CHIEF COMPLAINT: Fatigue and dyspnea on exertion

PRESENT ILLNESS: 73 year old female has a history of
s/p LAD stenting in [**2063**], stents to the OM
and
RCA in [**2128-3-15**] at [**Hospital1 2025**]. Her most recent catheterization was in
[**2135-4-15**] for exertional dyspnea. This revealed non
obstructive
CAD and high-normal right sided filling pressures. Medical
management was continued. She reports that over the past three
months she has noticed marked fatigue and a significant decline
in her activity tolerance with dyspnea with minimal activities.
There are days where she is so tired that she "can barely get up
out of a chair to do anything". She also describes occasional
bilateral arm and shoulder numbness, and occasional mild chest
pressure that can occur at any time, particularly after eating
supper. Recent non invasive testing has revealed a decline in
her
LVEF compared to last year with her most recent echo revealing
an
LVEF of 40-45%. She was referred for right and left heart
catheterization to further evaluate. She was found to have three
vessel disease and is now referred to cardiac surgery for
revascularization

MEDICAL HISTORY: CAD, DOE, B TKA [**2132**], sleep apnea, hiatal hernia, GERD, DM, HTN,
Hyperlipidemia, Restless leg syndrome, s/p stent to LAD in [**2126**],
Stent to RCA and OM in [**2128**], appendectomy, hysterectomy, CTR
left wrist, laser surgery OU, cataract

MEDICATION ON ADMISSION: Medications at home:
ALLOPURINOL -  (Prescribed by Other Provider) - 300 mg Tablet -
1
Tablet(s) by mouth qam
ATENOLOL -  (Prescribed by Other Provider) - 100 mg Tablet - 1
Tablet(s) by mouth twice a day
ATORVASTATIN [LIPITOR] -  (Prescribed by Other Provider) - 80 mg
Tablet - 1 Tablet(s) by mouth at bedtime
CPAP WITH 2 LITERS OF OXYGEN AT NIGHT -  (Prescribed by Other
Provider) - Dosage uncertain
DOXAZOSIN -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth every morning
FUROSEMIDE -  (Prescribed by Other Provider) - 80 mg Tablet - 3
Tablet(s) by mouth twice a day
INSULIN LISPRO [HUMALOG] -  (Prescribed by Other Provider) - 100
unit/mL Solution - 60 units every morning, 57 units at lunch, 80
units at dinner
ISOSORBIDE MONONITRATE -  (Prescribed by Other Provider) - 30 mg
Tablet Extended Release 24 hr - 1 Tablet(s) by mouth qam
LISINOPRIL -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once a day
NITROGLYCERIN -  (Prescribed by Other Provider) - 0.4 mg Tablet,
Sublingual - 1 Tablet(s) sublingually every five minutes for
chest discomfort. Call 911 if pain persists longer than 15
minutes
PANTOPRAZOLE -  (Prescribed by Other Provider) - 40 mg Tablet,
Delayed Release (E.C.) - 1 Tablet(s) by mouth every morning\
PRAMIPEXOLE [MIRAPEX] -  (Prescribed by Other Provider) - 0.5 mg
Tablet - 1 Tablet(s) by mouth at bedtime
PREDNISOLONE ACETATE [PRED FORTE] -  (Prescribed by Other
Provider) - 1 % Drops, Suspension - 1 drop right eye twice a day
x 5 days , then once a day x 5 days (started [**2137-7-10**])
RALOXIFENE [EVISTA] -  (Prescribed by Other Provider) - 60 mg
Tablet - 1 Tablet(s) by mouth once a day
SPIRONOLACTONE -  (Prescribed by Other Provider) - 25 mg Tablet
-
1 Tablet(s) by mouth qam
VERAPAMIL -  (Prescribed by Other Provider) - 180 mg Cap,Ext
Release Pellets 24 hr - 1 Cap(s) by mouth every morning

ALLERGIES: Morphine / Baclofen / adhesive bandage / penicillin G / Aldomet

PHYSICAL EXAM: Pulse:66 Resp:16  O2 sat:97/RA
B/P  Right:126/39    Left:135/50
Height:5'6"     Weight:217 lbs

FAMILY HISTORY: NC

SOCIAL HISTORY: denies smoking or alcohol, lives in a senior community
Coronary atherosclerosis of native coronary artery,Unspecified sleep apnea,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Restless legs syndrome (RLS),Osteoporosis, unspecified,Cardiac pacemaker in situ
Crnry athrscl natve vssl,Sleep apnea NOS,Diaphragmatic hernia,Esophageal reflux,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Restless legs syndrome,Osteoporosis NOS,Status cardiac pacemaker
Admission Date:  [**2137-7-18**]              Discharge Date:   [**2137-7-22**]

Date of Birth:  [**2063-12-24**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Morphine / Baclofen / adhesive bandage / penicillin G / Aldomet

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Fatigue and dyspnea on exertion


Major Surgical or Invasive Procedure:
s/p CABGx2 (SVG to Ramus, free LIMA to OM Y to SVG)


History of Present Illness:
73 year old female has a history of
s/p LAD stenting in [**2063**], stents to the OM
and
RCA in [**2128-3-15**] at [**Hospital1 2025**]. Her most recent catheterization was in
[**2135-4-15**] for exertional dyspnea. This revealed non
obstructive
CAD and high-normal right sided filling pressures. Medical
management was continued. She reports that over the past three
months she has noticed marked fatigue and a significant decline
in her activity tolerance with dyspnea with minimal activities.
There are days where she is so tired that she "can barely get up
out of a chair to do anything". She also describes occasional
bilateral arm and shoulder numbness, and occasional mild chest
pressure that can occur at any time, particularly after eating
supper. Recent non invasive testing has revealed a decline in
her
LVEF compared to last year with her most recent echo revealing
an
LVEF of 40-45%. She was referred for right and left heart
catheterization to further evaluate. She was found to have three
vessel disease and is now referred to cardiac surgery for
revascularization

Past Medical History:
CAD, DOE, B TKA [**2132**], sleep apnea, hiatal hernia, GERD, DM, HTN,
Hyperlipidemia, Restless leg syndrome, s/p stent to LAD in [**2126**],
Stent to RCA and OM in [**2128**], appendectomy, hysterectomy, CTR
left wrist, laser surgery OU, cataract

Social History:
denies smoking or alcohol, lives in a senior community


Family History:
NC

Physical Exam:
Pulse:66 Resp:16  O2 sat:97/RA
B/P  Right:126/39    Left:135/50
Height:5'6"     Weight:217 lbs

General:NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  no Murmur [] grade ______
Abdomen: Soft [x] non-distended [x] non-tender []  bowel sounds
+
[]
Extremities: Warm [], well-perfused []  Edema [] _____
Varicosities: None []s/p vein stripping
Neuro: Grossly intact []
Pulses:
Femoral      Right: +1  Left:+1
DP           Right: +1  Left:+1
PT           [**Name (NI) 167**]:+1   Left:+1
Radial       Right:+1   Left:+1

Carotid Bruit        Right:none    Left:none


Pertinent Results:
CXR [**7-21**]:
Heart is upper limits of normal in size. There is no vascular
congestion.
There is no pneumothorax. There are small bilateral effusions
and minimal
streaky atelectasis at the lung bases.

IMPRESSION: Small effusion and bibasilar atelectasis, otherwise
good
post-operative appearance.

TEE:
PRE-CPB:
The left atrium is markedly dilated. No thrombus is seen in the
left atrial appendage. 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. Overall left ventricular
systolic function is mildly to moderately depressed (LVEF= 40
%). Right ventricular chamber size and free wall motion are
normal.

There are complex (mobile) atheroma in the descending aorta. No
thoracic aortic dissection is seen. The aortic valve leaflets
(3) appear structurally normal with good leaflet excursion and
no aortic stenosis. No aortic regurgitation is seen.

The mitral valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen.

Moderate [2+] tricuspid regurgitation is seen, likely due to two
pacing wires crossing into the RV.

POST-CPB:

.
[**2137-7-22**] 07:49AM BLOOD WBC-7.4 RBC-3.28* Hgb-10.0* Hct-30.7*
MCV-93 MCH-30.5 MCHC-32.6 RDW-17.8* Plt Ct-241
[**2137-7-18**] 12:38PM BLOOD WBC-6.6 RBC-2.83*# Hgb-8.6*# Hct-24.8*#
MCV-88 MCH-30.4 MCHC-34.7 RDW-17.5* Plt Ct-146*
[**2137-7-18**] 02:11PM BLOOD PT-13.9* PTT-31.2 INR(PT)-1.2*
[**2137-7-18**] 12:38PM BLOOD PT-14.9* PTT-24.9 INR(PT)-1.3*
[**2137-7-22**] 07:49AM BLOOD Glucose-122* UreaN-28* Creat-0.9 Na-139
K-4.5 Cl-101 HCO3-29 AnGap-14
[**2137-7-18**] 02:11PM BLOOD UreaN-48* Creat-1.3* Na-143 K-4.8 Cl-111*
HCO3-23 AnGap-14

Brief Hospital Course:
Ms.[**Name14 (STitle) **] was admitted to the hospital and brought to the
operating room on [**2137-7-18**] where the she underwent Coronary artery
bypass grafting x2, with reversed
saphenous vein graft to the ramus intermedius artery and a free
left internal mammary artery graft to the obtuse marginal artery
Y'd to the vein graft.Cross clamp time= 71 minutes.
Cardiopulmonary Bypass time= 85 minutes. Please see operative
report for further surgical details. Overall the patient
tolerated the procedure well and post-operatively was
transferred to the CVICU intubated and sedated in stable
condition. She weaned off pressor support, awoke neurologically
intact and was extubated postoperatively. Beta
blocker/Statin/Aspirin and diuresis were  initiated and the
patient was gently diuresed toward the preoperative weight. She
was transferred to the telemetry floor for further recovery.
Chest tubes and pacing wires were discontinued per protocol,
without complication.  The patient was evaluated by the physical
therapy service for assistance with strength and mobility.  By
the time of discharge on POD #4 Ms.[**Last Name (Titles) 77882**]  wound was healing
and pain was controlled with oral analgesics.  She was
discharged to [**Hospital 38**] Rehabilitation in good condition with
appropriate follow up instructions. She is to follow up w/Dr [**Last Name (STitle) **]
in 4 weeks.

Medications on Admission:
Medications at home:
ALLOPURINOL -  (Prescribed by Other Provider) - 300 mg Tablet -
1
Tablet(s) by mouth qam
ATENOLOL -  (Prescribed by Other Provider) - 100 mg Tablet - 1
Tablet(s) by mouth twice a day
ATORVASTATIN [LIPITOR] -  (Prescribed by Other Provider) - 80 mg
Tablet - 1 Tablet(s) by mouth at bedtime
CPAP WITH 2 LITERS OF OXYGEN AT NIGHT -  (Prescribed by Other
Provider) - Dosage uncertain
DOXAZOSIN -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth every morning
FUROSEMIDE -  (Prescribed by Other Provider) - 80 mg Tablet - 3
Tablet(s) by mouth twice a day
INSULIN LISPRO [HUMALOG] -  (Prescribed by Other Provider) - 100
unit/mL Solution - 60 units every morning, 57 units at lunch, 80
units at dinner
ISOSORBIDE MONONITRATE -  (Prescribed by Other Provider) - 30 mg
Tablet Extended Release 24 hr - 1 Tablet(s) by mouth qam
LISINOPRIL -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once a day
NITROGLYCERIN -  (Prescribed by Other Provider) - 0.4 mg Tablet,
Sublingual - 1 Tablet(s) sublingually every five minutes for
chest discomfort. Call 911 if pain persists longer than 15
minutes
PANTOPRAZOLE -  (Prescribed by Other Provider) - 40 mg Tablet,
Delayed Release (E.C.) - 1 Tablet(s) by mouth every morning\
PRAMIPEXOLE [MIRAPEX] -  (Prescribed by Other Provider) - 0.5 mg
Tablet - 1 Tablet(s) by mouth at bedtime
PREDNISOLONE ACETATE [PRED FORTE] -  (Prescribed by Other
Provider) - 1 % Drops, Suspension - 1 drop right eye twice a day
x 5 days , then once a day x 5 days (started [**2137-7-10**])
RALOXIFENE [EVISTA] -  (Prescribed by Other Provider) - 60 mg
Tablet - 1 Tablet(s) by mouth once a day
SPIRONOLACTONE -  (Prescribed by Other Provider) - 25 mg Tablet
-
1 Tablet(s) by mouth qam
VERAPAMIL -  (Prescribed by Other Provider) - 180 mg Cap,Ext
Release Pellets 24 hr - 1 Cap(s) by mouth every morning

Medications - OTC
ACETAMINOPHEN [TYLENOL ARTHRITIS] -  (Prescribed by Other
Provider) - 650 mg Tablet Extended Release - 2 Tablet(s) by
mouth
as needed
ASCORBIC ACID [VITAMIN C] -  (Prescribed by Other Provider) -
1,000 mg Tablet - 1 Tablet(s) by mouth once a day
ASPIRIN -  (Prescribed by Other Provider) - 325 mg Tablet,
Delayed Release (E.C.) - 1 Tablet(s) by mouth once a day
CALCIUM CARBONATE-VITAMIN D3 [CALCIUM 600 + D(3)] -  (Prescribed
by Other Provider) - Dosage uncertain
CHOLECALCIFEROL (VITAMIN D3) [VITAMIN D] -  (Prescribed by Other
Provider) - 2,000 unit Capsule - 2 Capsule(s) by mouth once a
day
FISH OIL-DHA-EPA [FISH OIL] -  (Prescribed by Other Provider) -
1,200 mg-144 mg Capsule - 1 Capsule(s) by mouth three times
daily
MULTIVITAMIN -  (Prescribed by Other Provider) - Dosage
uncertain
NPH INSULIN HUMAN RECOMB [HUMULIN N] -  (Prescribed by Other
Provider) - 100 unit/mL Suspension - 86 units twice a day


Discharge Medications:
1. allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every four (4)
hours as needed for pain.
3. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
4. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain, fever.
8. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
9. prednisolone acetate 1 % Drops, Suspension Sig: One (1) Drop
Ophthalmic DAILY (Daily).
10. pramipexole 0.5 mg Tablet Sig: One (1) Tablet PO hs ().
11. ascorbic acid 500 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
12. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
13. omega-3 fatty acids     Capsule Sig: One (1) Capsule PO BID
(2 times a day).
14. multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. furosemide 10 mg/mL Solution Sig: Four (4)  Injection TID (3
times a day).
16. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO Q12H (every 12 hours).
17. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
18. metoprolol tartrate 25 mg Tablet Sig: Three (3) Tablet PO
TID (3 times a day).
19. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

20. metolazone 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

21. insulin lispro 100 unit/mL Solution Sig: One (1)
Subcutaneous ASDIR (AS DIRECTED).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**]

Discharge Diagnosis:
-CAD s/p s/p CABGx2 (SVG to Ramus, free LIMA to OM Y to SVG)
-Secondary:
Hypertension
Hyperlipidemia
Diabetes Type II
CAD s/p LAD, OM and RCA stenting
Prior pacemaker implant at [**Hospital3 417**] Hospital, implanted in
[**2126**], replaced in [**2134**]
Restless leg syndrome
Sleep apnea (CPAP with O2)
Spinal stenosis
[**2136-10-15**]: L3 burst fracture, wears back brace during the
day
Hiatal hernia
GERD
Osteoporosis
Appendectomy
bilateral carpal tunnel syndrome,
Cataracts
Gout
Arthritis


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with walker, gait steady
Sternal pain managed with dilaudid


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart
No driving for approximately one month until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge


Followup Instructions:
RECOMMENDED FOLLOW-UP:
Please call to schedule appointments
Surgeon Dr.[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8583**], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2137-8-22**] at 1:00
Cardiologist Dr.[**Last Name (STitle) 7047**] office will call patient, need to find
time to see her in

Please call cardiac surgery if need arises for evaluation or
readmission to hospital [**Telephone/Fax (1) 170**]



Completed by:[**2137-7-22**]
{'Coronary atherosclerosis of native coronary artery,Unspecified sleep apnea,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Restless legs syndrome (RLS),Osteoporosis, unspecified,Cardiac pacemaker in situ'}


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: Fatigue and dyspnea on exertion

PRESENT ILLNESS: 73 year old female has a history of
s/p LAD stenting in [**2063**], stents to the OM
and
RCA in [**2128-3-15**] at [**Hospital1 2025**]. Her most recent catheterization was in
[**2135-4-15**] for exertional dyspnea. This revealed non
obstructive
CAD and high-normal right sided filling pressures. Medical
management was continued. She reports that over the past three
months she has noticed marked fatigue and a significant decline
in her activity tolerance with dyspnea with minimal activities.
There are days where she is so tired that she "can barely get up
out of a chair to do anything". She also describes occasional
bilateral arm and shoulder numbness, and occasional mild chest
pressure that can occur at any time, particularly after eating
supper. Recent non invasive testing has revealed a decline in
her
LVEF compared to last year with her most recent echo revealing
an
LVEF of 40-45%. She was referred for right and left heart
catheterization to further evaluate. She was found to have three
vessel disease and is now referred to cardiac surgery for
revascularization

MEDICAL HISTORY: CAD, DOE, B TKA [**2132**], sleep apnea, hiatal hernia, GERD, DM, HTN,
Hyperlipidemia, Restless leg syndrome, s/p stent to LAD in [**2126**],
Stent to RCA and OM in [**2128**], appendectomy, hysterectomy, CTR
left wrist, laser surgery OU, cataract

MEDICATION ON ADMISSION: Medications at home:
ALLOPURINOL -  (Prescribed by Other Provider) - 300 mg Tablet -
1
Tablet(s) by mouth qam
ATENOLOL -  (Prescribed by Other Provider) - 100 mg Tablet - 1
Tablet(s) by mouth twice a day
ATORVASTATIN [LIPITOR] -  (Prescribed by Other Provider) - 80 mg
Tablet - 1 Tablet(s) by mouth at bedtime
CPAP WITH 2 LITERS OF OXYGEN AT NIGHT -  (Prescribed by Other
Provider) - Dosage uncertain
DOXAZOSIN -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth every morning
FUROSEMIDE -  (Prescribed by Other Provider) - 80 mg Tablet - 3
Tablet(s) by mouth twice a day
INSULIN LISPRO [HUMALOG] -  (Prescribed by Other Provider) - 100
unit/mL Solution - 60 units every morning, 57 units at lunch, 80
units at dinner
ISOSORBIDE MONONITRATE -  (Prescribed by Other Provider) - 30 mg
Tablet Extended Release 24 hr - 1 Tablet(s) by mouth qam
LISINOPRIL -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once a day
NITROGLYCERIN -  (Prescribed by Other Provider) - 0.4 mg Tablet,
Sublingual - 1 Tablet(s) sublingually every five minutes for
chest discomfort. Call 911 if pain persists longer than 15
minutes
PANTOPRAZOLE -  (Prescribed by Other Provider) - 40 mg Tablet,
Delayed Release (E.C.) - 1 Tablet(s) by mouth every morning\
PRAMIPEXOLE [MIRAPEX] -  (Prescribed by Other Provider) - 0.5 mg
Tablet - 1 Tablet(s) by mouth at bedtime
PREDNISOLONE ACETATE [PRED FORTE] -  (Prescribed by Other
Provider) - 1 % Drops, Suspension - 1 drop right eye twice a day
x 5 days , then once a day x 5 days (started [**2137-7-10**])
RALOXIFENE [EVISTA] -  (Prescribed by Other Provider) - 60 mg
Tablet - 1 Tablet(s) by mouth once a day
SPIRONOLACTONE -  (Prescribed by Other Provider) - 25 mg Tablet
-
1 Tablet(s) by mouth qam
VERAPAMIL -  (Prescribed by Other Provider) - 180 mg Cap,Ext
Release Pellets 24 hr - 1 Cap(s) by mouth every morning

ALLERGIES: Morphine / Baclofen / adhesive bandage / penicillin G / Aldomet

PHYSICAL EXAM: Pulse:66 Resp:16  O2 sat:97/RA
B/P  Right:126/39    Left:135/50
Height:5'6"     Weight:217 lbs

FAMILY HISTORY: NC

SOCIAL HISTORY: denies smoking or alcohol, lives in a senior community 

### Response:
{'Coronary atherosclerosis of native coronary artery,Unspecified sleep apnea,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Restless legs syndrome (RLS),Osteoporosis, unspecified,Cardiac pacemaker in situ'}
