 Tablet(s)* Refills:*2*
7. Warfarin 2 mg Tablet Sig: One (1) Tablet PO once a day: dose
may change based on your INR, a blood test; follow Dr.[**Name (NI) 5452**]
instructions .
Disp:*75 Tablet(s)* Refills:*2*
8. Outpatient [**Name (NI) **] Work
PT, INR, check twice weekly (Monday, Thursday) after discharge
fax result to Dr. [**Last Name (STitle) **], fax number [**Telephone/Fax (1) 5453**].
9. Aromasin 25 mg Tablet Sig: One (1) Tablet PO once a day.
10. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: 1.5
Tablet Sustained Release 24 hrs PO once a day.
Disp:*45 Tablet Sustained Release 24 hr(s)* Refills:*2*


Discharge Disposition:
Home With Service

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

Discharge Diagnosis:
Non-ST elevation MI
Polymorphic Ventricular Tachycardia
.
Systolic heart failure, acute on chronic
hypertension
hyperlipidemia


Discharge Condition:
Hemodynamically stable, afebrile


Discharge Instructions:
You were admitted to [**Hospital1 18**] due to a heart failure exacerbation
and were found to have a heart attack. You had a cardiac
catheterization and a stent placed in one of your heart's blood
vessels.
.
You also had an irregular heart rhythm of your heart, called
polymorphic ventricular tachycardia. You were treated with
medication to correct this and your dofetilide was stopped.
.
Your coumadin levels were adjusted during your stay. You will
need to get [**Hospital1 **] work, and have the results sent to Dr. [**Last Name (STitle) **] to
adjust your coumadin level. Please have your blood work checked
twice a week (Monday and Thursday) until you see Dr. [**Last Name (STitle) **]. You
will be given a [**Last Name (STitle) **] order to take to your local [**Last Name (STitle) **] or have your
visiting nurse draw your labs. Please have results faxed to Dr [**Name (NI) 5454**] office @ [**Telephone/Fax (1) 5453**].
.
Your medicaions were changed, please take your medications as
instructed.
Diovan was decreased to 80mg daily
Toprol XL was changed to 75mg daily
Dofetilide was stopped
Norvasc was stopped
Lipitor was changed to 80mg
Warfarin (coumadin) is continued at 2mg daily
Clopidogrel (plavix) was started
Aspirin continued
.
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Fluid Restriction: do not drink more than 2liters of fluids per
day
.
Seek medical attention if you have chest pain, shortness of
breath, groin pain or bleeding, or any other concerning symptom.

Followup Instructions:
Dr [**Last Name (STitle) **] - Please call ([**Telephone/Fax (1) 5455**] and make an appointment for
in 2 weeks from discharge. He may adjust your coumadin levels
before that.
.
Please call Dr. [**Last Name (STitle) 5456**] (PCP) at [**Telephone/Fax (1) 5457**] to call and make an
appointment to discuss your stay.
.



Completed by:[**2132-12-14**]
{'Subendocardial infarction, initial episode of care,Acute on chronic systolic heart failure,Paroxysmal ventricular tachycardia,Secondary malignant neoplasm of pleura,Cardiac rhythm regulators causing adverse effects in therapeutic use,Unspecified essential hypertension,Malignant neoplasm of breast (female), unspecified,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia'}


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

PRESENT ILLNESS: Ms [**Known lastname 5448**] is an 89yo pt with h/o CAD s/p RCA stent in [**2124**],
a-fib on warfarin and dofetilide, who presented to OSH on
[**2132-12-7**] with CHF exacerbation. BNP was 326 (1-100). CT ruled
out PE but showed extensive metastatic disease to pleura.
Initial tropI was negative but the 2nd tropI was positive at
1.43 at 7AM and 1.79 at 12:30PM. EKG showed e/o possible prior
septal infarct, no acute ST changes. Cardiology saw her and felt
that, given her age and comorbidity (breast cancer w/mets), she
is not suitable for further intervention and recommended medical
management. Pt was started on nitro patch. However, her primary
cardiologist (Dr. [**Last Name (STitle) **] felt otherwise and was willing to cath
her, so she was transferred to [**Hospital1 18**] for catheterization. Per
report, she had an episode of chest pain that responded to nitro
this afternoon. Also, after speaking with medical team at OSH,
the discussion was had about her code status and decision was
made DNR.
.
At home, pt reports passing out 5 days ago. She was getting into
bed, felt SOB, lost consciousness for a couple of minutes. She
reports hitting her head on the left side of her forehead on a
thick rug. Her sons were with her. Episode of SOB while watching
TV as well as +Substernal pressure, rating [**7-13**], no radiation.
No assoc lightheaded, diaphrosis, SOB, n/v, palpitations. No
orthopnea, pedal edema, wt gain. +PND 5 days ago.  She denies
headaches, dyarthia, vision changes, numbness/tingling, focal
muscle weakness, gait disturbance.
.
On arrival to [**Hospital Ward Name 121**] 5, patient denied any chest pain. However,
she had frequent runs of polymorphic VT, 5-30 seconds each.
Patient was transferred to CCU emergently, given Mg infusion,
started on isoproterenol gtt, which broke the torsades.
Throughout this episode, her BP was stable with SBP in the 110s,
and she remained asymptomatic except for some brief nausea.
.
On review of systems, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery. Pt denies fever, chills, cough, hemoptysis,
abdominal pain, diarrhea, constipation, BRBPR, melena, myalgias,
joint pains. All of the other review of systems were negative.

MEDICAL HISTORY: -Breast Cancer with mets to pleura: On hormonal therapy for
breast ca, no chemo or xrt.
-CAD s/p PCI and stent placed 3 years ago
-CHF
-HTN
-HL
-PAF
-s/p hysterectomy
-s/p knee replacement

MEDICATION ON ADMISSION: Pt does not remember, pharmacy: Rite Aide ([**Location (un) 5450**], NH) -
[**Telephone/Fax (1) 5451**]
.
Warfarin 2mg PO daily
Dofetilide 500 mg [**Hospital1 **]
Metoprolol tartrate 50 mg daily (checked w pharmacist)
Lipitor 10 mg daily
Diovan 160 mg daily
Lasix 40 mg daily
Aromasin 25 mg daily
Percocet 1 pill a day  PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T98.2, 134/79, 89, 18, 95% on 5L
GENERAL: elderly female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink. MMM.
NECK: Supple without LAD, JVP of 9 cm.
CARDIAC: Irregularly irregular. Normal S1, S2. No m/r/g. No
thrills, lifts. No S3 or S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Bibasilar crackles
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

FAMILY HISTORY: Father with MI at 58 yo.

SOCIAL HISTORY: Pt lives with her son. She quit smoking 40 years ago, 1ppd x 2
years. Glass of wine once in awhile. 

### Response:
{'Subendocardial infarction, initial episode of care,Acute on chronic systolic heart failure,Paroxysmal ventricular tachycardia,Secondary malignant neoplasm of pleura,Cardiac rhythm regulators causing adverse effects in therapeutic use,Unspecified essential hypertension,Malignant neoplasm of breast (female), unspecified,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia'}
