CHIEF COMPLAINT: Dyspnea with fever

PRESENT ILLNESS: 61M hx iCM EF 15-20%, CAD with AMI [**2167**], VFib arrest from IST
[**2167**] s/p ICD implantation, COPD on 2L O2 baseline, DM, [**Hospital **]
transferred from [**Hospital3 **] for ICD explantation.
.
Recently admitted to [**Hospital1 46**] from [**Date range (1) 98806**] for respiratory
failure secondary to CHF and COPD exacerbation. Patient with
chronic exertional dyspnea with mild-moderate activity,
minimally ambulatory, lives in a Nursing Home due to his medical
comorbidities. The staff at his NH noted that he was tachypneic
(RR 28) and requiring additional oxygen supplementation. His
temperature at the time was 100.2F and he was transferred to the
[**First Name4 (NamePattern1) 46**] [**Last Name (NamePattern1) **]. He remained febrile (temp 100.5-104F as per report)
and his SBP was noted to be 80-90s. Blood cultures were obtained
and he was given ceftazidime, vancomycin, and levofloxacin. At
[**Hospital1 46**] he grew MRSA from the bloodstream. Over the course of his
hospitalization there, his ICD pocket became erythematous, warm
and swollen. It had increased to baseball sized by the time of
transfer, and was fluctuant and warm. TEE was negative for
vegetations there, and blood cultures have since been negative
or NGTD per report (not included in OSH transfer records).
.
He was transfered to [**Hospital1 18**] for ICD explantation.  On arrival, he
was in mild respiratory distress and was found to have bibasilar
crackles and a swollen ~4 inch fluctuant mass over the ICD
implant that was erythematous, warm, and tender.  Vitals were T
98.2, BP 105/73, HR 87, RR 20, and SpO2 97% on 3LNC.  He was
continued on Vancomycin for MRSA infection, and diuresed
overnight using Furosemide 40 mg IV followed by 5 mg/hr drip.
He had good urine output and fluid balance negative 1500 ml
overnight.

MEDICAL HISTORY: # CAD -- h/o MI
-- ?stent thrombosis in [**2167**] with subsequent thrombectomy
-- stent placement x3 to his LAD in [**2169**]
# VFib arrest -- s/p ICD implantation in [**9-/2168**]
# Ischemic cardiomyopathy -- LVEF 15-20%
# COPD -- on 2L home oxygen
# Hypertension
# Hyperlipidemia
# Anemia -- with h/o transfusions, etiology unclear
# Chronic Kidney Disease
-- (time course unclear, Cr 0.91 in [**2170-7-9**])

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Tiotropium Bromide 1 CAP IH DAILY
2. Fluticasone-Salmeterol Diskus (250/50)  1 INH IH [**Hospital1 **]
3. DuoNeb *NF* (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg
base)/3 mL Inhalation q6h sob/wheeze
4. Thiamine 100 mg PO DAILY
5. FoLIC Acid 1 mg PO DAILY
6. Neutra-Phos 1 PKT PO DAILY
7. Digoxin 0.25 mg PO DAILY
8. Lisinopril 2.5 mg PO DAILY
9. Metoprolol Succinate XL 12.5 mg PO BID
10. Furosemide 40 mg PO BID
11. Pantoprazole 40 mg PO Q24H
12. Spironolactone 25 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION:
VS: 98.2 105/73 87 20 97%3LNC
GENERAL: Older male in NAD, intubated and sedated.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
NECK: Supple without elevated JVP .
CARDIAC: RRR, normal S1, S2. No M/R/G.
LUNGS: Synchronous on vent.  CTAB without crackles, wheezes, or
rhonchi.
ABDOMEN: Soft, NT, ND. No HSM.
EXTREMITIES: No C/C/E. No femoral bruits.
SKIN: Pressure dressing over left chest ICD site C/D/I.  Drain
with serosanguinous fluid.
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

SOCIAL HISTORY: # Home: Married, lives at [**Hospital 62931**].
# Work: Former electrician.
# Tobacco: 40 pack year smoking history, quit 5 months ago
# Alcohol: Alcohol abuse history but also quit 5 months ago
# Illicit: None
Infection and inflammatory reaction due to cardiac device, implant, and graft,Acute on chronic systolic heart failure,Bacteremia,Chronic airway obstruction, not elsewhere classified,Other dependence on machines, supplemental oxygen,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Chronic kidney disease, unspecified,Old myocardial infarction
React-cardiac dev/graft,Ac on chr syst hrt fail,Bacteremia,Chr airway obstruct NEC,Depend-supplement oxygen,Hy kid NOS w cr kid I-IV,MRSA elsewhere/NOS,Abn react-artif implant,Crnry athrscl natve vssl,Status-post ptca,Hyperlipidemia NEC/NOS,Chronic kidney dis NOS,Old myocardial infarct
Admission Date:  [**2170-7-26**]              Discharge Date:   [**2170-8-3**]

Date of Birth:  [**2109-4-22**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2736**]
Chief Complaint:
Dyspnea with fever

Major Surgical or Invasive Procedure:
ICD extraction

History of Present Illness:
61M hx iCM EF 15-20%, CAD with AMI [**2167**], VFib arrest from IST
[**2167**] s/p ICD implantation, COPD on 2L O2 baseline, DM, [**Hospital **]
transferred from [**Hospital3 **] for ICD explantation.
.
Recently admitted to [**Hospital1 46**] from [**Date range (1) 98806**] for respiratory
failure secondary to CHF and COPD exacerbation. Patient with
chronic exertional dyspnea with mild-moderate activity,
minimally ambulatory, lives in a Nursing Home due to his medical
comorbidities. The staff at his NH noted that he was tachypneic
(RR 28) and requiring additional oxygen supplementation. His
temperature at the time was 100.2F and he was transferred to the
[**First Name4 (NamePattern1) 46**] [**Last Name (NamePattern1) **]. He remained febrile (temp 100.5-104F as per report)
and his SBP was noted to be 80-90s. Blood cultures were obtained
and he was given ceftazidime, vancomycin, and levofloxacin. At
[**Hospital1 46**] he grew MRSA from the bloodstream. Over the course of his
hospitalization there, his ICD pocket became erythematous, warm
and swollen. It had increased to baseball sized by the time of
transfer, and was fluctuant and warm. TEE was negative for
vegetations there, and blood cultures have since been negative
or NGTD per report (not included in OSH transfer records).
.
He was transfered to [**Hospital1 18**] for ICD explantation.  On arrival, he
was in mild respiratory distress and was found to have bibasilar
crackles and a swollen ~4 inch fluctuant mass over the ICD
implant that was erythematous, warm, and tender.  Vitals were T
98.2, BP 105/73, HR 87, RR 20, and SpO2 97% on 3LNC.  He was
continued on Vancomycin for MRSA infection, and diuresed
overnight using Furosemide 40 mg IV followed by 5 mg/hr drip.
He had good urine output and fluid balance negative 1500 ml
overnight.

He was taken to the OR morning of [**2170-7-27**].  His ICD was removed
with purulent material in the pocket.  After explantation, there
was continued oozing from the site and a drain was left in
place.  He remained intubated following the procedure, and was
transferred to the PACU in stable condition.

Past Medical History:
# CAD -- h/o MI
-- ?stent thrombosis in [**2167**] with subsequent thrombectomy
-- stent placement x3 to his LAD in [**2169**]
# VFib arrest -- s/p ICD implantation in [**9-/2168**]
# Ischemic cardiomyopathy -- LVEF 15-20%
# COPD -- on 2L home oxygen
# Hypertension
# Hyperlipidemia
# Anemia -- with h/o transfusions, etiology unclear
# Chronic Kidney Disease
-- (time course unclear, Cr 0.91 in [**2170-7-9**])

Social History:
# Home: Married, lives at [**Hospital 62931**].
# Work: Former electrician.
# Tobacco: 40 pack year smoking history, quit 5 months ago
# Alcohol: Alcohol abuse history but also quit 5 months ago
# Illicit: None

Family History:
Father with MI

Physical Exam:
ADMISSION:
VS: 98.2 105/73 87 20 97%3LNC
GENERAL: Older male in NAD, intubated and sedated.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
NECK: Supple without elevated JVP .
CARDIAC: RRR, normal S1, S2. No M/R/G.
LUNGS: Synchronous on vent.  CTAB without crackles, wheezes, or
rhonchi.
ABDOMEN: Soft, NT, ND. No HSM.
EXTREMITIES: No C/C/E. No femoral bruits.
SKIN: Pressure dressing over left chest ICD site C/D/I.  Drain
with serosanguinous fluid.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

DISCHARGE:
VS: 98.7 81 108/73 18
GENERAL: Older male in NAD, intubated and sedated.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
NECK: Supple without elevated JVP, Large EJ.
CARDIAC: RRR, normal S1, S2. No M/R/G.
LUNGS: Decreased breath sounds over lower lung fields. No
crackles, wheezes, or rhonchi.
ABDOMEN: Distended, firm. Non-tender, +BS.
EXTREMITIES: No C/C/E. No femoral bruits. No edema.
SKIN: Dressing over pocket, with serosanguinous fluid.
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:
ADMISSION:

[**2170-7-26**] 11:27PM BLOOD WBC-10.5 RBC-2.94* Hgb-8.4* Hct-26.5*
MCV-90 MCH-28.5 MCHC-31.7 RDW-21.8* Plt Ct-153
[**2170-7-26**] 11:27PM BLOOD Neuts-87.4* Lymphs-8.2* Monos-2.6 Eos-1.3
Baso-0.5
[**2170-7-26**] 11:27PM BLOOD PT-15.3* PTT-39.1* INR(PT)-1.4*
[**2170-7-26**] 11:27PM BLOOD Glucose-92 UreaN-22* Creat-0.8 Na-130*
K-4.7 Cl-99 HCO3-26 AnGap-10
[**2170-7-26**] 11:27PM BLOOD ALT-15 AST-18 AlkPhos-119 TotBili-1.5
[**2170-7-26**] 11:27PM BLOOD Calcium-8.5 Phos-2.2* Mg-2.4

STUDIES:
(CXR [**2170-7-27**]) Moderate-to-large right greater than left pleural
effusions.  The additional presence of pneumonia cannot be
excluded
.
(ECHO [**2170-7-28**]) The left atrium is moderately dilated. The right
atrium is moderately dilated. No atrial septal defect is seen by
2D or color Doppler. The estimated right atrial pressure is at
least 15 mmHg. Left ventricular wall thicknesses are normal. The
left ventricular cavity is moderately dilated. There is severe
global left ventricular hypokinesis (LVEF = 15 %). No masses or
thrombi are seen in the left ventricle. There is no ventricular
septal defect. The right ventricular cavity is moderately
dilated with moderate global free wall hypokinesis. The
diameters of aorta at the sinus, ascending and arch levels are
normal. The aortic valve leaflets (3) appear structurally normal
with good leaflet excursion and no aortic stenosis or aortic
regurgitation. No masses or vegetations are seen on the aortic
valve. The mitral valve leaflets are structurally normal. No
mass or vegetation is seen on the mitral valve. Moderate (2+)
mitral regurgitation is seen. Moderate to severe [3+] tricuspid
regurgitation is seen. There is severe pulmonary artery systolic
hypertension. No vegetation/mass is seen on the tricuspid or
pulmonic valves. There is no pericardial effusion.

Brief Hospital Course:
61M with history of CAD, MI, sCHF EF 15-20%, VFib arrest s/p ICD
placement in [**2167**], COPD on 2L home O2, who presents from [**Hospital1 **] with MRSA bacteremia and ICD pocket infection.
.
# MRSA ICD INFECTION with Bacteremia: MRSA bacteremia found at
OSH, Positive growth of Staph aureus from ICD pocket, blood cx
negative since admission here. Pocket has appeared infected over
the past few days, culminating in a ~4 inch fluctuant mass that
was erythematous, warm, and tender over the ICD implant.  S/P
ICD explantation and pocket washout with placement of drain. Pt
required temporary phenylephrine, and epinephrine. He had a
drain placed which was pulled on [**2170-8-2**].  He had a transient
decrease in HCT with oozing around pocket, and was 26.7 on day
of discharge.  He will require monitoring of his CBC at rehab.
ID was consulted who recommended 6 weeks of Vancomycin. Pt has
PICC line in right basilic vein for Vancomycin 750mg q12 (stop
date [**2170-8-27**]).
.
# Acute on Chronic Systolic CHF: Initially hypoxic beyond
baseline (3L on admission, 2L at home) with bibasilar rales and
bilateral effusions, JVP elevation, peripheral edema.  Likely
due to iatrogenic causes in setting of MRSA bacteremia and
initial presentation of sepsis.  Pt initially on pressors,
weaned on the first day. [**Name (NI) 98807**], Pt was started on Lasix
drip fluid status improved and we continued PRN Lasix to goal of
-1L/day. Lisinopril and Spironolactone were initially held due
to SBPs 80s-90s, Lisinopril restarted several days prior to
discharge, and Spirolactone will need to be added on as an
outpatient with better SBPs. Pt discharged on Metop Succinate XL
25mg Daily, Lisinopril 2.5mg daily, Dig .25mg/day, and
Furosemide 80mg TID.  His BPs were in the 80-90s on d/c but
patient was asymptomatic with no orthostasis on exam.  In
addition, he was able to ambulate with no lightheadedness,
dizziness, SOB, or syncope.
.
# COPD: During this admissio patient was weaned to his home
baseline oxygen requirement of 2L day and night. Home 2L NC at
baseline. No cough or increased sputum to suggest COPD
exacerbation. Hypoxia/dyspnea likely related to CHF as above.
Pt did require intubation after ICD extraction for less than 24
hours. We Continued Ipratropium, Albuterol and Advair.
.
# CAD / VFib arrest: Large MI in [**2167**] with IST and VFib arrest,
s/p DESx3 to LAD.  Currently CP free.  ICD placement [**9-/2168**],
extracted on this admission per above.  Per report no further
episodes of VFib or VTach.  We continued his Aspirin and Statin
and increased Metoprolol XL to 25mg PO daily which decreased the
ectopy captured on tele.
.
# CKD: Reportedly with elevated Cr in the past (1.2 +) although
during this admission patient discharged with Cr 0.8, and range
was .8 - 1.0. Cr 1.3 on OSH admission, 0.8 prior to transfer. We
monitored renal function daily and dosed medications renally.
.
# TRANSITIONAL
- Add Spironolactone as outpatient if SBP tolerates.
- Monitor weekly Vancomycin troughs, CBC and CMP (electrolytes)
- Discussion of future ICD need


Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Tiotropium Bromide 1 CAP IH DAILY
2. Fluticasone-Salmeterol Diskus (250/50)  1 INH IH [**Hospital1 **]
3. DuoNeb *NF* (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg
base)/3 mL Inhalation q6h sob/wheeze
4. Thiamine 100 mg PO DAILY
5. FoLIC Acid 1 mg PO DAILY
6. Neutra-Phos 1 PKT PO DAILY
7. Digoxin 0.25 mg PO DAILY
8. Lisinopril 2.5 mg PO DAILY
9. Metoprolol Succinate XL 12.5 mg PO BID
10. Furosemide 40 mg PO BID
11. Pantoprazole 40 mg PO Q24H
12. Spironolactone 25 mg PO DAILY


Discharge Medications:
1. Digoxin 0.25 mg PO DAILY
2. Fluticasone-Salmeterol Diskus (250/50)  1 INH IH [**Hospital1 **]
3. FoLIC Acid 1 mg PO DAILY
4. Lisinopril 2.5 mg PO DAILY
Hold SBP< 90
5. Metoprolol Succinate XL 25 mg PO DAILY
6. Pantoprazole 40 mg PO Q24H
7. Thiamine 100 mg PO DAILY
8. Heparin Flush (10 units/ml) 2 mL IV PRN line flush
PICC, heparin dependent: Flush with 10mL Normal Saline followed
by Heparin as above daily and PRN per lumen.
9. Potassium Chloride 20 mEq PO DAILY Duration: 24 Hours
Hold for K > 4.5
10. DuoNeb *NF* (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg
base)/3 mL Inhalation q6h sob/wheeze
11. Tiotropium Bromide 1 CAP IH DAILY
12. Vancomycin 750 mg IV Q 12H
Please give at 8am and 8pm
13. Torsemide 60 mg PO DAILY


Discharge Disposition:
Extended Care

Facility:
[**Hospital 671**] HealthCare/Pediatric Center at [**Location (un) 3320**]

Discharge Diagnosis:
1) Implantable cardioverter-defibrillator (ICD) Pocket Infection
2) Staph Coag positive bacteremia
3) Coronary artery disease
4) Acute on Chronic systolic congestive heart failure


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


Discharge Instructions:
Mr. [**Known lastname **],

You were transferred from [**Hospital3 3583**] due to fevers and
elevated levels of blood cells that fight infection. It was
determined that your ICD(Implantable cardioverter-defibrillator)
was infected and we removed it to prevent the infection from
getting worse. We also started you on an antibiotic called
Vancomycin through your vein.


Followup Instructions:
.
Department: INFECTIOUS DISEASE
When: TUESDAY [**2170-8-21**] at 3:30 PM
With: [**First Name11 (Name Pattern1) 1037**] [**Last Name (NamePattern4) 2335**], MD [**Telephone/Fax (1) 457**]
Building: LM [**Hospital Unit Name **] [**Hospital 1422**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: INFECTIOUS DISEASE
When: FRIDAY [**2170-9-14**] at 11:30 AM
With: [**Name6 (MD) 27568**] [**Name8 (MD) 27569**], MD [**Telephone/Fax (1) 457**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Hospital 1422**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: CARDIAC SERVICES
When: TUESDAY [**2170-8-14**] at 11:30 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5855**], NP [**Telephone/Fax (1) 285**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Name: [**Last Name (LF) **],[**Name8 (MD) 2064**] MD
Location: [**Location (un) 511**] Cardiology
Address: [**State **], [**Location (un) 2498**]
Phone: [**Telephone/Fax (1) **]
Appt:  [**9-10**] at 1:50pm
{'Infection and inflammatory reaction due to cardiac device, implant, and graft,Acute on chronic systolic heart failure,Bacteremia,Chronic airway obstruction, not elsewhere classified,Other dependence on machines, supplemental oxygen,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Chronic kidney disease, unspecified,Old myocardial infarction'}


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: Dyspnea with fever

PRESENT ILLNESS: 61M hx iCM EF 15-20%, CAD with AMI [**2167**], VFib arrest from IST
[**2167**] s/p ICD implantation, COPD on 2L O2 baseline, DM, [**Hospital **]
transferred from [**Hospital3 **] for ICD explantation.
.
Recently admitted to [**Hospital1 46**] from [**Date range (1) 98806**] for respiratory
failure secondary to CHF and COPD exacerbation. Patient with
chronic exertional dyspnea with mild-moderate activity,
minimally ambulatory, lives in a Nursing Home due to his medical
comorbidities. The staff at his NH noted that he was tachypneic
(RR 28) and requiring additional oxygen supplementation. His
temperature at the time was 100.2F and he was transferred to the
[**First Name4 (NamePattern1) 46**] [**Last Name (NamePattern1) **]. He remained febrile (temp 100.5-104F as per report)
and his SBP was noted to be 80-90s. Blood cultures were obtained
and he was given ceftazidime, vancomycin, and levofloxacin. At
[**Hospital1 46**] he grew MRSA from the bloodstream. Over the course of his
hospitalization there, his ICD pocket became erythematous, warm
and swollen. It had increased to baseball sized by the time of
transfer, and was fluctuant and warm. TEE was negative for
vegetations there, and blood cultures have since been negative
or NGTD per report (not included in OSH transfer records).
.
He was transfered to [**Hospital1 18**] for ICD explantation.  On arrival, he
was in mild respiratory distress and was found to have bibasilar
crackles and a swollen ~4 inch fluctuant mass over the ICD
implant that was erythematous, warm, and tender.  Vitals were T
98.2, BP 105/73, HR 87, RR 20, and SpO2 97% on 3LNC.  He was
continued on Vancomycin for MRSA infection, and diuresed
overnight using Furosemide 40 mg IV followed by 5 mg/hr drip.
He had good urine output and fluid balance negative 1500 ml
overnight.

MEDICAL HISTORY: # CAD -- h/o MI
-- ?stent thrombosis in [**2167**] with subsequent thrombectomy
-- stent placement x3 to his LAD in [**2169**]
# VFib arrest -- s/p ICD implantation in [**9-/2168**]
# Ischemic cardiomyopathy -- LVEF 15-20%
# COPD -- on 2L home oxygen
# Hypertension
# Hyperlipidemia
# Anemia -- with h/o transfusions, etiology unclear
# Chronic Kidney Disease
-- (time course unclear, Cr 0.91 in [**2170-7-9**])

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Tiotropium Bromide 1 CAP IH DAILY
2. Fluticasone-Salmeterol Diskus (250/50)  1 INH IH [**Hospital1 **]
3. DuoNeb *NF* (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg
base)/3 mL Inhalation q6h sob/wheeze
4. Thiamine 100 mg PO DAILY
5. FoLIC Acid 1 mg PO DAILY
6. Neutra-Phos 1 PKT PO DAILY
7. Digoxin 0.25 mg PO DAILY
8. Lisinopril 2.5 mg PO DAILY
9. Metoprolol Succinate XL 12.5 mg PO BID
10. Furosemide 40 mg PO BID
11. Pantoprazole 40 mg PO Q24H
12. Spironolactone 25 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION:
VS: 98.2 105/73 87 20 97%3LNC
GENERAL: Older male in NAD, intubated and sedated.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
NECK: Supple without elevated JVP .
CARDIAC: RRR, normal S1, S2. No M/R/G.
LUNGS: Synchronous on vent.  CTAB without crackles, wheezes, or
rhonchi.
ABDOMEN: Soft, NT, ND. No HSM.
EXTREMITIES: No C/C/E. No femoral bruits.
SKIN: Pressure dressing over left chest ICD site C/D/I.  Drain
with serosanguinous fluid.
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

SOCIAL HISTORY: # Home: Married, lives at [**Hospital 62931**].
# Work: Former electrician.
# Tobacco: 40 pack year smoking history, quit 5 months ago
# Alcohol: Alcohol abuse history but also quit 5 months ago
# Illicit: None 

### Response:
{'Infection and inflammatory reaction due to cardiac device, implant, and graft,Acute on chronic systolic heart failure,Bacteremia,Chronic airway obstruction, not elsewhere classified,Other dependence on machines, supplemental oxygen,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Chronic kidney disease, unspecified,Old myocardial infarction'}
