CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 61 yo male with hx AML, s/p 7+3 induction chemo with idarubicin
and cytarabine (Day 1=[**2149-11-23**]), complicated aspergillus
pneumonia tx with voriconazole. Also, pt found to have a newly
depressed EF to 30-40% with focal hypokinesis. He had a left
heart cath that found 3VD and had 3 BMS placed to LAD, 1
proximal and 2 to the mid LAD on [**2149-12-24**]. The pt was discharged
on [**2149-12-26**] on aspirin and plavix. He now presents with a chief
complaint of chest pain starting this morning.
.
This morning he felt "cold and clammy" and he had suddent onset
of chest pain. He describes the pain as dull/pressure, focused
in the center of his chest, [**7-7**]. It was non-radiating and
associated with diaphoresis and shortness of breath, but no
dizziness, palpitations, nausea or vomiting. Of note, he had
similar chest pain several months ago while raking leaves (pain
resolved on its own at that time). He called 911 and was taken
by the ambulance to the [**Hospital6 **]. CP resolved at OSH
with nitro and morphine. Trop T was elevated to 0.12 and EKG
showed no ischemic changes. He had a CTA showing no PE. He was
transferred to [**Hospital1 18**] for further management. In our ED, initial
vitals were T 96.2 HR 99 BP 105/73 RR14 SaO2 97%. He was given
vancomycin and zosyn, and blood cultures were sent. Also given
tylenol 650mg x 1. CEs were trending up.
.
Per nursing report prior to transfer the patient became
hypotensive and tachycardic when standing up. He was bolused
500cc and placed in a supine position.  On arrival to the floor
his vitals were T 100.7, HR 114, BP 108/65, SaO2 99% on 2L. He
denied any chest pain or pressure but did report feeling unable
to take a deep breath and feeling intermittent chills/rigors
throughout the afternoon. Additionally, he reported dysuria
starting this morning. He denied GI sx or productive cough. He
was given 1 liter NS, then given demerol for the rigors and his
BP dropped to 90s. He was started on a 3rd liter and his BP
improved. His temp increased to 102. His EKG showed some mild
STE vs J point elevation changes in the anterior leads,
cardiology felt it was not consistent with a instent thormbosis.
He was transfered to the unit for sepsis.
.
REVIEW OF SYSTEMS:
He denies GI sx, no hematuria or prior dsyuria other than today,
no cough, no vision changes, no neck stiffness. Had a mild HA
today. Has a tender right wrist (where cath was done).

MEDICAL HISTORY: -3VD (see HPI), BMS x 3 to LAD [**2149-12-24**]
-AML s/p induction chemo starting [**2149-11-23**]

MEDICATION ON ADMISSION: MEDICATIONS at home:
1. Clopidogrel 75 mg daily
2. Aspirin 325 mg daily
3. Voriconazole 200 mg Q12H
4. Lisinopril 5 mg daily
5. Toprol 37.5 mg daily
6. Atorvastatin 40 mg daily
.
Transfer Medications:
- Meperidine 12.5 mg IV ONCE
- Metoprolol Succinate XL 37.5 mg PO DAILY
- Oseltamivir 75 mg PO DAILY
- Acetaminophen [**Telephone/Fax (1) 1999**] mg PO/NG Q6H:PRN pain or fever
- Piperacillin-Tazobactam 4.5 g IV Q8H
- Aspirin 325 mg PO/NG DAILY
- Atorvastatin 80 mg PO/NG DAILY
- Clopidogrel 75 mg PO/NG DAILY
- Vancomycin 1000 mg IV Q 12H
- Heparin IV Sliding Scale
- Voriconazole 200 mg PO Q12H
- Lisinopril 5 mg PO/NG DAILY

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
VS: temp- T- 101.4 HR- 130 BP 106/60 RR-15 Sat- 99% 2 liters
GENERAL: NAD. Oriented x3. Mood, affect appropriate. Eyes closed
during most of the exam
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
NECK: Supple with no LAD
CARDIAC: RR, normal S1, S2. No m/r/g. No S3 or S4. 2+ pulses
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. +BS
EXTREMITIES: No c/c/e.
SKIN: No rashs, skin warm and moist
NEURO: altert, cn 2-12 grossly intact, gait not assessed, moving
all limbs appropriately

FAMILY HISTORY: Brother with AML s/p transplant here at [**Hospital1 18**] in [**2145**]. Father
with a history of "multiple small heart attacks," but died in
his 80s.

SOCIAL HISTORY: Married here with wife. [**Name (NI) **] daughter & son. both married & live
an hour away.
-Tobacco history: denies
-ETOH: denies
-Illicit drugs: denies
Unspecified septicemia,Pneumonia, organism unspecified,Subendocardial infarction, initial episode of care,Acute myeloid leukemia, without mention of having achieved remission,Chronic systolic heart failure,Intestinal infection due to Clostridium difficile,Sepsis,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status
Septicemia NOS,Pneumonia, organism NOS,Subendo infarct, initial,Ac myl leuk wo achv rmsn,Chr systolic hrt failure,Int inf clstrdium dfcile,Sepsis,Atrial fibrillation,Crnry athrscl natve vssl,Status-post ptca
Admission Date:  [**2149-12-27**]              Discharge Date:   [**2150-1-2**]

Date of Birth:  [**2088-4-13**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3233**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
PICC line placement (Right)


History of Present Illness:
61 yo male with hx AML, s/p 7+3 induction chemo with idarubicin
and cytarabine (Day 1=[**2149-11-23**]), complicated aspergillus
pneumonia tx with voriconazole. Also, pt found to have a newly
depressed EF to 30-40% with focal hypokinesis. He had a left
heart cath that found 3VD and had 3 BMS placed to LAD, 1
proximal and 2 to the mid LAD on [**2149-12-24**]. The pt was discharged
on [**2149-12-26**] on aspirin and plavix. He now presents with a chief
complaint of chest pain starting this morning.
.
This morning he felt "cold and clammy" and he had suddent onset
of chest pain. He describes the pain as dull/pressure, focused
in the center of his chest, [**7-7**]. It was non-radiating and
associated with diaphoresis and shortness of breath, but no
dizziness, palpitations, nausea or vomiting. Of note, he had
similar chest pain several months ago while raking leaves (pain
resolved on its own at that time). He called 911 and was taken
by the ambulance to the [**Hospital6 **]. CP resolved at OSH
with nitro and morphine. Trop T was elevated to 0.12 and EKG
showed no ischemic changes. He had a CTA showing no PE. He was
transferred to [**Hospital1 18**] for further management. In our ED, initial
vitals were T 96.2 HR 99 BP 105/73 RR14 SaO2 97%. He was given
vancomycin and zosyn, and blood cultures were sent. Also given
tylenol 650mg x 1. CEs were trending up.
.
Per nursing report prior to transfer the patient became
hypotensive and tachycardic when standing up. He was bolused
500cc and placed in a supine position.  On arrival to the floor
his vitals were T 100.7, HR 114, BP 108/65, SaO2 99% on 2L. He
denied any chest pain or pressure but did report feeling unable
to take a deep breath and feeling intermittent chills/rigors
throughout the afternoon. Additionally, he reported dysuria
starting this morning. He denied GI sx or productive cough. He
was given 1 liter NS, then given demerol for the rigors and his
BP dropped to 90s. He was started on a 3rd liter and his BP
improved. His temp increased to 102. His EKG showed some mild
STE vs J point elevation changes in the anterior leads,
cardiology felt it was not consistent with a instent thormbosis.
He was transfered to the unit for sepsis.
.
REVIEW OF SYSTEMS:
He denies GI sx, no hematuria or prior dsyuria other than today,
no cough, no vision changes, no neck stiffness. Had a mild HA
today. Has a tender right wrist (where cath was done).


Past Medical History:
-3VD (see HPI), BMS x 3 to LAD [**2149-12-24**]
-AML s/p induction chemo starting [**2149-11-23**]

Social History:
Married here with wife. [**Name (NI) **] daughter & son. both married & live
an hour away.
-Tobacco history: denies
-ETOH: denies
-Illicit drugs: denies


Family History:
Brother with AML s/p transplant here at [**Hospital1 18**] in [**2145**]. Father
with a history of "multiple small heart attacks," but died in
his 80s.


Physical Exam:
On admission:
VS: temp- T- 101.4 HR- 130 BP 106/60 RR-15 Sat- 99% 2 liters
GENERAL: NAD. Oriented x3. Mood, affect appropriate. Eyes closed
during most of the exam
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
NECK: Supple with no LAD
CARDIAC: RR, normal S1, S2. No m/r/g. No S3 or S4. 2+ pulses
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. +BS
EXTREMITIES: No c/c/e.
SKIN: No rashs, skin warm and moist
NEURO: altert, cn 2-12 grossly intact, gait not assessed, moving
all limbs appropriately

Pertinent Results:
EKG:  sinus tach at 135, STE vs j point elevations in V2-V4,
qwave in III (ST changes are new from ER EKG)
.
TTE [**2149-12-23**]: The left atrium is normal in size. Left ventricular
wall thicknesses are normal. The left ventricular cavity size is
normal. Overall left ventricular systolic function is moderately
depressed (LVEF= 30-40 %) secondary to hypokinesis of the
anterior septum, inferior septum, anterior free wall, lateral
wall, and apex. There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. There
are focal calcifications in the aortic arch. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
no mitral valve prolapse. The pulmonary artery systolic pressure
could not be determined. There is no pericardial effusion.
Compared with the findings of the prior study (images reviewed)
of [**2149-11-19**], the left ventricular ejection fraction is
further reduced.
.
CARDIAC CATH [**2149-12-24**]:
1. Selective coronary angiography of this right dominant system

demonstrated three vessel coronary artery disease. The LMCA was
not
present. There were separate ostia for the LAD and LCx. The LAD
had a 60-70% proximal eccentric lesion, a total occlusion of the
mid-LAD and a 50-60% lesion of the diagonal branch. The LCs had
a 40% stenosis in a large OM and a 60-70% stenosis in the
smaller distal LCx into the OM2. There was a large patent ramus.
The RCA was 100% occluded proximally. The PDA and PL filled by
left to left collaterals.
2. Limited resting hemodynamics revealed normal systemic
arterial
pressure of 96/73 mmHg.
3. Successful PTCA and placement of a 3.0x12mm Vision bare-metal
stent in the proximal LAD and overlapping 2.5x23mm and 2.5x12mm
Mini Vision bare-metal stents in the mid LAD were performed.
Final angiography showed normal flow, no apparent dissection,
and no residual stenoses. IVUS showed good stent apposition.
(See PTCA comments.)
FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Placement of bare-metal stents in the LAD.

.
CK: 175  MB: 21  MBI: 12.0  Trop-T: 0.61 (9pm)
CK: 95  MB: 12  MBI: 12.6  Trop-T: 0.20 (2pm)
UA: yellow, Clear, SpecGr 1.023, pH 5.0, Urobil neg, Bili Neg,
Leuk
Neg, Bld Sm , Nitr neg, Prot Tr, Glu Neg, Ket Neg, RBC 0-2, WBC
[**1-30**], bact Few, Yeast None, Epi 0-2
Lactate:1.1
.
139  106  13   AGap=14
------------<113
4.6  24  0.7
.
wbc 11.6, plt 680, hct 31.3
N:69.3 L:16.6 M:13.0 E:0.1 Bas:1.1
PT: 12.7  PTT: 27.0  INR: 1.1
.
OSH labs:
Trop T: 0.12, CK 47
WBC 11.1, Hct 32, plt 584
.
CT abd/pelvis w/ and w/o contrast:
1. No evidence of retroperitoneal hematoma. No focal abscess or
overt
infection in the abdomen or pelvis.
2. Interval development of bilateral moderate pleural effusions
with
compressive atelectasis, left greater than right. Area of focal
consolidation vs mass in the left upper lobe as previously
identified is not encompassed by today's study, however, is
evident on scout radiograph.
3. Multiple bilateral sub-4 mm pulmonary nodules are better
demonstrated on prior CT from [**2149-12-13**].
4. 9-mm hypodense liver lesion is too small to fully
characterize but likely represents a cyst. Focal fatty
infiltration in anterior left lobe of liver.
5. Trace pelvic fluid, a non-specific finding.

Brief Hospital Course:
61 yo m with hx of AML, s/p 7+3 induction chemo c/b presumed
fungal pneumonia treated with voriconazole, and reduced EF
(30-40%), CAD s/p PCI with BMS x3 in LAD([**2149-12-24**]) who now
presents with chest pain and fevers/tachycardia.
.
# Fever/Leukocytosis/tachycardia: Pt had SIRS criteria, new
leukocytosis and rigors on admission. Pt has known lingular
opacity seen on prior imaging last week, as well as OSH imaging
that confirmed this finding that in the past was thought to be a
Aspergillus infection, since the Ag was positive and B-glucan
was present.  He denies GI sx, however, did have C. diff
infection on [**2149-12-2**], and just completed flagyl 2 days prior to
infection.  Also had mild hypotension concerning for sepsis at
the time of admission.  OSH CTA was negative for PE.  He
initially required an ICU stay for management of his hypotension
and sepsis, he was treated with vancomycin and cefepime for a
hospital acquired pneumonia and also continued on prior
voriconazole.  He was also continued on treatment for C.diff
with po vancomycin.  Infectious disease was consulted and felt
that he should complete a 14 day course of vancomycin/cefepime
for a hospital acquired pneumonia, a PICC was placed for him to
complete his antibiotic course as an outpatient.
.
# CAD, chest pain: As above, patient s/p PCI with BMS to LAD
several days prior to admission, now with chest pain and
elevated troponin.  Patient was seen by cardiology who felt that
the bump in enzymes was related to demand ischemia in the
setting of hypotension, and as a result did not feel that he
needed to have a repeat catheterization.  GIven his three vessel
disease he was evaluated by CT surgery, who felt that he was not
a candidate for a CABG, so he was continued with medical
management. He was continued on his aspirin, plavix and statin.

.
# Atrial Fibrillation: during this hospitalization patient was
found to be in atrial fibrillation with rapid ventricular
response.  He was started on amiodarone and converted back to
normal sinus rhythm.  He was continued on metoprolol for rate
control, and at the time of discharge was sent home on an
amiodarone taper, with EP follow up to determine the duration of
amiodarone therapy.
.
# Heart Failure: Pt with chronic systolic heart failure with
recent TTE showing EF worsened to 30-40%.  He did not have any
signs of decompensated heart failure during his admission.  He
was continued on his beta blocker and ACE inhibitor during his
admission.
.
# Acute AML s/p induction chemotherapy: patient had a bone
marrow biopsy during his stay that was to be followed up with
Dr. [**Last Name (STitle) **] as an outpatient.  He was continued on
voriconazole during his stay and at the time of discharge had
outpatient follow up to determine the next step in his treatment
plan.


Medications on Admission:
MEDICATIONS at home:
1. Clopidogrel 75 mg daily
2. Aspirin 325 mg daily
3. Voriconazole 200 mg Q12H
4. Lisinopril 5 mg daily
5. Toprol 37.5 mg daily
6. Atorvastatin 40 mg daily
.
Transfer Medications:
- Meperidine 12.5 mg IV ONCE
- Metoprolol Succinate XL 37.5 mg PO DAILY
- Oseltamivir 75 mg PO DAILY
- Acetaminophen [**Telephone/Fax (1) 1999**] mg PO/NG Q6H:PRN pain or fever
- Piperacillin-Tazobactam 4.5 g IV Q8H
- Aspirin 325 mg PO/NG DAILY
- Atorvastatin 80 mg PO/NG DAILY
- Clopidogrel 75 mg PO/NG DAILY
- Vancomycin 1000 mg IV Q 12H
- Heparin IV Sliding Scale
- Voriconazole 200 mg PO Q12H
- Lisinopril 5 mg PO/NG DAILY


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 511**] Home Therapies

Discharge Diagnosis:
Primary:
Pneumonia
NSTEMI
Atrial Fibrillation
AML s/p induction chemotherapy

Secondary:
AML


Discharge Condition:
Vitals stable
Ambulating
Alert and Oriented to person, place, time and purpose


Discharge Instructions:
You were admitted to the hospital with chest pain and came to
the ICU for low blood blood pressure and concern for infection.
You are being treated with iv antibiotics for pneumonia and you
had a PICC line placed.  You will received the iv antibiotics at
home for an additional 3 days.

You should continue taking the Plavix 75 mg once a day (a
medication for the stents placed in the blood vessels in your
heart). You will need to take this for at least one month.  Dr.
[**First Name (STitle) 437**] will determine if you need to take this longer.
Additionally, you must continue to take a full strength aspirin
indefinitely.

The following medications were added:
- Cefepime 2g iv twice a day through [**2150-1-3**]
- Vancomycin 1g iv twice a day through [**2150-1-3**]
- Oral Vancomycin 250mg four times a day, you will continue
taking this through [**2150-1-11**]
- Amiodarone 400mg twice a day for one week, then 200mg once a
day for another 3 weeks.  This is for your abnormal heart rhythm
(atrial fibrillation).  Dr. [**Last Name (STitle) **] will determine if you need
to take this for a longer period of time.

Appointments have been made for you for cardiology (Dr. [**First Name (STitle) 437**]
and Dr. [**Last Name (STitle) **], infectious disease (Dr. [**Last Name (STitle) 724**], Oncology (Dr.
[**Last Name (STitle) **].  If you need to change them, please call the
numbers listed below.

It was a pleasure meeting you and participating in your care.

Followup Instructions:
PICC Line Removal:
7 [**Hospital Ward Name 1826**] Outpatient Clinic
[**2150-1-5**] at 1pm (you can come over after your cardiology
appointment)

Hematology/Oncology:
Dr. [**Last Name (STitle) **]
[**2150-1-6**] at 1pm
7 [**Hospital Ward Name 1826**] Outpatient Clinic

CARDIOLOGY:
Dr. [**First Name (STitle) 437**]: Phone:[**Telephone/Fax (1) 62**] [**2150-1-5**] 4:00pm [**Hospital Ward Name 23**] [**Location (un) 436**]
Dr. [**Last Name (STitle) **]: Phone:[**Telephone/Fax (1) 62**]  [**2150-1-15**]  11:00am [**Hospital Ward Name 23**] [**Location (un) **]

Please follow up with your primary care doctor within one month
of discharge.
{'Unspecified septicemia,Pneumonia, organism unspecified,Subendocardial infarction, initial episode of care,Acute myeloid leukemia, without mention of having achieved remission,Chronic systolic heart failure,Intestinal infection due to Clostridium difficile,Sepsis,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}


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: 61 yo male with hx AML, s/p 7+3 induction chemo with idarubicin
and cytarabine (Day 1=[**2149-11-23**]), complicated aspergillus
pneumonia tx with voriconazole. Also, pt found to have a newly
depressed EF to 30-40% with focal hypokinesis. He had a left
heart cath that found 3VD and had 3 BMS placed to LAD, 1
proximal and 2 to the mid LAD on [**2149-12-24**]. The pt was discharged
on [**2149-12-26**] on aspirin and plavix. He now presents with a chief
complaint of chest pain starting this morning.
.
This morning he felt "cold and clammy" and he had suddent onset
of chest pain. He describes the pain as dull/pressure, focused
in the center of his chest, [**7-7**]. It was non-radiating and
associated with diaphoresis and shortness of breath, but no
dizziness, palpitations, nausea or vomiting. Of note, he had
similar chest pain several months ago while raking leaves (pain
resolved on its own at that time). He called 911 and was taken
by the ambulance to the [**Hospital6 **]. CP resolved at OSH
with nitro and morphine. Trop T was elevated to 0.12 and EKG
showed no ischemic changes. He had a CTA showing no PE. He was
transferred to [**Hospital1 18**] for further management. In our ED, initial
vitals were T 96.2 HR 99 BP 105/73 RR14 SaO2 97%. He was given
vancomycin and zosyn, and blood cultures were sent. Also given
tylenol 650mg x 1. CEs were trending up.
.
Per nursing report prior to transfer the patient became
hypotensive and tachycardic when standing up. He was bolused
500cc and placed in a supine position.  On arrival to the floor
his vitals were T 100.7, HR 114, BP 108/65, SaO2 99% on 2L. He
denied any chest pain or pressure but did report feeling unable
to take a deep breath and feeling intermittent chills/rigors
throughout the afternoon. Additionally, he reported dysuria
starting this morning. He denied GI sx or productive cough. He
was given 1 liter NS, then given demerol for the rigors and his
BP dropped to 90s. He was started on a 3rd liter and his BP
improved. His temp increased to 102. His EKG showed some mild
STE vs J point elevation changes in the anterior leads,
cardiology felt it was not consistent with a instent thormbosis.
He was transfered to the unit for sepsis.
.
REVIEW OF SYSTEMS:
He denies GI sx, no hematuria or prior dsyuria other than today,
no cough, no vision changes, no neck stiffness. Had a mild HA
today. Has a tender right wrist (where cath was done).

MEDICAL HISTORY: -3VD (see HPI), BMS x 3 to LAD [**2149-12-24**]
-AML s/p induction chemo starting [**2149-11-23**]

MEDICATION ON ADMISSION: MEDICATIONS at home:
1. Clopidogrel 75 mg daily
2. Aspirin 325 mg daily
3. Voriconazole 200 mg Q12H
4. Lisinopril 5 mg daily
5. Toprol 37.5 mg daily
6. Atorvastatin 40 mg daily
.
Transfer Medications:
- Meperidine 12.5 mg IV ONCE
- Metoprolol Succinate XL 37.5 mg PO DAILY
- Oseltamivir 75 mg PO DAILY
- Acetaminophen [**Telephone/Fax (1) 1999**] mg PO/NG Q6H:PRN pain or fever
- Piperacillin-Tazobactam 4.5 g IV Q8H
- Aspirin 325 mg PO/NG DAILY
- Atorvastatin 80 mg PO/NG DAILY
- Clopidogrel 75 mg PO/NG DAILY
- Vancomycin 1000 mg IV Q 12H
- Heparin IV Sliding Scale
- Voriconazole 200 mg PO Q12H
- Lisinopril 5 mg PO/NG DAILY

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
VS: temp- T- 101.4 HR- 130 BP 106/60 RR-15 Sat- 99% 2 liters
GENERAL: NAD. Oriented x3. Mood, affect appropriate. Eyes closed
during most of the exam
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
NECK: Supple with no LAD
CARDIAC: RR, normal S1, S2. No m/r/g. No S3 or S4. 2+ pulses
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. +BS
EXTREMITIES: No c/c/e.
SKIN: No rashs, skin warm and moist
NEURO: altert, cn 2-12 grossly intact, gait not assessed, moving
all limbs appropriately

FAMILY HISTORY: Brother with AML s/p transplant here at [**Hospital1 18**] in [**2145**]. Father
with a history of "multiple small heart attacks," but died in
his 80s.

SOCIAL HISTORY: Married here with wife. [**Name (NI) **] daughter & son. both married & live
an hour away.
-Tobacco history: denies
-ETOH: denies
-Illicit drugs: denies 

### Response:
{'Unspecified septicemia,Pneumonia, organism unspecified,Subendocardial infarction, initial episode of care,Acute myeloid leukemia, without mention of having achieved remission,Chronic systolic heart failure,Intestinal infection due to Clostridium difficile,Sepsis,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}
