CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 73 y.o. woman w/ PMH significant for DM, ESRD, initially
presenting from dialysis w/ substernal chest pain. The pain felt
tight, like pressure in the middle of her chest. It was not
associated with radiation to her arms or jaw, was not associated
with nausea, or diaphoresis. The patient reports having this
pain frequently, however, she reports never having been
hospitalized for the pain. However, the patient was admitted
last week with the same chief complaint. Apparently, the patient
is sensitive to fluid shifts given her HOCM, and this is the
precipitant of her chest pain. Her chest pain is non-exertional
in nature. She denies SOB, orthopnea, PND. She denies fever. She
reports having a productive cough, without hemoptysis. She
denies palpitations, lightheadedness, or headache. She denies
brbpr, or melena.
.
In the ED:her vitals were 97.3 126/92 130s 20 100%2L. ekg showed
ST depressions. Troponins positive 0.18. She received lopressor
5mg IV X1, some IVF, and SL nitro. Her pain resolved.

MEDICAL HISTORY: PMH:
- Hypertension
- Diabetes
- Peripheral vascular disease status post bilateral knee
amputations in [**2146**] (L) and [**2157**] (R)
- GERD
- Hypercholesterolemia
- ESRD on hemodialysis M,W,F. Receives dialysis at [**Location (un) **]
hemodialysis center in [**Location (un) **].
- Paroxysmal atrial flutter, s/p failed ablation
- Peptic ulcer disease
- Hypertrophic obstructive cardiomyopathy
- Mild mitral stenosis (MVA 1.5-2.0 cm2)
- Secondary Hyperparathyroidism
.
PSurgH:
- Peripheral vascular disease status post bilateral knee
amputations in [**2146**] (L) and [**2157**] (R)

MEDICATION ON ADMISSION: Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic Q8H
Dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic TID
Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS
Aspirin 81 mg Tablet daily
Sevelamer HCl 800 mg Tablet Sig: One (1) Tablet PO TID with
meals
Warfarin 3 mg daily
Simvastatin 40 mg Tablet daily
Ranitidine HCl 150 mg Tablet once daily
Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **]
Prednisolone Acetate 1 % Drops, Suspension Sig: One (1) Drop
four times daily
Metoprolol Tartrate 50 mg [**Hospital1 **]
Diltiazem HCl 120 mg Capsule
Insulin NPH Human 16 units QAM

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T:97.9 P:91 BP:137/60 R:18 SaO2:92% 2L
General: Awake, alert, NAD.
HEENT: NC/AT, PERRL, left pupil unresponsive EOMI without
nystagmus, no scleral icterus noted, MMM, no lesions noted in OP

FAMILY HISTORY: Her father died in his 90's and mother at the age of 102.
Patient unable to specify cause of death. She has one living
sister and 6 sisters and one brother who passed away. Her family
history is significant for coronary artery disease, cancer, and
diabetes.

SOCIAL HISTORY: Social history is significant for the presence of current
tobacco use (1 pack per week), and [**12-22**] PPD x 50 years. There is
no history of alcohol abuse. Lives in [**Hospital3 **] facility
and uses a mobile wheelchair or a walker.
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Cardiac arrest,Acute respiratory failure,Other primary cardiomyopathies,Secondary hyperparathyroidism (of renal origin),Chest pain, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of native arteries of the extremities, unspecified,Esophageal reflux,Altered mental status,Hyperpotassemia,Other and unspecified hyperlipidemia,Unspecified glaucoma,Below knee amputation status
Mal hyp kid w cr kid V,End stage renal disease,Cardiac arrest,Acute respiratry failure,Prim cardiomyopathy NEC,Sec hyperparathyrd-renal,Chest pain NOS,DMII wo cmp nt st uncntr,Athscl extrm ntv art NOS,Esophageal reflux,Altered mental status,Hyperpotassemia,Hyperlipidemia NEC/NOS,Glaucoma NOS,Status amput below knee
Name:  [**Known lastname **],[**Known firstname 194**]                  Unit No:   [**Numeric Identifier 17893**]

Admission Date:  [**2163-3-23**]              Discharge Date:   [**2163-4-5**]

Date of Birth:  [**2090-1-9**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 16607**]
Addendum:
Code Status: full code

Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Health Care - [**Hospital1 **]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 16608**] MD [**Last Name (un) 16609**]

Completed by:[**2163-4-5**]

Admission Date:  [**2163-3-23**]              Discharge Date:   [**2163-4-5**]

Date of Birth:  [**2090-1-9**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 30201**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
none

History of Present Illness:
73 y.o. woman w/ PMH significant for DM, ESRD, initially
presenting from dialysis w/ substernal chest pain. The pain felt
tight, like pressure in the middle of her chest. It was not
associated with radiation to her arms or jaw, was not associated
with nausea, or diaphoresis. The patient reports having this
pain frequently, however, she reports never having been
hospitalized for the pain. However, the patient was admitted
last week with the same chief complaint. Apparently, the patient
is sensitive to fluid shifts given her HOCM, and this is the
precipitant of her chest pain. Her chest pain is non-exertional
in nature. She denies SOB, orthopnea, PND. She denies fever. She
reports having a productive cough, without hemoptysis. She
denies palpitations, lightheadedness, or headache. She denies
brbpr, or melena.
.
In the ED:her vitals were 97.3 126/92 130s 20 100%2L. ekg showed
ST depressions. Troponins positive 0.18. She received lopressor
5mg IV X1, some IVF, and SL nitro. Her pain resolved.

Past Medical History:
PMH:
- Hypertension
- Diabetes
- Peripheral vascular disease status post bilateral knee
amputations in [**2146**] (L) and [**2157**] (R)
- GERD
- Hypercholesterolemia
- ESRD on hemodialysis M,W,F. Receives dialysis at [**Location (un) **]
hemodialysis center in [**Location (un) **].
- Paroxysmal atrial flutter, s/p failed ablation
- Peptic ulcer disease
- Hypertrophic obstructive cardiomyopathy
- Mild mitral stenosis (MVA 1.5-2.0 cm2)
- Secondary Hyperparathyroidism
.
PSurgH:
- Peripheral vascular disease status post bilateral knee
amputations in [**2146**] (L) and [**2157**] (R)

Social History:
Social history is significant for the presence of current
tobacco use (1 pack per week), and [**12-22**] PPD x 50 years. There is
no history of alcohol abuse. Lives in [**Hospital3 **] facility
and uses a mobile wheelchair or a walker.


Family History:
Her father died in his 90's and mother at the age of 102.
Patient unable to specify cause of death. She has one living
sister and 6 sisters and one brother who passed away. Her family
history is significant for coronary artery disease, cancer, and
diabetes.


Physical Exam:
Vitals: T:97.9 P:91 BP:137/60 R:18 SaO2:92% 2L
General: Awake, alert, NAD.
HEENT: NC/AT, PERRL, left pupil unresponsive EOMI without
nystagmus, no scleral icterus noted, MMM, no lesions noted in OP

Neck: supple, no JVD or carotid bruits appreciated
Pulmonary: Lungs crackles at bases bilaterally
Cardiac: irregular, nl. 3/6 systolic murmur at RUSB.
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: fistula w/ palpable thrill on left upper extremity.
b/l bka. radial pulse 2+ b/l
Skin: no rashes or lesions noted.
Neurologic:
-mental status: Alert, oriented x 3. Able to relate history
without difficulty.
-cranial nerves: II-XII intact
-motor: normal bulk, strength and tone throughout. No abnormal
movements noted.

Pertinent Results:
[**2163-3-23**] 10:00AM   WBC-7.6 RBC-3.60* HGB-10.5* HCT-35.0* MCV-97
MCH-29.3 MCHC-30.1* RDW-17.6*
[**2163-3-23**] 10:00AM   NEUTS-77.2* LYMPHS-16.3* MONOS-5.1 EOS-1.0
BASOS-0.4
[**2163-3-23**] 10:00AM   GLUCOSE-140* UREA N-16 CREAT-3.4*# SODIUM-145
POTASSIUM-5.6* CHLORIDE-102 TOTAL CO2-29 ANION GAP-20
.
Rib Films ([**2163-3-30**])
No fracture. Persistent CHF. Right-sided PICC unchanged.
.
Echo ([**2163-3-24**])The left atrium is moderately dilated. There is
severe symmetric left ventricular hypertrophy. The left
ventricular cavity is unusually small. Left ventricular systolic
function is hyperdynamic (EF>75%). There is a mild resting left
ventricular outflow tract obstruction. Right ventricular chamber
size and free wall motion are normal. The aortic valve leaflets
are moderately thickened. There is severe mitral annular
calcification. There is moderate functional mitral stenosis
(mean gradient 9 mmHg) due to mitral annular calcification.
Trivial mitral regurgitation is seen. [Due to acoustic
shadowing, the severity of mitral regurgitation may be
significantly UNDERestimated.] There is moderate pulmonary
artery systolic hypertension. There is a small pericardial
effusion.
IMPRESSION: Severe symmetric LVH with a small cavity and
hyperdynamic systolic function. Minimal resting LVOT
obstruction. Moderate functional mitral stenosis. Moderate
pulmonary hypertension.
.
Head CT ([**2163-4-4**])
FINDINGS: There is no evidence of hemorrhage, mass,
hydrocephalus, shift of normally midline structures, or major
vascular territorial infarction.
Periventricular [**Known lastname **] matter hypodensities are consistent with
mildly severe small vessel ischemic disease. A hyperdensity in
the left frontal lobe in the suprasellar region may represent
partial volume averaging or a small meningioma. Tiny
calcifications are again noted in the basal ganglia. A punctate
calcification along the sulci in the right parietal region is
unchanged. There is no fracture. The visualized paranasal
sinuses and the mastoid air cells are well aerated.
IMPRESSION:
1. No evidence of acute intracranial hemorrhage.
2. Mildly severe small vessel ischemic disease.
3. Hyperdensity in the left frontal lobe in the suprasellar
region may
represent partial volume averaging versus a small meningioma.
Attention to
this region is recommended on followup imaging.

Brief Hospital Course:
The patient was initially admitted for an episode of SSCP
following her usual dialysis. She has had this pain before and
was recently admitted for CP. She denied radiation, nausea,
diaphoresis, palps, SOB with her pain. This pain has been
attributed to her HOCM due to fluid shifts during her dialysis.
She otherwise denied F/C, HA, lightheadedness.
.
Following admission, her hospital course was uneventful until
about 1AM on HD1. At that time, the patient awoke agitated and
complaining of SOB. 02 96% on 5L NC and lungs with crackles per
report. She then quickly developed more difficulty breathing and
became somnolent. Code blue was called.  BP of 90s systolic, FS
71.  She subsequently became more somnolent and became
bradycardic. She lost per pulse and PEA arrest was called. Chest
compressions were initiated. She was given 1mg atropine with
improvement in her HR to 100s, 110/50->170s. Pt was also given
CaCL, HC03, insulin/D50 for presumed hyperkalemia given previous
K 5.6 (hemolyzed). A R femoral CVL was placed. The patient was
intubated and transferred to the MICU. In the MICU, she improved
rapidly with supportive care and was extubated. The precise
cause of her respiratory failure and PEA arrest were unable to
be determined, although fluid shifts related to HD, perhaps with
associated metabolic derrangments were strongly suspected. The
pt was transferred to the general medical floor on [**2163-3-31**].
.
On the floor, the pt remained stable. Her medication regimen was
optimized. HD was continued. Her continued treatment by problem
included the following:
.
Hypertension: The pt required IV labetalol for hypertensive
urgency twice during her admission, however her BP stabilized as
her overall status improved. Metoprolol, diltiazem and
lisinopril, along with hemodialysis, were continued.
.
Obstructive cardiomyopathy: An echo performed during the pt's
admission confirmed mild to moderate resting left ventricular
outflow tract obstruction. This was attributed to long-standing
hypertensive heart disease. Based on this finding and the pt's
clinical course, it is felt that she is very sensitive to fluid
shifts, particularly as may occur during HD. The pt's ASA, BB
and ACEi were continued. Tight BP and heart rate control were
maintained as best as possible. Cardiology was involved in the
pt's clear.  Caution should used in giving the patient agents
that will reduce pre-load or afterload as doing this may worsen
the patient's outflow tract obstruction.
.
Chest Pain: The pt complained of very frequent chest and arm
discomfort during much of her hospital stay.  Her initial chest
pain was thought to be related to her obstructive cardiac
physiology.  Multiple ECGs were checked and did not show
abnormalities compared to baseline; she was ruled out for MI at
the beginning of her course by biomarkers.  Following her
cardiac arrest, which included chest compressions, the patient
developed more persistent central, non-radiating chest pain that
was worse with movement.  The chest pain was reproducible on
exam.  It is thought that the pain is musculoskeletal in origin
from the trauma sustained during the chest compressions.  Rib
films were negative for fracture.  The pt had some relief with
Tylenol, though low dose oxycodone was more effective.  There
was a reluctance to use narcotics, as it was thought these may
alter the pt's mental status.  However, she did seem to tolerate
2.5mg of oxycodone.
.
Mental status changes: The pt was noted by providers and family
members to be slightly off her mental baseline. Her neuro exam
was consistently non-focal. A work-up for delirium, include two
UAs, TSH, Folate, B12 and RPR testing was unrevealing. A head CT
was obtained on the day prior to discharge which showed small
vessel ischemic changes but no acute findings. Ultimately it was
thought that the pt's altered mental status may have been the
result of anoxic injury that occurred during her cardiac arrest.
.
ESRD: Three times weekly hemodialysis was continued during the
pt's stay. She was followed by the renal team. Sevelemer and
Nephrocaps were continued. At future HD sessions, the pt be
premedicated with beta blocker and will not have more than 1 kg
of fluid removed to help maintain her hemodynamics in the
setting of her obstructive cardiac physiology.
.
PAF/Flutter: The pt's HR was well-controlled on diltiazem and
metoprolol. Anticoagulation with Coumadin was continued. ***At
the time of discharge, the pt's INR was elevated at 4.4, and
thus her Coumadin was being held.*** Close monitoring of the INR
over the next few days is highly suggested.
.
Hyperlipidemia: Simvastatin 40 mg QHS was continued.
.
PVD: Aspirin was continued.
.
DM: The pt's home insulin was continued with a sliding scale.
Her blood sugar remained under good control.
.
Glaucoma: The pt's home eye drops were continued.
.
GERD/PUD: Ranitidine was continued.

Medications on Admission:
Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic Q8H
Dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic TID
Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS
Aspirin 81 mg Tablet daily
Sevelamer HCl 800 mg Tablet Sig: One (1) Tablet PO TID with
meals
Warfarin 3 mg daily
Simvastatin 40 mg Tablet daily
Ranitidine HCl 150 mg Tablet once daily
Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **]
Prednisolone Acetate 1 % Drops, Suspension Sig: One (1) Drop
four times daily
Metoprolol Tartrate 50 mg [**Hospital1 **]
Diltiazem HCl 120 mg Capsule
Insulin NPH Human 16 units QAM

Discharge Medications:
1. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Sixteen
(16) units Subcutaneous with breakfast every morning.
2. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.
3. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic Q8H
(every 8 hours).
4. Dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic TID (3
times a day).
5. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
6. Sevelamer HCl 800 mg Tablet Sig: One (1) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
7. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO at bedtime.
8. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO qAM.
9. Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **]
(2 times a day).
10. Prednisolone Acetate 1 % Drops, Suspension Sig: One (1) Drop
Ophthalmic QID (4 times a day).
11. Metoprolol Tartrate 100 mg Tablet Sig: One (1) Tablet PO
three times a day: To be given every day, including dialysis
days.
12. Irbesartan 150 mg Tablet Sig: One (1) Tablet PO daily ().
13. Nephrocaps 1 mg Capsule Sig: One (1) Capsule PO once a day.

14. Calcium Acetate 667 mg Capsule Sig: Two (2) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
15. Humalog 100 unit/mL Cartridge Sig: sliding scale units
Subcutaneous four times daily; with meals and at bedtime:
Standard sliding scale with coverage beginnig with 2 units at
150 and increasing by 2 units for every 50 point increase in BS.

16. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
17. Albuterol Sulfate 0.63 mg/3 mL Solution for Nebulization
Sig: One (1) neb Inhalation every six (6) hours as needed for
shortness of breath or wheezing.
18. Lisinopril 30 mg Tablet Sig: One (1) Tablet PO once a day.
19. Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
20. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical Q 24H (Every 24 Hours)
as needed for pain.
21. Warfarin 3 mg Tablet Sig: One (1) Tablet PO once a day:
***This medication was being held at the time of discharge due
to an elevated INR.***.
22. dialysis
Pt's next hemodialysis scheduled for [**2163-4-6**] at 6:15 AM at
[**Location (un) **] in [**Location (un) **], MA.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Health Care - [**Hospital1 **]

Discharge Diagnosis:
hypertension
kidney disease on dialysis
hypercholesterolemia
GERD
peripheral vascular disease
glaucoma
atrial flutter
diabetes
s/p cardiac arrest


Discharge Condition:
Vitals stable, improved overall.


Discharge Instructions:
-You were admitted with chest pain. Testing has not identified a
precise cause for this, however we do not believe it due to a
problem with your heart. During your stay, your hospital course
was complicated  by a cardiac arrest that required treatment in
the ICU. You underwent CPR and were on a breathing machine for a
short period.  Following the CPR, you developed more persistent
chest pain, which we think was due to the chest compressions.
Again, there was not clear evidence for a heart attack as the
cause of your pain.

You have now recovered and are going to a rehab facility to help
regain your strength.
-It is important that you continue to take your medications as
directed. On this admission, lisinopril was added and metoprolol
was increased to better control your blood pressure.
-Contact your doctor or come to the Emergency Room should your
symptoms return. Also seek medical attention if you develop any
new fever, chills, trouble breathing, chest pain, nausea,
vomiting or unusual stools.

Followup Instructions:
Please call Dr.[**Name (NI) 51374**] office at [**Telephone/Fax (1) 250**] to schedule
a follow-up appointment when you are discharged from rehab.
.
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2163-5-18**] 10:40
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Cardiac arrest,Acute respiratory failure,Other primary cardiomyopathies,Secondary hyperparathyroidism (of renal origin),Chest pain, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of native arteries of the extremities, unspecified,Esophageal reflux,Altered mental status,Hyperpotassemia,Other and unspecified hyperlipidemia,Unspecified glaucoma,Below knee amputation 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: chest pain

PRESENT ILLNESS: 73 y.o. woman w/ PMH significant for DM, ESRD, initially
presenting from dialysis w/ substernal chest pain. The pain felt
tight, like pressure in the middle of her chest. It was not
associated with radiation to her arms or jaw, was not associated
with nausea, or diaphoresis. The patient reports having this
pain frequently, however, she reports never having been
hospitalized for the pain. However, the patient was admitted
last week with the same chief complaint. Apparently, the patient
is sensitive to fluid shifts given her HOCM, and this is the
precipitant of her chest pain. Her chest pain is non-exertional
in nature. She denies SOB, orthopnea, PND. She denies fever. She
reports having a productive cough, without hemoptysis. She
denies palpitations, lightheadedness, or headache. She denies
brbpr, or melena.
.
In the ED:her vitals were 97.3 126/92 130s 20 100%2L. ekg showed
ST depressions. Troponins positive 0.18. She received lopressor
5mg IV X1, some IVF, and SL nitro. Her pain resolved.

MEDICAL HISTORY: PMH:
- Hypertension
- Diabetes
- Peripheral vascular disease status post bilateral knee
amputations in [**2146**] (L) and [**2157**] (R)
- GERD
- Hypercholesterolemia
- ESRD on hemodialysis M,W,F. Receives dialysis at [**Location (un) **]
hemodialysis center in [**Location (un) **].
- Paroxysmal atrial flutter, s/p failed ablation
- Peptic ulcer disease
- Hypertrophic obstructive cardiomyopathy
- Mild mitral stenosis (MVA 1.5-2.0 cm2)
- Secondary Hyperparathyroidism
.
PSurgH:
- Peripheral vascular disease status post bilateral knee
amputations in [**2146**] (L) and [**2157**] (R)

MEDICATION ON ADMISSION: Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic Q8H
Dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic TID
Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS
Aspirin 81 mg Tablet daily
Sevelamer HCl 800 mg Tablet Sig: One (1) Tablet PO TID with
meals
Warfarin 3 mg daily
Simvastatin 40 mg Tablet daily
Ranitidine HCl 150 mg Tablet once daily
Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **]
Prednisolone Acetate 1 % Drops, Suspension Sig: One (1) Drop
four times daily
Metoprolol Tartrate 50 mg [**Hospital1 **]
Diltiazem HCl 120 mg Capsule
Insulin NPH Human 16 units QAM

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T:97.9 P:91 BP:137/60 R:18 SaO2:92% 2L
General: Awake, alert, NAD.
HEENT: NC/AT, PERRL, left pupil unresponsive EOMI without
nystagmus, no scleral icterus noted, MMM, no lesions noted in OP

FAMILY HISTORY: Her father died in his 90's and mother at the age of 102.
Patient unable to specify cause of death. She has one living
sister and 6 sisters and one brother who passed away. Her family
history is significant for coronary artery disease, cancer, and
diabetes.

SOCIAL HISTORY: Social history is significant for the presence of current
tobacco use (1 pack per week), and [**12-22**] PPD x 50 years. There is
no history of alcohol abuse. Lives in [**Hospital3 **] facility
and uses a mobile wheelchair or a walker. 

### Response:
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Cardiac arrest,Acute respiratory failure,Other primary cardiomyopathies,Secondary hyperparathyroidism (of renal origin),Chest pain, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of native arteries of the extremities, unspecified,Esophageal reflux,Altered mental status,Hyperpotassemia,Other and unspecified hyperlipidemia,Unspecified glaucoma,Below knee amputation status'}
