CHIEF COMPLAINT: DOE/Edema

PRESENT ILLNESS: 65 year old with pmhx of CABGx4 in [**2154**] and severe biventricular
decompensated heart failure s/p AICD/PPM with known tricuspid
and mitral valve regurgitation followed by serial
echocardiogram. He was admitted earlier this month for CHF where
an echo showed 3+ MR and 3+ TR. Massive diuresis was initiated
and he was referred for surgical revascularization.

MEDICAL HISTORY: -CAD s/p MI [**2153**] s/p CABG [**2154**]
-h/o VT s/p ICD [**2164**]
-CHF w/ EF<20% by echo [**5-27**]
-DM on insulin
-HTN
-Hypercholesterol
-CRF w/ baseline Cr (1.5-1.8)
-Hypercalcemia
-Osteopenia
-Erectile Dysfunction
-Hypothyroid
-Obesity
-LFT abnormalities attributed to NASH, possibly amio

MEDICATION ON ADMISSION: Aspirin 81 qd, Fosamax, Ambien 10 qhs, Imdur 30 qd, Lipitor 20
qd, Folate, Coreg 50 [**Hospital1 **], Amiodarone 200 qd, Lisinopril 2.5 qd,
Levoxyl, Senispan 30 qod, Humalog, Humulin, Allopurinol,
Torsemide 100qd, Digoxin 0.125 qd, Zoloft 50 qd, Spirinolactone
25 qd

ALLERGIES: Penicillins / Heparin Agents

PHYSICAL EXAM: PE: Postop
97.8  130/66  61  95-98% ra
gen well appearing, non-diaphoretic, nad
cv distant heart sound
lungs crackles in bases bilaterally
abd active bs, soft ntnd, no organomegaly appreciated
ext bilateral lower ext pitting edema; right lower ext bandage
c/d/i; right upper extremity with edema > left

FAMILY HISTORY: Father d. MI at 60; DM in mother's side.

SOCIAL HISTORY: Lives with his wife and two adopted sons in [**Name (NI) 28318**], MA. Remote
hx THC. Rare EtOH; denies tobacco, IVDA. Retired attorney.
Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Urinary tract infection, site not specified,Paroxysmal ventricular tachycardia,Primary pulmonary hypertension,Anticoagulants causing adverse effects in therapeutic use,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Cardiac pacemaker in situ,Aortocoronary bypass status,Family history of ischemic heart disease,Family history of diabetes mellitus,Old myocardial infarction,Unspecified sleep apnea
Mitral valve disorder,Crnry athrscl natve vssl,CHF NOS,DMII renal uncntrld,Urin tract infection NOS,Parox ventric tachycard,Prim pulm hypertension,Adv eff anticoagulants,Nephritis NOS in oth dis,Hypertension NOS,Pure hypercholesterolem,Hypothyroidism NOS,Status cardiac pacemaker,Aortocoronary bypass,Fam hx-ischem heart dis,Fam hx-diabetes mellitus,Old myocardial infarct,Sleep apnea NOS
Admission Date:  [**2177-4-7**]              Discharge Date:   [**2177-4-26**]

Date of Birth:  [**2111-6-10**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Heparin Agents

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
DOE/Edema

Major Surgical or Invasive Procedure:
[**2177-4-8**] Redo coronary artery bypass graft x2 (Saphenous vein
graft > right coronary artery, Saphenous vein graft >
interposition to Saphenous vein graft> obtuse marginal graft)
Mitral Valve replacement (31mm [**Company 1543**] Mosaic Porcine valve)


History of Present Illness:
65 year old with pmhx of CABGx4 in [**2154**] and severe biventricular
decompensated heart failure s/p AICD/PPM with known tricuspid
and mitral valve regurgitation followed by serial
echocardiogram. He was admitted earlier this month for CHF where
an echo showed 3+ MR and 3+ TR. Massive diuresis was initiated
and he was referred for surgical revascularization.

Past Medical History:
-CAD s/p MI [**2153**] s/p CABG [**2154**]
-h/o VT s/p ICD [**2164**]
-CHF w/ EF<20% by echo [**5-27**]
-DM on insulin
-HTN
-Hypercholesterol
-CRF w/ baseline Cr (1.5-1.8)
-Hypercalcemia
-Osteopenia
-Erectile Dysfunction
-Hypothyroid
-Obesity
-LFT abnormalities attributed to NASH, possibly amio


Social History:
Lives with his wife and two adopted sons in [**Name (NI) 28318**], MA. Remote
hx THC. Rare EtOH; denies tobacco, IVDA. Retired attorney.


Family History:
Father d. MI at 60; DM in mother's side.


Physical Exam:
PE: Postop
97.8  130/66  61  95-98% ra
gen well appearing, non-diaphoretic, nad
cv distant heart sound
lungs crackles in bases bilaterally
abd active bs, soft ntnd, no organomegaly appreciated
ext bilateral lower ext pitting edema; right lower ext bandage
c/d/i; right upper extremity with edema > left


Pertinent Results:
[**2177-4-26**] 06:16AM BLOOD WBC-8.7 RBC-3.37* Hgb-10.0* Hct-31.3*
MCV-93 MCH-29.6 MCHC-31.9 RDW-17.1* Plt Ct-267
[**2177-4-7**] 05:24PM BLOOD WBC-10.8 RBC-4.74 Hgb-14.5 Hct-41.8
MCV-88 MCH-30.6 MCHC-34.7 RDW-17.1* Plt Ct-129*
[**2177-4-26**] 06:16AM BLOOD Plt Ct-267
[**2177-4-26**] 06:16AM BLOOD PT-31.5* PTT-37.9* INR(PT)-3.4*
[**2177-4-7**] 05:24PM BLOOD Plt Ct-129*
[**2177-4-7**] 05:24PM BLOOD PT-11.6 PTT-26.6 INR(PT)-1.0
[**2177-4-26**] 06:16AM BLOOD Glucose-120* UreaN-64* Creat-2.8* Na-142
K-4.0 Cl-97 HCO3-37* AnGap-12
[**2177-4-7**] 05:24PM BLOOD Glucose-224* UreaN-100* Creat-2.9* Na-136
K-4.7 Cl-97 HCO3-27 AnGap-17

CHEST (PA & LAT)  [**2177-4-24**] 11:33 AM

CHEST (PA & LAT)

Reason: evaluate pleural effusions

[**Hospital 93**] MEDICAL CONDITION:
65 year old man s/p MVR
REASON FOR THIS EXAMINATION:
evaluate pleural effusions
REASON FOR EXAMINATION: Follow up of patient after mitral valve
replacement.

PA and lateral upright chest radiograph compared to [**2177-4-19**].

The right internal jugular line tip terminates at the cavoatrial
junction. There is no pneumothorax or apical hematoma. The heart
size is markedly enlarged but stable. There is no change in the
mediastinal contours. The ICD-pacemaker terminating in the right
atrium and right ventricle are again noted .
Small amount of pleural effusion decreased compared to [**2177-4-18**].
The lungs are essentially clear.

IMPRESSION:

1) Cardiomegaly, no evidence of failure.

2) Decreased pleural effusion, small.

3) Standard position of right internal jugular line.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name4 (NamePattern1) 2618**] [**Last Name (NamePattern1) 2619**]
DR. [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) 1508**]Approved: FRI [**2177-4-25**] 1:25 PM

PATIENT/TEST INFORMATION:
Indication: Left ventricular function. Valvular heart disease.
Height: (in) 66
Weight (lb): 252
BSA (m2): 2.21 m2
BP (mm Hg): 113/60
HR (bpm): 64
Status: Inpatient
Date/Time: [**2177-4-18**] at 10:13
Test: TTE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2007W031-0:00
Test Location: West Echo Lab
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **]

MEASUREMENTS:
Left Atrium - Long Axis Dimension: *5.1 cm (nl <= 4.0 cm)
Left Atrium - Four Chamber Length: *5.8 cm (nl <= 5.2 cm)
Right Atrium - Four Chamber Length: *6.0 cm (nl <= 5.0 cm)
Left Ventricle - Septal Wall Thickness: 1.1 cm (nl 0.6 - 1.1 cm)

Left Ventricle - Inferolateral Thickness: 1.1 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: *7.6 cm (nl <= 5.6 cm)
Left Ventricle - Systolic Dimension: 7.2 cm
Left Ventricle - Fractional Shortening: *0.05 (nl >= 0.29)
Left Ventricle - Ejection Fraction: *<= 20% (nl >=55%)
Aorta - Valve Level: *4.0 cm (nl <= 3.6 cm)
Aorta - Arch: 2.8 cm (nl <= 3.0 cm)
Aortic Valve - Peak Velocity: 1.2 m/sec (nl <= 2.0 m/sec)
Mitral Valve - Mean Gradient: 5 mm Hg
Mitral Valve - Pressure Half Time: 81 ms
Mitral Valve - E Wave: 1.9 m/sec
Mitral Valve - A Wave: 1.4 m/sec
Mitral Valve - E/A Ratio: 1.36
Mitral Valve - E Wave Deceleration Time: 456 msec
TR Gradient (+ RA = PASP): *33 mm Hg (nl <= 25 mm Hg)

INTERPRETATION:

Findings:

This study was compared to the prior study of [**2177-2-22**].


LEFT ATRIUM: Moderate LA enlargement.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Moderately dilated RA. A
catheter or pacing
wire is seen in the RA and extending into the RV.

LEFT VENTRICLE: Normal LV wall thickness. Severely dilated LV
cavity. Severe
regional LV systolic dysfunction. No LV mass/thrombus. No
resting LVOT
gradient.

RIGHT VENTRICLE: Mildly dilated RV cavity. Borderline normal RV
systolic
function.

AORTA: Moderately dilated aortic sinus. Normal aortic arch
diameter.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. Mild (1+)
AR.

MITRAL VALVE: Bioprosthetic mitral valve prosthesis (MVR). MVR
well seated,
with normal leaflet/disc motion and transvalvular gradients. No
MR. [Due to
acoustic shadowing, the severity of MR may be significantly
UNDERestimated.]

TRICUSPID VALVE: Mildly thickened tricuspid valve leaflets.
Moderate to severe
[3+] TR. Mild PA systolic hypertension.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with
physiologic PR.

PERICARDIUM: No pericardial effusion.

Conclusions:
The left and right atria are moderately dilated. Left
ventricular wall
thicknesses are normal. The left ventricular cavity is severely
dilated. There
is severe regional left ventricular systolic dysfunction with
thinning and
akinesis of septum, anterior and lateral walls, and hypokinesis
of the
remaining segments. No masses or thrombi are seen in the left
ventricle. The
right ventricular cavity is mildly dilated, and right
ventricular systolic
function is borderline normal. The aortic root is moderately
dilated athe
sinus level. The aortic valve leaflets (3) appear structurally
normal with
good leaflet excursion. There is no aortic valve stenosis. Mild
(1+) aortic
regurgitation is seen. A bioprosthetic mitral valve prosthesis
is present,
with normal leaflet motion and transvalvular gradients. No
mitral
regurgitation is seen. [Due to acoustic shadowing, the severity
of mitral
regurgitation may be significantly UNDERestimated.] The
tricuspid valve
leaflets are mildly thickened. Moderate to severe [3+] tricuspid
regurgitation
is seen. There is mild pulmonary artery systolic hypertension.
There is no
pericardial effusion.

IMPRESSION: Dilated left ventricle with severe systolic
dysfunction.
Borderline-mild right ventricular systolic dysfunction.
Normally-functioning
mitral valve bioprosthesis. Moderate-to-severe tricuspid
regurgitation. Mild
pulmonary hypertension.

Compared with the prior study (images reviewed) of [**2177-2-22**],
regurgitant
native mitral valve is no longer present, replaced by a
bioprosthesis. The
other findings are similar.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 171**], MD on [**2177-4-18**] 11:37.
[**Location (un) **] PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].


   RADIOLOGY  Final Report

UNILAT UP EXT VEINS US LEFT  [**2177-4-13**] 12:04 PM

UNILAT UP EXT VEINS US LEFT

Reason: pt with swollen left hand. Pls eval for UE DVT.

[**Hospital 93**] MEDICAL CONDITION:
65 year old man with
REASON FOR THIS EXAMINATION:
pt with swollen left hand. Pls eval for UE DVT.
INDICATION: Fall on left hand, evaluate for upper extremity DVT.

No prior examinations.

LEFT UPPER EXTREMITY DEEP VENOUS ULTRASOUND: [**Doctor Last Name **]-scale and
Doppler examination of the left internal jugular vein,
subclavian, axillary, brachial, cephalic, and basilic veins was
performed. These demonstrate intraluminal thrombus with the left
cephalic vein with expansion of the vein suggestive of acute
clot. This thrombus extends to the confluence of the subclavian
vein, however, does not extend into the subclavian vein. The
remainder of the veins demonstrates normal compressibility,
augmentability, and respiratory variation and flow.

IMPRESSION: Left cephalic vein thrombus extending to the
confluence with the subclavian vein, presumably due to recent IV
line.

Findings were discussed with the ordering provider, [**First Name8 (NamePattern2) 915**] [**Last Name (NamePattern1) 916**]
at 1:10 p.m. on [**2177-4-13**].

The study and the report were reviewed by the staff radiologist.
DR. [**First Name (STitle) 18394**] [**Name (STitle) 18395**]
DR. [**First Name11 (Name Pattern1) 8711**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Approved: MON [**2177-4-14**] 9:34 AM

Pathology Examination

Name Birthdate    Age     Sex Pathology #     [**Hospital1 18**] [**Known lastname 106730**],[**Known firstname **]       [**2111-6-10**]    65 Male      [**Numeric Identifier 106731**]
[**Numeric Identifier 106732**]
Report to:   DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]
Gross Description by:   DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/cofc



SPECIMEN SUBMITTED: MITRAL VALVE LEAFLETS (1).

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2177-4-8**] [**2177-4-8**] [**2177-4-10**] DR. [**Last Name (STitle) **]. LOMO/mrr??????



DIAGNOSIS:



Mitral valve, valvuloplasty:

Valve leaflet with myxoid degeneration.

Clinical:

Mitral valve disorder/mitral valve replacement; TVR; possible
replacement via right thorax.
Gross:

The specimen is received in saline labeled with "[**Known firstname 5987**]
[**Known lastname **]," the medical record number, and "mitral valve leaflets".
It consists of a single piece of cardiac valve with attached
chordae, measuring 2.3 x 1.1 x 0.4 cm. No significant
calcifications are grossly noted. It is represented in A.




Brief Hospital Course:
Mr. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2177-4-7**] for surgical
management of his valvular heart and coronary artery disease. On
[**4-8**], Dr. [**Last Name (STitle) 1290**] performed a redo-sternotomy with
coronary artery bypass grafting and a mitral valve replacement
with a 31 mm [**Company 1543**] mosaic porcine valve. Postoperatively he
was taken to the cardiac surgical intensive care unit for
invasive monitoring. Within 24 hours, he awoke neurologically
intact and was extubated without incident. He maintained stable
hemodynamics as he gradually weaned from pressor support. Low
dose beta blockade was resumed. Due to persistent blood glucose
levels, the [**Last Name (un) **] service was consulted to assist in the postop
management of his type II diabetes mellitus. His CSRU course was
otherwise uneventful and he transferred to the CSRU on
postoperative day four.  He was noted to have swelling in his
left upper extremity. He was also thrombocytopenic at that time.
Postoperative platelet count dropped as low as 69K. Ultrasound
revealed a left cephalic vein thrombus extending to the
confluence with the subclavian vein. HIT assay returned positive
for HEPARIN PF4 antibodies. Argatroban anticoagulation was
subsequently started with slow transition to Warfarin. Further
evaluation included a lower extremity ultrasound which found no
evidence of deep vein thrombosis. Postop course was also
complicated by significant fluid overload and heart failure
which temporarily required intravenous Lasix drip. The
cardiology service was consulted to assist in the management on
his congestive heart failure and diuretic regimen. Diuretics
were titrated daily with gradual improvement in fluid status. He
was slowly transitioned to PO/oral diuretics. His renal function
remained relatively stable throughout his hospital stay. He also
experienced sternal drainage with a leukocytosis. He remained
afebrile. White count peaked to 17K, and he was empirically
treated with Vancomycin.  By discharge, his white count
normalized and his sternal drainage improved. He eventually
became therapeutic on Warfarin with appropriate Argatroban
overlap. Warfarin should be dosed for a goal INR between 2.0 -
3.0. Given thrombus in setting of positive HIT assay, he will
need Warfarin for at least six months. Plan for follow up with
coumadin dosing by [**Company 191**] anti coagulation clinic.


Medications on Admission:
Aspirin 81 qd, Fosamax, Ambien 10 qhs, Imdur 30 qd, Lipitor 20
qd, Folate, Coreg 50 [**Hospital1 **], Amiodarone 200 qd, Lisinopril 2.5 qd,
Levoxyl, Senispan 30 qod, Humalog, Humulin, Allopurinol,
Torsemide 100qd, Digoxin 0.125 qd, Zoloft 50 qd, Spirinolactone
25 qd

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Levothyroxine 100 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Cinacalcet 30 mg Tablet Sig: One (1) Tablet PO QOD ().
Disp:*30 Tablet(s)* Refills:*0*
9. 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:*0*
10. Alendronate 70 mg Tablet Sig: One (1) Tablet PO QTHUR (every
Thursday).
Disp:*30 Tablet(s)* Refills:*0*
11. Coreg 6.25 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
12. Coumadin 1 mg Tablet Sig: 1-2 Tablets PO once a day: hold
coumadin tonite. restart sun.
Disp:*60 Tablet(s)* Refills:*2*
13. Torsemide 100 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Company **]

Discharge Diagnosis:
Mitral Regurgitation s/p MVR
Coronary Artery Disease s/p CABG
Heparin Indued Thromboctyopenia c/b Upper Extremity Thrombosis
Postop Leukocytosis with Sternal Drainage
Ischemic Cardiomyopathy
Systolic Heart Failure
Chronic Renal Insufficiency
Ventricular tachycardia w/ AICD
Hyperparathyroid
Elevated cholesterol
Diabetes mellitus type 2
Obesity
Sleep Apnea
Hypothyroidism


Discharge Condition:
Good


Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs. Adhere
to 2 gm sodium diet with 100ml fluid Restriction. [**Month (only) 116**] shower, no
baths or swimming. Monitor wounds for infection - redness,
drainage, or increased pain. Report any fever greater than 101.
No creams, lotions, powders, or ointments to incisions. No
driving for approximately one month. No lifting more than 10
pounds for 10 weeks. Take Warfarin as directed. Goal INR 2.0 -
3.0. INR shouled be checked within 48-72 hours of discharge. Dr.
[**First Name4 (NamePattern1) 1169**] [**Last Name (NamePattern1) **] will manage Warfarin as an outpatient. Fax
[**Telephone/Fax (1) 106733**] Office [**Telephone/Fax (1) 250**]



Followup Instructions:
1)Dr [**Last Name (STitle) 1290**] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for
appointment
2)Dr [**Last Name (STitle) **] in [**12-24**] weeks ([**Telephone/Fax (1) 250**]) please call for
appointment
3)Dr [**First Name (STitle) 437**] in [**12-24**] week - please call for appointment
4)Dr [**Last Name (STitle) **] in [**1-26**] weeks - please call for appointment
5)Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3633**])
Coumadin dosing by [**Hospital 191**] [**Hospital3 **]



Completed by:[**2177-4-28**]
{'Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Urinary tract infection, site not specified,Paroxysmal ventricular tachycardia,Primary pulmonary hypertension,Anticoagulants causing adverse effects in therapeutic use,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Cardiac pacemaker in situ,Aortocoronary bypass status,Family history of ischemic heart disease,Family history of diabetes mellitus,Old myocardial infarction,Unspecified sleep apnea'}


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: DOE/Edema

PRESENT ILLNESS: 65 year old with pmhx of CABGx4 in [**2154**] and severe biventricular
decompensated heart failure s/p AICD/PPM with known tricuspid
and mitral valve regurgitation followed by serial
echocardiogram. He was admitted earlier this month for CHF where
an echo showed 3+ MR and 3+ TR. Massive diuresis was initiated
and he was referred for surgical revascularization.

MEDICAL HISTORY: -CAD s/p MI [**2153**] s/p CABG [**2154**]
-h/o VT s/p ICD [**2164**]
-CHF w/ EF<20% by echo [**5-27**]
-DM on insulin
-HTN
-Hypercholesterol
-CRF w/ baseline Cr (1.5-1.8)
-Hypercalcemia
-Osteopenia
-Erectile Dysfunction
-Hypothyroid
-Obesity
-LFT abnormalities attributed to NASH, possibly amio

MEDICATION ON ADMISSION: Aspirin 81 qd, Fosamax, Ambien 10 qhs, Imdur 30 qd, Lipitor 20
qd, Folate, Coreg 50 [**Hospital1 **], Amiodarone 200 qd, Lisinopril 2.5 qd,
Levoxyl, Senispan 30 qod, Humalog, Humulin, Allopurinol,
Torsemide 100qd, Digoxin 0.125 qd, Zoloft 50 qd, Spirinolactone
25 qd

ALLERGIES: Penicillins / Heparin Agents

PHYSICAL EXAM: PE: Postop
97.8  130/66  61  95-98% ra
gen well appearing, non-diaphoretic, nad
cv distant heart sound
lungs crackles in bases bilaterally
abd active bs, soft ntnd, no organomegaly appreciated
ext bilateral lower ext pitting edema; right lower ext bandage
c/d/i; right upper extremity with edema > left

FAMILY HISTORY: Father d. MI at 60; DM in mother's side.

SOCIAL HISTORY: Lives with his wife and two adopted sons in [**Name (NI) 28318**], MA. Remote
hx THC. Rare EtOH; denies tobacco, IVDA. Retired attorney. 

### Response:
{'Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Urinary tract infection, site not specified,Paroxysmal ventricular tachycardia,Primary pulmonary hypertension,Anticoagulants causing adverse effects in therapeutic use,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Cardiac pacemaker in situ,Aortocoronary bypass status,Family history of ischemic heart disease,Family history of diabetes mellitus,Old myocardial infarction,Unspecified sleep apnea'}
