CHIEF COMPLAINT: chest pain during elective coronary angiography

PRESENT ILLNESS: 51 year old man with h/o CAD s/p PCI with DESX2 to RCA in [**2148**]
admitted d/t chest pain episode during elective coronary cath
likely [**2-6**] to jailing of septal perforator.
.
Patient has h/o of NSTEMI in [**2148**] s/p mid/distal RCA stenting at
the time with 2 overlapping CYPHER stents,  also found to have
40% LAD + 60% D1 lesions + 40% lesion in the origin of OM1.
.
Over past 2-3 months reports episodes 30-90 minutes long
continous pain and discomfort in right proximal arm and
posterior neck sometimes accompanied by anterior chest "ponding
sensation". Had upto one episode per week always at rest and
unrelated to exertion. He also describes a continous mild
inter-scapular pain  for the past 1-2 months. He denies SOB,
nausea or other associated symptoms. He works as an electrical
contractor, he says he climbs up upto 20 flights of stairs daily
without becoming symptomatic. His STEMI in [**2148**] had presented at
the time with anterior, lower jaw and left arm pain.  Of note at
home patient is on aspirin, statin and metoprolol, no nitrates.
.
The patient was recently seen by Dr. [**Last Name (STitle) 59323**] and had a
stress test which demonstrated inferior, posterolateral and
anterolateral ischemia with an EF of 71%.  He has been enrolled
in the CORE 320 CT trial and referred today for coronary
catheterization.
.
Cath lab noted that patient vagaled during obtaining access, he
was given atropine and fluid (for HR of 30s and SBP of 60s) with
resolution.  Case was continued, RCA 60% distal, mid Lcx 70%,
mid LAD 80%. DES in LAD.  Patient developed 8/10 chest pain, he
was found to have a small jailed septal which was crossed with
wire with partial restoration of flow. Patient was placed on
nitro gtt for cp control and transferred to CCU for overnight
monitoring.
.
On ICU admission he is on NG [**Last Name (un) **] and HD stable with SBPs in the
low 100's high 90's. Reports pain [**1-14**] and significant malaise
and nausea which improved with IV morphine + zophran +
metoclopramide.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: + Dyslipidemia
2. CARDIAC HISTORY:
- CABG: none
- PERCUTANEOUS CORONARY INTERVENTIONS:  CAD s/p 3.0 x 18mm and
3.5 x 33mm overlapping Cypher stents to RCA [**2148**]
- PACING/ICD: none
3. OTHER PAST MEDICAL HISTORY:
NSTEMI
Tonsillectomy
Adenoidectomy
Hyperlipidemia
Carotid artery disease: 60% [**Country **] per ultrasound (pt to have
further eval of this in near future)
.
.

MEDICATION ON ADMISSION: CITALOPRAM -  (Prescribed by Other Provider) - 10 mg Tablet - 1
Tablet(s) by mouth daily
METOPROLOL TARTRATE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 Tablet(s) by mouth twice a day
PANTOPRAZOLE -  (Prescribed by Other Provider) - 40 mg Tablet,
Delayed Release (E.C.) - 1 Tablet(s) by mouth daily
ROSUVASTATIN [CRESTOR] -  (Prescribed by Other Provider) - 40 mg
Tablet - 1 Tablet(s) by mouth daily
.
Medications - OTC
ASPIRIN -  (Prescribed by Other Provider) - 81 mg Tablet,
Chewable - 1 Tablet(s) by mouth daily
B COMPLEX VITAMINS [VITAMIN B COMPLEX] -  (Prescribed by Other
Provider) - Dosage uncertain
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] -  (Prescribed by Other
Provider) - Dosage uncertain
OMEGA-3 FATTY ACIDS [FISH OIL] -  (Prescribed by Other Provider)
- Dosage uncertain
.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAMINATION on ICU admission:

FAMILY HISTORY: FAMILY HISTORY:
- Father: IHD with PCI and stenting in the 70's
- Mother: HTN
- Brother: HTN
- Brother: HLD
- Brother: Obesity
.

SOCIAL HISTORY: Electricity conntractor
- Tobacco history: none
- ETOH:  2 beers once weekly
- Illicit drugs:  none
.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Examination of participant in clinical trial,Old myocardial infarction,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension
Crnry athrscl natve vssl,Intermed coronary synd,Exam-clincal trial,Old myocardial infarct,Hyperlipidemia NEC/NOS,Status-post ptca,Hypertension NOS
Admission Date:  [**2154-5-17**]              Discharge Date:   [**2154-5-19**]

Date of Birth:  [**2098-8-2**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2736**]
Chief Complaint:
chest pain during elective coronary angiography

Major Surgical or Invasive Procedure:
Cardiac Catheterization


History of Present Illness:
51 year old man with h/o CAD s/p PCI with DESX2 to RCA in [**2148**]
admitted d/t chest pain episode during elective coronary cath
likely [**2-6**] to jailing of septal perforator.
.
Patient has h/o of NSTEMI in [**2148**] s/p mid/distal RCA stenting at
the time with 2 overlapping CYPHER stents,  also found to have
40% LAD + 60% D1 lesions + 40% lesion in the origin of OM1.
.
Over past 2-3 months reports episodes 30-90 minutes long
continous pain and discomfort in right proximal arm and
posterior neck sometimes accompanied by anterior chest "ponding
sensation". Had upto one episode per week always at rest and
unrelated to exertion. He also describes a continous mild
inter-scapular pain  for the past 1-2 months. He denies SOB,
nausea or other associated symptoms. He works as an electrical
contractor, he says he climbs up upto 20 flights of stairs daily
without becoming symptomatic. His STEMI in [**2148**] had presented at
the time with anterior, lower jaw and left arm pain.  Of note at
home patient is on aspirin, statin and metoprolol, no nitrates.
.
The patient was recently seen by Dr. [**Last Name (STitle) 59323**] and had a
stress test which demonstrated inferior, posterolateral and
anterolateral ischemia with an EF of 71%.  He has been enrolled
in the CORE 320 CT trial and referred today for coronary
catheterization.
.
Cath lab noted that patient vagaled during obtaining access, he
was given atropine and fluid (for HR of 30s and SBP of 60s) with
resolution.  Case was continued, RCA 60% distal, mid Lcx 70%,
mid LAD 80%. DES in LAD.  Patient developed 8/10 chest pain, he
was found to have a small jailed septal which was crossed with
wire with partial restoration of flow. Patient was placed on
nitro gtt for cp control and transferred to CCU for overnight
monitoring.
.
On ICU admission he is on NG [**Last Name (un) **] and HD stable with SBPs in the
low 100's high 90's. Reports pain [**1-14**] and significant malaise
and nausea which improved with IV morphine + zophran +
metoclopramide.


Past Medical History:
1. CARDIAC RISK FACTORS: + Dyslipidemia
2. CARDIAC HISTORY:
- CABG: none
- PERCUTANEOUS CORONARY INTERVENTIONS:  CAD s/p 3.0 x 18mm and
3.5 x 33mm overlapping Cypher stents to RCA [**2148**]
- PACING/ICD: none
3. OTHER PAST MEDICAL HISTORY:
NSTEMI
Tonsillectomy
Adenoidectomy
Hyperlipidemia
Carotid artery disease: 60% [**Country **] per ultrasound (pt to have
further eval of this in near future)
.
.

Social History:
Electricity conntractor
- Tobacco history: none
- ETOH:  2 beers once weekly
- Illicit drugs:  none
.

Family History:
FAMILY HISTORY:
- Father: IHD with PCI and stenting in the 70's
- Mother: HTN
- Brother: HTN
- Brother: HLD
- Brother: Obesity
.

Physical Exam:
PHYSICAL EXAMINATION on ICU admission:

T: 96.6 ??????
HR: 66  bpm
BP: 102/64(71)mmHg
RR: 21
SpO2: 97%

GENERAL: NAD. Oriented x3 but somnulent post IV morphine.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with no JVD
CARDIAC: RRR, normal S1, S2. No m/r/g. No thrills, lifts. No S3
or S4.
LUNGS: minimal scattered expiratory wheezing.  no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. No abdominial bruits.

EXTREMITIES: No c/c/e. groins w/o swelling hematoma or femoral
bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ DP doplerable PT doplerable
Left: Carotid 2+ Femoral 2+  DP doplerable PT doplerable
.


Pertinent Results:
admission labs:
.
.
[**2154-5-17**] 07:15PM BLOOD WBC-13.6*# RBC-4.40* Hgb-13.8* Hct-38.9*
MCV-88 MCH-31.4 MCHC-35.5* RDW-12.8 Plt Ct-278
[**2154-5-17**] 07:15PM BLOOD PT-14.8* PTT-147.0* INR(PT)-1.3*
[**2154-5-17**] 07:15PM BLOOD Glucose-151* UreaN-17 Creat-0.9 Na-137
K-3.7 Cl-101 HCO3-26 AnGap-14
[**2154-5-18**] 06:21AM BLOOD ALT-30 AST-51* LD(LDH)-189 CK(CPK)-388*
AlkPhos-56 TotBili-1.4
[**2154-5-17**] 07:15PM BLOOD Calcium-8.8 Phos-1.9*# Mg-2.0
[**2154-5-17**] 11:57PM BLOOD %HbA1c-5.6 eAG-114
[**2154-5-17**] 11:57PM BLOOD Triglyc-119 HDL-47 CHOL/HD-3.5 LDLcalc-92
[**2154-5-17**] 07:19PM BLOOD Type-[**Last Name (un) **] pO2-67* pCO2-45 pH-7.38
calTCO2-28
.
cardiac enzymes:
[**2154-5-17**] 07:15PM BLOOD CK-MB-3                cTropnT-<0.01
[**2154-5-17**] 11:57PM BLOOD CK-MB-13* MB Indx-7.0* cTropnT-0.06*
[**2154-5-18**] 06:21AM BLOOD CK-MB-32* MB Indx-8.2* cTropnT-0.20*
[**2154-5-18**] 02:09PM BLOOD CK-MB-43* MB Indx-7.5* cTropnT-0.83*
[**2154-5-18**] 08:24PM BLOOD CK-MB-30* MB Indx-5.4 cTropnT-0.84*
[**2154-5-19**] 06:22AM BLOOD CK-MB-14* MB Indx-3.9 cTropnT-0.64*
.
Discharge labs:
[**2154-5-19**] 06:22AM BLOOD WBC-10.5 RBC-4.11* Hgb-13.0* Hct-36.7*
MCV-89 MCH-31.6 MCHC-35.5* RDW-12.9 Plt Ct-207
[**2154-5-19**] 06:22AM BLOOD PT-13.0 PTT-27.1 INR(PT)-1.1
[**2154-5-19**] 06:22AM BLOOD Glucose-100 UreaN-13 Creat-0.8 Na-142
K-3.7 Cl-108 HCO3-26 AnGap-12
[**2154-5-19**] 06:22AM BLOOD Calcium-7.9* Phos-2.3*# Mg-2.1
.
- ECG on CCU admission:  sinus 75, normal axis, small Q + NTW in
III, biphasic T wave in AVF, good RWP across precordial leads,
no significant change from tracing during cath. Compared to [**2148**]
tracing no significant changes except that Q wave in III is now
less pronounced, .
.
- ECHO [**2154-5-18**]: The left atrium and right atrium are normal in
cavity size. Left ventricular wall thickness, cavity size and
regional/global systolic function are normal (LVEF >55%). Right
ventricular chamber size and free wall motion are normal. The
diameters of aorta at the sinus, ascending and arch levels are
normal. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. Trace aortic regurgitation is
seen. The mitral valve leaflets are structurally normal. Mild
(1+) mitral regurgitation is seen. There is mild pulmonary
artery systolic hypertension. There is no pericardial effusion.

IMPRESSION: Normal global and regional biventricular systolic
function. Mild mitral regurgitation. Mild pulmonary
hypertension.

Brief Hospital Course:
51 year old man with h/o CAD s/p PCI with DESX2 to RCA in [**2148**]
admitted [**5-17**] d/t chest pain episode during elective coronary
cath [**2-6**] to jailing of septal perforator during the procedure.
.
# CAD: h/o CAD s/p PCI with DESX2 to RCA in [**2148**] admitted for
elective cath d/t recent symptoms of right arm, posterior neck
pain and interscapular pain at rest and a nuclear scan positive
for inferior, posterolateral and anterolateral ischemia. In cath
lab vagal episode during access which resolved with atropine and
fluids. Diagnosis RCA 60% distal, mid Lcx 70%, mid LAD 80%.
Intervention: DES to LAD.  Patient developed 8/10 chest pain
during procedure likely [**2-6**] small jailed septal which was
crossed with wire with partial restoration of flow. Patient did
not have significant ECG changes but on follow-up produced
enzymes to Tn peak .84, MB peak 43 and CK peak 571. Patient was
initially treated with nitro gtt and admitted to the CCU for
further managment. He had recieved his daily aspirin 325mg the
morning of the procedure and was plavix loaded 600mg prior to
procedure. On admission to CCU pain was [**1-14**] and resolved
completely with IV morphine. NG was weaned off overnight. He was
sunsequently HD stable with no further complaints. Home
metoprolol 25mg [**Hospital1 **] was continued as was his home Aspirin 325mg
daily and crestor 40 mg pO daily; Clopidogrel 75mg daily was
started and should be continued for 1 year Lisinopril 5mg PO was
also started.
.
# Pump:  No known Hx of CHF. No symptoms suggestive of CHF per
history.  TTE with Normal global and regional biventricular
systolic function. Mild mitral regurgitation. Mild pulmonary
hypertension. (LVEF >55%).
.
# RHYTHM:  Sinus. No events on telemetry.
.
# Interscapular pain: this has been stable and ongoing over past
months and is was unchanged during this admission. He did not
have wide mediastinum on CXR or significant difference in BP
between his arms. Patient's recent complaints of right arm,
posterior neck and interscapular pain at rest are likely not
anginotic and may be of musculoskeletal or spinal/nueral origin.
These complaints may be further worked up in the outpatient
setting.
.
# HLD:  HDL 47, LDL 92. Continued on his home rosuvastatin 40mg
daily. [**Month (only) 116**] require second [**Doctor Last Name 360**] as is maxed on crestor given
goal of LDL <= 70. will coninue outpatient f/u
.
# DVT PROPHYLAXIS:  recieved sq heparin during this admission.
.
# CODE STATUS: was full during this admission
.
.
Out patient issues:
- cardiology f/u with Dr [**Last Name (STitle) 59323**].
- work-up of interscapular, right arm and neck pain as above.
- f/u of lipid profile and management as appropriate to LDL goal
<= 70.



Medications on Admission:

CITALOPRAM -  (Prescribed by Other Provider) - 10 mg Tablet - 1
Tablet(s) by mouth daily
METOPROLOL TARTRATE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 Tablet(s) by mouth twice a day
PANTOPRAZOLE -  (Prescribed by Other Provider) - 40 mg Tablet,
Delayed Release (E.C.) - 1 Tablet(s) by mouth daily
ROSUVASTATIN [CRESTOR] -  (Prescribed by Other Provider) - 40 mg
Tablet - 1 Tablet(s) by mouth daily
.
Medications - OTC
ASPIRIN -  (Prescribed by Other Provider) - 81 mg Tablet,
Chewable - 1 Tablet(s) by mouth daily
B COMPLEX VITAMINS [VITAMIN B COMPLEX] -  (Prescribed by Other
Provider) - Dosage uncertain
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] -  (Prescribed by Other
Provider) - Dosage uncertain
OMEGA-3 FATTY ACIDS [FISH OIL] -  (Prescribed by Other Provider)
- Dosage uncertain
.

Discharge Medications:
1. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1)
Sublingual Q5MIN () as needed for chest pain: [**Month (only) 116**] repeat every 5
minutes X 2.  If no response, call 911.
Disp:*30 tablets* Refills:*0*
2. citalopram 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. rosuvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Zantac 150 mg Tablet Sig: One (1) Tablet PO once a day.
5. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*0*
6. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
8. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. omega-3 fatty acids     Capsule Sig: One (1) Capsule PO BID
(2 times a day).
10. ergocalciferol (vitamin D2)  Oral
11. B complex vitamins  Oral


Discharge Disposition:
Home

Discharge Diagnosis:
Coronary Artery Disease, sp NSEMI and RCA stent in [**2148**]
Carotid Artery Disease
Hyperlipidemia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Mr [**Known lastname 60590**] it was a pleasure taking care of you.
.
You were admitted to the hospital for a cardiac catheterization
to evaluate your righ arm discomfort.  You were found to have a
blockage in the left anterior descending artery and a stent was
placed. Unfortunately during stent placement on of your
accessory arteries was blocked. Post-procedure you were
monitored closely and remained hemodynamically stable. You were
started on medications to help remodel your heart after the
event as well as medications, Aspirin (at an increased dose) and
Plavix, that are integral to maintain stent patency.
.
You were started on a new medication, plavix.  You will need to
take this medication .  . Stopping this medication early could
result in a heart attack.
.
CHANGES TO YOUR MEDICATIONS:
To maintain stent patency:
1. Plavix 75mg tablets. Take one tablet daily for at least the
next 12 months
2. Aspirin 325mg tablets. Take one tablet daily.
** Again do not stop these medications unless instructed to do
so by Dr. [**Last Name (STitle) 59323**].
To treat blood pressure as well as aid heart remodeling:
1. Start taking Lisinopril 5mg tablets. Take one daily.
2. Transition from metoprolol 25mg twice daily to metoprolol
50mg XL daily.
.
Again it was a pleasure taking care of you. Please feel free to
contact with any questions or concerns.


Followup Instructions:
Dr [**Last Name (STitle) 60591**] office will call you to arrange an appointment



Completed by:[**2154-5-20**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Examination of participant in clinical trial,Old myocardial infarction,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension'}


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: chest pain during elective coronary angiography

PRESENT ILLNESS: 51 year old man with h/o CAD s/p PCI with DESX2 to RCA in [**2148**]
admitted d/t chest pain episode during elective coronary cath
likely [**2-6**] to jailing of septal perforator.
.
Patient has h/o of NSTEMI in [**2148**] s/p mid/distal RCA stenting at
the time with 2 overlapping CYPHER stents,  also found to have
40% LAD + 60% D1 lesions + 40% lesion in the origin of OM1.
.
Over past 2-3 months reports episodes 30-90 minutes long
continous pain and discomfort in right proximal arm and
posterior neck sometimes accompanied by anterior chest "ponding
sensation". Had upto one episode per week always at rest and
unrelated to exertion. He also describes a continous mild
inter-scapular pain  for the past 1-2 months. He denies SOB,
nausea or other associated symptoms. He works as an electrical
contractor, he says he climbs up upto 20 flights of stairs daily
without becoming symptomatic. His STEMI in [**2148**] had presented at
the time with anterior, lower jaw and left arm pain.  Of note at
home patient is on aspirin, statin and metoprolol, no nitrates.
.
The patient was recently seen by Dr. [**Last Name (STitle) 59323**] and had a
stress test which demonstrated inferior, posterolateral and
anterolateral ischemia with an EF of 71%.  He has been enrolled
in the CORE 320 CT trial and referred today for coronary
catheterization.
.
Cath lab noted that patient vagaled during obtaining access, he
was given atropine and fluid (for HR of 30s and SBP of 60s) with
resolution.  Case was continued, RCA 60% distal, mid Lcx 70%,
mid LAD 80%. DES in LAD.  Patient developed 8/10 chest pain, he
was found to have a small jailed septal which was crossed with
wire with partial restoration of flow. Patient was placed on
nitro gtt for cp control and transferred to CCU for overnight
monitoring.
.
On ICU admission he is on NG [**Last Name (un) **] and HD stable with SBPs in the
low 100's high 90's. Reports pain [**1-14**] and significant malaise
and nausea which improved with IV morphine + zophran +
metoclopramide.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: + Dyslipidemia
2. CARDIAC HISTORY:
- CABG: none
- PERCUTANEOUS CORONARY INTERVENTIONS:  CAD s/p 3.0 x 18mm and
3.5 x 33mm overlapping Cypher stents to RCA [**2148**]
- PACING/ICD: none
3. OTHER PAST MEDICAL HISTORY:
NSTEMI
Tonsillectomy
Adenoidectomy
Hyperlipidemia
Carotid artery disease: 60% [**Country **] per ultrasound (pt to have
further eval of this in near future)
.
.

MEDICATION ON ADMISSION: CITALOPRAM -  (Prescribed by Other Provider) - 10 mg Tablet - 1
Tablet(s) by mouth daily
METOPROLOL TARTRATE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 Tablet(s) by mouth twice a day
PANTOPRAZOLE -  (Prescribed by Other Provider) - 40 mg Tablet,
Delayed Release (E.C.) - 1 Tablet(s) by mouth daily
ROSUVASTATIN [CRESTOR] -  (Prescribed by Other Provider) - 40 mg
Tablet - 1 Tablet(s) by mouth daily
.
Medications - OTC
ASPIRIN -  (Prescribed by Other Provider) - 81 mg Tablet,
Chewable - 1 Tablet(s) by mouth daily
B COMPLEX VITAMINS [VITAMIN B COMPLEX] -  (Prescribed by Other
Provider) - Dosage uncertain
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] -  (Prescribed by Other
Provider) - Dosage uncertain
OMEGA-3 FATTY ACIDS [FISH OIL] -  (Prescribed by Other Provider)
- Dosage uncertain
.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAMINATION on ICU admission:

FAMILY HISTORY: FAMILY HISTORY:
- Father: IHD with PCI and stenting in the 70's
- Mother: HTN
- Brother: HTN
- Brother: HLD
- Brother: Obesity
.

SOCIAL HISTORY: Electricity conntractor
- Tobacco history: none
- ETOH:  2 beers once weekly
- Illicit drugs:  none
. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Examination of participant in clinical trial,Old myocardial infarction,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension'}
