CHIEF COMPLAINT: congestive heart failure

PRESENT ILLNESS: 58 year old male with a history of Type II DM, HTN,
hyperlipdiemia, and ischemic heart disease (EF 20%,
medicallymanaged)recently admitted with NYHA class III symptoms.
The patient was wintering in [**State 108**] and developed
chest pain and R/I for NSTEMI. Per the patient's report, he was
admitted to the ICU for observation given his presenting
asymptomatic SBP in the 70s mmHg; he did not require IABP or
assist device.  TTE showed severely depressed LVEF 15-20%,
consistent with admission TTE on [**2141-8-18**]. LHC was performed
during this admission, with mild progression of his CAD with LAD
80%,D1 95%, D2 70% OM1/OM2 70/90%, chronic total occlusion RCA.
The patient was counseled on ICD placement by his providers in
[**State 108**] but declined at that time. He had been medically managed
for systolic left heart failure with Diovan, Coreg, and Lasix
since that time.  He reports progressive DOE, weight gain, and
worsening LE edema over the past month. He denied chest pain,
orthopnea, PND, pre-syncope/syncope.  He presented to [**Hospital1 18**] with
LE edema and has been managed with diuretics, beta blockade, and
[**Last Name (un) **]. Since admission, the patient notes improvement in his LE
edema. Csurg was consulted for evaluation for CABG

MEDICAL HISTORY: Multivessel CAD, medically managed
Prior MI w/ systolic HF of 40%
Mild MR
HTN
Hyperlipidemia
DM2 w/ complications

MEDICATION ON ADMISSION: -1. Aspirin 325 mg Tablet [**Location (un) **]: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Lisinopril

PHYSICAL EXAM: Admission:
VS - 98.8 97/68 87 20 100RA
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Father is a diabetic. Mother with CAD with stent in her 70s. He
has 5 brothers and 1 sister. His sister died from a "staph
infection." His brother died from CAD and cocaine use.

SOCIAL HISTORY: Worked as a firefighter and EMT but now on disability.
Former heavy smoker (>25 pack years)quit back in [**2135**].
ETOH: very heavily (over a case a week)in past, no alcohol in
over a year.
Declines any history of drug use.
Lives alone. Has a 26 year old son.
Coronary atherosclerosis of native coronary artery,Cardiac arrest,Acute on chronic systolic heart failure,Cardiogenic shock,Cardiac complications, not elsewhere classified,Jaundice, unspecified, not of newborn,Unspecified pleural effusion,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Oliguria and anuria,Subendocardial infarction, subsequent episode of care,Personal history of tobacco use,Other and unspecified hyperlipidemia,Mitral valve disorders,Diseases of tricuspid valve,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other diseases of trachea and bronchus,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage II (mild),Old myocardial infarction
Crnry athrscl natve vssl,Cardiac arrest,Ac on chr syst hrt fail,Cardiogenic shock,Surg compl-heart,Jaundice NOS,Pleural effusion NOS,Abn react-anastom/graft,Oliguria & anuria,Subendo infarct, subseq,History of tobacco use,Hyperlipidemia NEC/NOS,Mitral valve disorder,Tricuspid valve disease,DMII wo cmp nt st uncntr,Trachea & bronch dis NEC,Hy kid NOS w cr kid I-IV,Chro kidney dis stage II,Old myocardial infarct
Admission Date:  [**2141-8-28**]              Discharge Date:   [**2141-9-18**]

Date of Birth:  [**2083-4-2**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Lisinopril

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
congestive heart failure

Major Surgical or Invasive Procedure:
coronary artery bypass grafts x5
(LIMA-LAD,SVG-mg,SVG-OM1,SVG-OM2,SVG-PDA)[**2141-9-1**]
Placement of intra-aortic balloon [**2141-9-4**]
closed thoracostomy -left [**2141-9-11**]
fiberoptic bronchoscopy [**2141-9-5**]


History of Present Illness:
58 year old male with a history of Type II DM, HTN,
hyperlipdiemia, and ischemic heart disease (EF 20%,
medicallymanaged)recently admitted with NYHA class III symptoms.
The patient was wintering in [**State 108**] and developed
chest pain and R/I for NSTEMI. Per the patient's report, he was
admitted to the ICU for observation given his presenting
asymptomatic SBP in the 70s mmHg; he did not require IABP or
assist device.  TTE showed severely depressed LVEF 15-20%,
consistent with admission TTE on [**2141-8-18**]. LHC was performed
during this admission, with mild progression of his CAD with LAD
80%,D1 95%, D2 70% OM1/OM2 70/90%, chronic total occlusion RCA.
The patient was counseled on ICD placement by his providers in
[**State 108**] but declined at that time. He had been medically managed
for systolic left heart failure with Diovan, Coreg, and Lasix
since that time.  He reports progressive DOE, weight gain, and
worsening LE edema over the past month. He denied chest pain,
orthopnea, PND, pre-syncope/syncope.  He presented to [**Hospital1 18**] with
LE edema and has been managed with diuretics, beta blockade, and
[**Last Name (un) **]. Since admission, the patient notes improvement in his LE
edema. Csurg was consulted for evaluation for CABG


Past Medical History:
Multivessel CAD, medically managed
Prior MI w/ systolic HF of 40%
Mild MR
HTN
Hyperlipidemia
DM2 w/ complications

Social History:
Worked as a firefighter and EMT but now on disability.
Former heavy smoker (>25 pack years)quit back in [**2135**].
ETOH: very heavily (over a case a week)in past, no alcohol in
over a year.
Declines any history of drug use.
Lives alone. Has a 26 year old son.


Family History:
Father is a diabetic. Mother with CAD with stent in her 70s. He
has 5 brothers and 1 sister. His sister died from a "staph
infection." His brother died from CAD and cocaine use.

Physical Exam:
Admission:
VS - 98.8 97/68 87 20 100RA
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

Neck: Supple with JVP of jaw line.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NT, slightly distended, no shifting dullness. No HSM
or tenderness. Abd aorta not enlarged by palpation. No
abdominial bruits.
Ext: 1+ pretibial edema to knee. No c/c. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
.
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:
[**2141-8-28**] 12:00PM BLOOD WBC-6.5 RBC-3.61* Hgb-9.0* Hct-29.1*
MCV-81* MCH-25.0* MCHC-31.1 RDW-21.0* Plt Ct-317
[**2141-8-28**] 12:00PM BLOOD Glucose-187* UreaN-17 Creat-1.1 Na-134
K-4.3 Cl-101 HCO3-24 AnGap-13
[**2141-8-29**] 06:10AM BLOOD ALT-20 AST-24 CK(CPK)-48 AlkPhos-87
TotBili-2.2* DirBili-1.2* IndBili-1.0
[**2141-9-14**] 02:54AM BLOOD ALT-39 AST-76* LD(LDH)-265* AlkPhos-116
TotBili-19.9*
[**2141-8-28**] 12:00PM BLOOD proBNP-8511*
[**2141-8-28**] 12:00PM BLOOD cTropnT-0.02*
Discharge:
[**2141-9-18**] 06:45AM BLOOD WBC-12.5* RBC-3.18* Hgb-9.2* Hct-28.8*
MCV-91 MCH-28.8 MCHC-31.8 RDW-25.7* Plt Ct-420
[**2141-9-18**] 06:45AM BLOOD Plt Ct-420
[**2141-9-13**] 03:51AM BLOOD PT-18.5* PTT-30.3 INR(PT)-1.7*
[**2141-9-18**] 06:45AM BLOOD Glucose-90 UreaN-24* Creat-1.0 Na-140
K-4.0 Cl-108 HCO3-23 AnGap-13
[**2141-9-18**] 06:45AM BLOOD ALT-53* AST-89* AlkPhos-117 TotBili-12.2*
[**2141-9-13**] 03:51AM BLOOD ALT-33 AST-68* LD(LDH)-241 AlkPhos-82
Amylase-15 TotBili-19.7*
[**2141-9-13**] 03:51AM BLOOD Lipase-146*

Radiology Report CHEST (PA & LAT) Study Date of [**2141-9-15**] 1:41 PM

Final Report CHEST RADIOGRAPH: INDICATION: Status post CABG.
COMPARISON: [**2141-9-13**].
FINDINGS: As compared to the previous radiograph, there is no
relevant
change. The pre-existing right IG line has been removed. The
nasogastric
tube and the left PICC line are in unchanged position. The left
chest tube
has also been removed. Moderate cardiomegaly. No evidence of
pneumothorax.
No pulmonary edema. Presence of a minimal left pleural effusion
cannot be
excluded.
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**]

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
[**Known lastname 56817**], [**Known firstname 1775**]   [**Hospital1 18**] [**Numeric Identifier 56819**]  Done [**2141-9-1**] at
10:28:05
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *4.5 cm  <= 4.0 cm
Left Ventricle - Septal Wall Thickness:  1.1 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.1 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  *6.0 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  20% to 25%  >= 55%
Aorta - Annulus:  2.1 cm  <= 3.0 cm
Aorta - Sinus Level:  3.2 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.9 cm  <= 3.0 cm
Aorta - Ascending:  3.3 cm  <= 3.4 cm
Aorta - Arch:  2.2 cm  <= 3.0 cm
Aorta - Descending Thoracic:  2.3 cm  <= 2.5 cm
Aortic Valve - LVOT diam:  2.1 cm
Tricuspid Valve - Peak Velocity:  0.3 m/sec
Findings
LEFT ATRIUM: Mild LA enlargement. Mild spontaneous echo contrast
in the body of the LA. Mild spontaneous echo contrast in the
LAA. Depressed LAA emptying velocity (<0.2m/s)
RIGHT ATRIUM/INTERATRIAL SEPTUM: No ASD by 2D or color Doppler.
LEFT VENTRICLE: Normal LV wall thickness. Moderately dilated LV
cavity. Severe global LV hypokinesis. Severely depressed LVEF.
RIGHT VENTRICLE: Moderate global RV free wall hypokinesis.
AORTA: Normal ascending aorta diameter. Normal aortic arch
diameter. Normal descending aorta diameter.
AORTIC VALVE: Normal aortic valve leaflets (3). No AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild to
moderate ([**2-4**]+) MR.
TRICUSPID VALVE: Mild to moderate [[**2-4**]+] TR.
PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.
PERICARDIUM: No pericardial effusion.
GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications. The patient appears to be in sinus rhythm.
Emergency study. Results were personally reviewed with the MD
caring for the patient. See Conclusions for post-bypass data The
post-bypass study was performed while the patient was receiving
vasoactive infusions (see Conclusions for listing of
medications).
REGIONAL LEFT VENTRICULAR WALL MOTION:
     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PREBYPASS:
The left atrium is mildly dilated. Mild spontaneous echo
contrast is seen in the body of the left atrium and in the left
atrial appendage. No atrial septal defect is seen by 2D or [**Last Name (un) **].
The left atrial appendage emptying velocity is depressed
(<0.2m/s).
Left ventricular wall thicknesses are normal. The left
ventricular cavity is moderately dilated. There is septal
akinesis; the remaining left ventricular segments are
hypokinetic. Overall left ventricular systolic function is
severely depressed (LVEF= 20%).
RV with moderate global free wall hypokinesis.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion. No aortic regurgitation is seen.
Mild to moderate ([**2-4**]+) mitral regurgitation is seen The jet is
eccentric.
Mild to moderate ([**2-4**]+) tricuspid regurgitation is seen.
Bilateral pleural effusions.
POSTBYPASS:
The patient is on infusions of milrinone, vasopressin, and
norepinephrine.
Left ventricular function is slightly improved with an LVEF of
30%.
RV remains mildly depressed.
The mitral regurgitation is moderate (2+) with eccentricity.
(toward the posterior leaflet; obvious with the inotrope use?)
No aortic regurgitation is seen.
Aortic contours remain normal.
Dr. [**Last Name (STitle) **] and the surgical team were notified in person of the
results.
  I certify that I was present for this procedure in compliance
with HCFA regulations.
Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2141-9-4**] 09:32


Brief Hospital Course:
Patient was admitted to [**Hospital1 18**] for sysptoms consistent with heart
failure. Following initial assessment and diuresis cardiac
surgery was consulted to assess for bypass grafting. On [**9-1**] he
went to the Operating Room for coronary artery bypass grafting.
Please see operative report for details in summary he had:
Coronary artery bypass grafting x5 with the left internal
mammary artery to the left anterior descending
artery and reverse sequential saphenous vein graft to the right
acute marginal artery and the posterior descending artery, and
reverse saphenous vein graft to the first and second obtuse
marginal artery. His bypass TIME was 97 minutes, with a
CROSSCLAMP TIME of 80 minutes. He weaned from bypass on
Milrinone, Levophed and Vasopressin.  Following the operation he
was transferred to the cardiac surgery ICU on inotropic and
pressor support. The patient self extubated on POD1 following
which he suffered a VT arrest requiring chest compressions.
Epinephrine was added to his inotropic support, however, he
remained unstable and oliguric and an inta-aortic balloon was
placed.  Following IABP placement he stabilized and improved.
The balloon was removed on [**9-6**] and pressors gradually weaned.
His post-op course was further compromised by hypoxia, a
bronchoscopy was unrevealing but CXR showed a large effusion. A
CT was placed on [**9-11**] with improvement.  He was extubated on
POD8, initially very confused, gradually cleared.
It should also be noted that following his arrest the patient
had an elevated bilirubin and was seen by Hepatology. An
abdominal ultrasound was done and showed no evidence of
cholecystitis or biliary dilatation, moderate ascites and
periodic reversal of flow in the portal vein which can be seen
with right heart failure or tricuspid regurgitation. The
bilirubin peaked at 19 and gradually resolved w/o treatment.
Due to lethargy the patient had difficulty meeting his caloric
needs orally and tube feeding were utilized for nutrition
support transiently until oral intake was felt to be adequate.
All tubes, lines and drains were removed according to cardiac
surgery protocols.
The patient remained in the cardiac ICU for close monitoring
until POD13 when he was transferred to the stepdown floor. Once
on the floor he continue to make progress with his activity and
the remainder of his hospital course was uneventful.
On POD17 he was transferred to rehabilitation at Newbridge on
the [**Doctor Last Name **] in [**Location (un) 1411**]

Medications on Admission:
-1. Aspirin 325 mg Tablet [**Location (un) **]: One (1) Tablet PO DAILY (Daily).

-2. Atorvastatin 80 mg daily
- 3. Spironolactone 25 mg daily
4. Valsartan 80 mg daily
-5. Gabapentin 300 mg [**Hospital1 **] prn leg pain
-6. Carvedilol 6.25 mg [**Hospital1 **]
-7. Furosemide 20 mg daily
-8. Glipizide 5 mg [**Hospital1 **]
-9. Nitroglycerin 0.3 mg prn


Discharge Medications:
1. Spironolactone 25 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
2. Atorvastatin 80 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
3. Gabapentin 300 mg Capsule [**Hospital1 **]: One (1) Capsule PO BID (2
times a day) as needed for leg pain.
4. Ferrous Sulfate 300  mg (60 mg Iron) Tablet [**Hospital1 **]: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Glipizide 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO twice a day.
6. Aspirin 81 mg Tablet, Delayed Release (E.C.) [**Hospital1 **]: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
7. Docusate Sodium 100 mg Capsule [**Hospital1 **]: One (1) Capsule PO BID (2
times a day).
8. Magnesium Hydroxide 400 mg/5 mL Suspension [**Hospital1 **]: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
9. Acetaminophen 325 mg Tablet [**Hospital1 **]: Two (2) Tablet PO every [**7-11**]
hours as needed for pain.
10. Bisacodyl 10 mg Suppository [**Month/Day (3) **]: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
11. Carvedilol 12.5 mg Tablet [**Month/Day (3) **]: One (1) Tablet PO BID (2
times a day).
12. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
13. Glipizide 5 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID (2 times a
day).
14. Atorvastatin 80 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO HS (at
bedtime).
15. Furosemide 20 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
16. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
[**Last Name (STitle) **]: One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily).
17. Diovan 40 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
Newbridge on the [**Doctor Last Name **] - [**Location (un) 1411**]

Discharge Diagnosis:
coronary artery disease
s/p coronary artery bypass grafts x5
postoperative VT arrest
noninsulin dependent diabetes mellitus
hypertension
hyperlipidemia
ischemic cardiomyopathy
h/o gastrointestinal bleed
post-operative hyperbilirubinemia-unknown etiology


Discharge Condition:
Alert and oriented x3 ,nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions: Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage.
Edema: 1+ edema bilat


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
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**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 170**]) on [**10-18**] @ 1PM

Please call to schedule appointments with:
Primary Care: Dr. [**First Name4 (NamePattern1) 2174**] [**Last Name (NamePattern1) **] in [**2-4**] weeks
Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 437**] in [**2-4**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2141-9-18**]
{'Coronary atherosclerosis of native coronary artery,Cardiac arrest,Acute on chronic systolic heart failure,Cardiogenic shock,Cardiac complications, not elsewhere classified,Jaundice, unspecified, not of newborn,Unspecified pleural effusion,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Oliguria and anuria,Subendocardial infarction, subsequent episode of care,Personal history of tobacco use,Other and unspecified hyperlipidemia,Mitral valve disorders,Diseases of tricuspid valve,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other diseases of trachea and bronchus,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage II (mild),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: congestive heart failure

PRESENT ILLNESS: 58 year old male with a history of Type II DM, HTN,
hyperlipdiemia, and ischemic heart disease (EF 20%,
medicallymanaged)recently admitted with NYHA class III symptoms.
The patient was wintering in [**State 108**] and developed
chest pain and R/I for NSTEMI. Per the patient's report, he was
admitted to the ICU for observation given his presenting
asymptomatic SBP in the 70s mmHg; he did not require IABP or
assist device.  TTE showed severely depressed LVEF 15-20%,
consistent with admission TTE on [**2141-8-18**]. LHC was performed
during this admission, with mild progression of his CAD with LAD
80%,D1 95%, D2 70% OM1/OM2 70/90%, chronic total occlusion RCA.
The patient was counseled on ICD placement by his providers in
[**State 108**] but declined at that time. He had been medically managed
for systolic left heart failure with Diovan, Coreg, and Lasix
since that time.  He reports progressive DOE, weight gain, and
worsening LE edema over the past month. He denied chest pain,
orthopnea, PND, pre-syncope/syncope.  He presented to [**Hospital1 18**] with
LE edema and has been managed with diuretics, beta blockade, and
[**Last Name (un) **]. Since admission, the patient notes improvement in his LE
edema. Csurg was consulted for evaluation for CABG

MEDICAL HISTORY: Multivessel CAD, medically managed
Prior MI w/ systolic HF of 40%
Mild MR
HTN
Hyperlipidemia
DM2 w/ complications

MEDICATION ON ADMISSION: -1. Aspirin 325 mg Tablet [**Location (un) **]: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Lisinopril

PHYSICAL EXAM: Admission:
VS - 98.8 97/68 87 20 100RA
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Father is a diabetic. Mother with CAD with stent in her 70s. He
has 5 brothers and 1 sister. His sister died from a "staph
infection." His brother died from CAD and cocaine use.

SOCIAL HISTORY: Worked as a firefighter and EMT but now on disability.
Former heavy smoker (>25 pack years)quit back in [**2135**].
ETOH: very heavily (over a case a week)in past, no alcohol in
over a year.
Declines any history of drug use.
Lives alone. Has a 26 year old son. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Cardiac arrest,Acute on chronic systolic heart failure,Cardiogenic shock,Cardiac complications, not elsewhere classified,Jaundice, unspecified, not of newborn,Unspecified pleural effusion,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Oliguria and anuria,Subendocardial infarction, subsequent episode of care,Personal history of tobacco use,Other and unspecified hyperlipidemia,Mitral valve disorders,Diseases of tricuspid valve,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other diseases of trachea and bronchus,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage II (mild),Old myocardial infarction'}
