CHIEF COMPLAINT: Altered mental status

PRESENT ILLNESS: [**Age over 90 **] y/o F with PMHx of Afib, s/p PCM, CAD s/p MI, PVD and CVA who
was transferred from NH for unresponsiveness. Per report, pt has
been in her usual state of health and this morning, she awoke
and ambulated with her [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 56231**] to breakfast.
However, she became notably unresponsive while waiting for her
breakfast. Her initial BS was 84, SBP 140s-180s, 84% on RA and
withdrew to sternal rub. She appeared to be moving extremities
but was overall unresponsive. EMS was called and pt was
transferred to [**Hospital1 18**] ED.
.
In the ED, initial vs were: T 98.8 P 70 BP 105/56 R 20-24 O2sat
96% on 3L. Pt was noted to desat on 3L but was repositioned and
sats came back up. Pupils were notably pinpoint but reactive.
Head CT was negative for ICH, CTA was negative for PE but
revealed large right pleural effusion. Urine tox screen was
negative. Urine and blood Cx were sent and pt was given
Levofloxacin, Ceftriaxone and Vancomycin for possible PNA.
.
On arrival to the ICU, pt was minimally responsive. She
withdraws to sternal rub but does not respond to verbal stim.
She was given Narcan 0.6mg without any significant
.
Of note, pt ambulates [**Hospital1 56231**] at baseline. She completes
most ADLs [**Hospital1 56231**] and is very hard of hearing. She can
read english but speaks russian. Pt interacts appropriately with
neice but is not oriented at all times. Her baseline is slurred
speach and difficulty swallowing.
.
Review of systems per NH charge nurse:
No fever, chills, night sweats, rhinorrhea or congestion. Denied
cough, shortness of breath. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits.

MEDICAL HISTORY: CHF with EF of 75% from echo
Atrial Fib on coumadin
s/p PCM
CAD s/p MI in 79
DM II (diet controlled )
Multiple CVA
PVD s/p femoral embolectomy

MEDICATION ON ADMISSION: Medication list sent from nursing home:
Digoxin 125 mcg every other day
Amlodipine 2.5 mg daily
Cozaar 50 mg daily
Furosemide 20mg daily
Multivitamin daily
Vitamin B-12 1,000 mcg daily
Vitamin C 500 mg daily
Metoprolol Tartrate 25 mg Q8h
Isordil 40mg TID
Docusate Sodium 100 mg TID
Simvastatin 10 mg QHS
Bisacodyl 10 mg PR prn
Albuterol inhaled
Atrovent inhaled
Coumadin dose unconfirmed
Tylenol 650mg prn
Lactulose prn
Fleets enema prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Discharge Physical Exam:
Vitals: T: 98.4 BP: 133/62 P: 71 R: 18 O2: 94% on 6L NC
General: alert, communicating with staff
HEENT: skin break down on bridge of nose
Neck: supple,
Lungs: diffuse crackles and wheezes
CV: Regular rate and rhythm, normal S2, no m/r/g
Abdomen: soft, NT/ND, bowel sounds present, no rebound or
guarding
Ext: Warm, well perfused, no clubbing or edema

FAMILY HISTORY: NC

SOCIAL HISTORY: Pt lives in [**Location **] and is independant of ADLs
Urinary tract infection, site not specified,Acute on chronic diastolic heart failure,Primary pulmonary hypertension,Unspecified pleural effusion,Atrial fibrillation,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Cardiac pacemaker in situ
Urin tract infection NOS,Ac on chr diast hrt fail,Prim pulm hypertension,Pleural effusion NOS,Atrial fibrillation,Klebsiella pneumoniae,Chronic kidney dis NOS,Crnry athrscl natve vssl,Periph vascular dis NOS,DMII wo cmp nt st uncntr,Long-term use anticoagul,Status cardiac pacemaker
Admission Date:  [**2102-6-13**]              Discharge Date:   [**2102-6-23**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5893**]
Chief Complaint:
Altered mental status

Major Surgical or Invasive Procedure:
Right thoracentesis under US guidance

History of Present Illness:
[**Age over 90 **] y/o F with PMHx of Afib, s/p PCM, CAD s/p MI, PVD and CVA who
was transferred from NH for unresponsiveness. Per report, pt has
been in her usual state of health and this morning, she awoke
and ambulated with her [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 56231**] to breakfast.
However, she became notably unresponsive while waiting for her
breakfast. Her initial BS was 84, SBP 140s-180s, 84% on RA and
withdrew to sternal rub. She appeared to be moving extremities
but was overall unresponsive. EMS was called and pt was
transferred to [**Hospital1 18**] ED.
.
In the ED, initial vs were: T 98.8 P 70 BP 105/56 R 20-24 O2sat
96% on 3L. Pt was noted to desat on 3L but was repositioned and
sats came back up. Pupils were notably pinpoint but reactive.
Head CT was negative for ICH, CTA was negative for PE but
revealed large right pleural effusion. Urine tox screen was
negative. Urine and blood Cx were sent and pt was given
Levofloxacin, Ceftriaxone and Vancomycin for possible PNA.
.
On arrival to the ICU, pt was minimally responsive. She
withdraws to sternal rub but does not respond to verbal stim.
She was given Narcan 0.6mg without any significant
.
Of note, pt ambulates [**Hospital1 56231**] at baseline. She completes
most ADLs [**Hospital1 56231**] and is very hard of hearing. She can
read english but speaks russian. Pt interacts appropriately with
neice but is not oriented at all times. Her baseline is slurred
speach and difficulty swallowing.
.
Review of systems per NH charge nurse:
No fever, chills, night sweats, rhinorrhea or congestion. Denied
cough, shortness of breath. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits.


Past Medical History:
CHF with EF of 75% from echo
Atrial Fib on coumadin
s/p PCM
CAD s/p MI in 79
DM II (diet controlled )
Multiple CVA
PVD s/p femoral embolectomy

Social History:
Pt lives in [**Location **] and is independant of ADLs

Communication: Patient via russian interpreter
Grand Niece & HCP-- [**Name (NI) 83407**] [**Telephone/Fax (1) 83408**] cell [**Telephone/Fax (1) 83409**]
[**Female First Name (un) 83410**] Daughter & 2nd HCP-- [**Telephone/Fax (1) 83411**]
NH-->[**Telephone/Fax (1) **]

Family History:
NC

Physical Exam:
Discharge Physical Exam:
Vitals: T: 98.4 BP: 133/62 P: 71 R: 18 O2: 94% on 6L NC
General: alert, communicating with staff
HEENT: skin break down on bridge of nose
Neck: supple,
Lungs: diffuse crackles and wheezes
CV: Regular rate and rhythm, normal S2, no m/r/g
Abdomen: soft, NT/ND, bowel sounds present, no rebound or
guarding
Ext: Warm, well perfused, no clubbing or edema

Pertinent Results:
Admission laboratories [**2102-6-13**]:
WBC-5.0 RBC-3.97* Hgb-11.3* Hct-34.0* MCV-86 MCH-28.3 MCHC-33.2
RDW-17.1* Plt Ct-201
Neuts-65.9 Lymphs-23.1 Monos-6.1 Eos-4.4* Baso-0.5
PT-32.6* PTT-33.5 INR(PT)-3.3*
Glucose-130* UreaN-25* Creat-1.5* Na-142 K-4.0 Cl-105 HCO3-31
AnGap-10 Calcium-8.8 Phos-3.6 Mg-2.1
ALT-17 AST-22  AlkPhos-113 TotBili-1.0, Lipase-28
VitB12-974* Folate-16.4 TSH-1.1, RPR: negative
Digoxin-0.3*
ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG
Tricycl-NEG
Type-ART pO2-69* pCO2-53* pH-7.37 calTCO2-32* Base XS-3
D Lactate-1.2
proBNP-3119*
.
Discharge labs [**2102-6-23**]:
WBC-8.6 RBC-4.22 Hgb-11.4* Hct-36.2 MCV-86 MCH-27.0 MCHC-31.5
RDW-16.8* Plt Ct-199
PT-14.0* PTT-50.9* INR(PT)-1.2*
Glucose-192* UreaN-55* Creat-1.5* Na-148* K-3.8 Cl-107 HCO3-34*
AnGap-11
CK-MB-5 cTropnT-0.01
Calcium-8.9 Phos-3.1 Mg-2.2
Albumin-2.8* Calcium-9.4 Phos-3.3 Mg-2.1
.
EKG ([**2102-6-13**]): paced rhythm at 70, no acute ST-T changes
.
Cardiac enzymes:
[**2102-6-14**] 03:36AM CK(CPK)-22* CK-MB-4 cTropnT-0.01
[**2102-6-13**] 08:50AM CK(CPK)-41 cTropnT-<0.01
.
Culture Data
[**2102-6-13**]: Urine--Klebsiella >100,000 ORGANISMS/ML.
Pending cultures: blood culture
.
CTA w/ and w/o contrast ([**2102-6-13**]):
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Moderate-to-large in size right pleural effusion and small
left pleural
effusion.
3. Scattered areas of linear atelectasis involving the right and
left lower lobes and the right middle [**Month/Day/Year 3630**].
4. Enlarged heterogeneous appearance of the thyroid, most
compatible with
multinodular goiter.
5. Enlarged mediastinal lymph nodes of uncertain etiology, could
be reactive in nature.
6. Borderline enlarged main pulmonary trunk measuring 3.3 cm,
compatible with pulmonary hypertension.

CT head ([**2102-6-13**]): No evidence of hemorrhage. Extensive
encephalomalacic changes. However, given the lack of prior
studies and the appearance of white matter changes in the right
frontal [**Last Name (LF) 3630**], [**First Name3 (LF) **] acute component of abnormality cannot be
exlcuded. In addition, identification of any small areas of
acute infarction is difficult given the extensive white matter
changes. Hence, MR [**Name13 (STitle) 430**] with DWI can be considered for better
assessment.
.
ECHO [**2102-6-16**]: severe pulmonary hypertension; moderate-to-severe
tricuspid regurgitation; dilated, hypocontractile right
ventricle
.
[**2102-6-21**] Right thoracentesis: 3+ PMNs, no micro organisms seens,
cytology and cultures pending

Brief Hospital Course:
[**Age over 90 **] y/o F with PMHx of Afib, CAD s/p MI and PVD who presents with
altered mental status.
.
Altered mental status: The patient intially presented with
altered mental status of unknown etiology with a Ddx of acute
CVA or intracranial hemorrhage, infection, post-ictal state,
opioid toxicity, hypercarbia, or pulmonary embolism. The patient
had a CTA with contrast that r/o a PE. A CT of the head revealed
old infarcts, however, new infarcts could not be excluded.
Neurology consulted on the patient and suggested a MRI given
difficulty in recognizing acute infarct on CT, however, patient
cannot get an MRI due to her pacemaker. A U/A revealed a UTI and
a urine culture revealed pan-sensitive Klebsiella. After a
course of antibiotics, the patient's mental status improved. A
RPR, TSH, B12 and folate were all within normal range.
.
Acute diastolic heart failure/pleural effusion: The patient had
a TTE showing LVEF=65=70% with no LVH. While in the the ICU, the
patient developed an acute episode of respiratory distress and
her BNP was elevated ~16,000 (on admission~3000). A Lasix gtt
was started and the patient's oxygenation improved. The patient
has a right>left pleural effusion, likely secondary to her
diastolic heart failure. The effusion was previously noted in an
admission to [**Hospital1 2025**] on [**12-26**] and it was treated with diuresis then.
Because of continued hypoxia and episodes of desaturation during
this admission, patient underwent IR guided thoracentesis during
which 1.2 L of serosanguinous fluid was removed from the right
pleural space.
.
#Hypoxia: Pt's hypoxia attributed to her chronic pleural
effusion and underlying pulmonary hypertension. Initially, there
was a possibly of PE, but CTA with contrast ruled out any PE.
The hypoxia is not responsive to oxygen therapy which raises the
possibility of a R-->L cardiac shunt or an intrapulmonary shunt.
A CT of the chest revealed atelectasis of the RLL which can be
contributing to her hypoxia. The effusion was drained [**2102-6-21**]
with improvement in oxygenation.  Patient was tried on BiPap but
did not tolerate the mask due to skin breakdown on bridge of
nose.  Concomitant face mask and nasal canula were used to
maintain her saturation.  Because of continued episodes of
desaturation, patient underwent thoracentesis of the right
pleural effusion with improvement of oxygenation status, able to
oxygenate well just on supplemental oxygen by nasal cannula.
Patient was discharged saturating 94% on 6L of O2 back to
nursing home.
.
# UTI: Pt with grossly positive UA and mental status changes, so
she was empirically started on Ceftriaxone. Cultures revealed
pan-sensitive Klebsiella and pt completed 10 day course of
ciprofloxacin with no growth seen on subsequent urine cultures.
.
# AFib: Pt with history of afib though currently paced.  She
remained rate controlled on Metoprolol during admission. She
also takes Coumadin for anticoagulation. Coumadin was stopped
for thoracentesis. INR at discharge was 1.2 and coumadin
restarted with goal INR [**12-20**].  Will need regular labs drawn and
coumadin dosages titrated at nursing home.  Patient discharged
with original home doses of digoxin and amlodipine, but
decreased dosage of metoprolol.
.
# Increased INR: Likely on Coumadin for A.fib, although nursing
home medication sheet does not have Coumadin listed.  Coumadin
restarted, will require regular follow up lab draws at nursing
home to assess INR for coumadin management.  Goal INR of [**12-20**].
.
# Chronic renal failure: The patient has a baseline Cr of 1.4.
Cr at discharge was 1.5.
.
# Pulmonary hypertension: An TTE on this admission revealed
pulmonary hyptertension and poor RV failure. A previous Echo
from an admission at [**Hospital1 2025**] in [**12-26**] showed the absence of pulmonary
hypertension. Currently, her pulmonary hyptension is attributed
to chronic hypoxia [**12-19**] her pleural effusion on the right side.
Other etiologies such as idiopathic or infectious are less
likely. CTA to evaluate for PE did not demonstrate any large
AVMs or intrapulmonary shunts. However, an enlarged pulmonary
arterial trunk without sign of aneurysm was noted and can be a
cause of pulmonary hypertension.

Medications on Admission:
Medication list sent from nursing home:
Digoxin 125 mcg every other day
Amlodipine 2.5 mg daily
Cozaar 50 mg daily
Furosemide 20mg daily
Multivitamin daily
Vitamin B-12 1,000 mcg daily
Vitamin C 500 mg daily
Metoprolol Tartrate 25 mg Q8h
Isordil 40mg TID
Docusate Sodium 100 mg TID
Simvastatin 10 mg QHS
Bisacodyl 10 mg PR prn
Albuterol inhaled
Atrovent inhaled
Coumadin dose unconfirmed
Tylenol 650mg prn
Lactulose prn
Fleets enema prn


Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
Constipation.
2. White Petrolatum-Mineral Oil 42.5-56.8 % Ointment Sig: One
(1) Appl Ophthalmic PRN (as needed) as needed for dry eye.
3. Isosorbide Mononitrate 20 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day): Hold SBP<100.
4. Hydralazine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours): Hold SBP<100.
5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24
hours).
6. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
7. Vitamin B-12 1,000 mcg Tablet Sig: One (1) Tablet PO once a
day.
8. Vitamin C 500 mg Tablet Sig: One (1) Tablet PO once a day.
9. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO three
times a day.
10. Coumadin 2 mg Tablet Sig: One (1) Tablet PO once a day:
Please check INR and dose coumadin to reach INR goal [**12-20**].
11. Tylenol 325 mg Tablet Sig: 1-2 Tablets PO PRN as needed for
pain.
12. Lactulose 10 gram Packet Sig: One (1) packet PO PRN as
needed for constipation.
13. Fleet Enema 19-7 gram/118 mL Enema Sig: One (1) enema Rectal
PRN as needed for constipation.
14. Outpatient Lab Work
Please draw labs to check PT, INR twice a week and dose coumadin
accordingly for goal INR of [**12-20**].  Once patient is therapeutic,
INR can be checked once a week
15. oxygen
Patient has a new oxygen requirement.  Please give supplemental
O2 by nasal cannula at 6L.  Patient can be wean as tolerated for
goal of O2 saturation of 86-92%
16. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) mL
Injection three times a day: Stop 3 days after reaching INR goal
[**12-20**].
17. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO
twice a day.
18. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO every other
day.
19. Amlodipine 2.5 mg Tablet Sig: One (1) Tablet PO once a day.

20. Cozaar 50 mg Tablet Sig: One (1) Tablet PO once a day.
21. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day.
22. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO at bedtime.

23. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) nebulizer Inhalation every 4-6 hours
as needed for shortness of breath or wheezing.
24. Ipratropium Bromide 0.02 % Solution Sig: One (1) nebulizer
Inhalation every 4-6 hours as needed for shortness of breath or
wheezing.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 2670**] - [**Location (un) **]

Discharge Diagnosis:
1. urinary tract infection
2. Pleural effusion
3. Hypoxia
4. Diastolic CHF, Atrial Fibrillation, coronary artery disease,
stroke


Discharge Condition:
Stable, afebrile, O2 sat 86-92% on 6 L nasal cannula


Discharge Instructions:
You were sent from your nursing home because you became
unresponsive. When you came to the [**Hospital1 18**], imaging was done of
your head and chest which showed you did not have a head bleed
or pulmonary embolism. Your mental status changes were
attributed to a urinary tract infection, which was treated with
antibiotics for 10 days and your mental status improved. You
also had difficulty breathing due to fluid around your right
lung most likely from your heart failure. We gave you medication
to remove the extra fluid and the pleural effusion was drained
with a needle with improvement in your breathing. Given the
insults to your lungs, you now need oxygen, which may be able to
be decreased as time goes on. We changed some of your blood
pressure medications to better control your blood pressure and
heart rate.

To be done at Nursing Home
1. Patient has been restarted on coumadin.  Please draw labs to
check for INR twice a week and dose coumadin accordingly for
goal INR of [**12-20**].  Once patient is therapeutic on coumadin, INR
checks can be done once a week.
.
2. Please perform physical therapy
.
3. Patient has a new oxygen requirement.  Please give patient 6L
of O2 via nasal cannula.  She sometimes transiently desaturates
because of positional changes and during sleep, please try
repositioning her and waking her up and having her draw large
breaths.  Her target oxygen saturation goal on supplemental
oxygen is 86-92%.  Patient can be weaned on the supplemental O2
as tolerated.
.
4. Please sit up and assist with eating to prevent aspiration

Followup Instructions:
1. Please call your primary care doctor, Dr. [**Last Name (STitle) 5404**] at
[**Telephone/Fax (1) **] to be seen within 1-2 weeks of discharge.
{"Urinary tract infection, site not specified,Acute on chronic diastolic heart failure,Primary pulmonary hypertension,Unspecified pleural effusion,Atrial fibrillation,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,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: Altered mental status

PRESENT ILLNESS: [**Age over 90 **] y/o F with PMHx of Afib, s/p PCM, CAD s/p MI, PVD and CVA who
was transferred from NH for unresponsiveness. Per report, pt has
been in her usual state of health and this morning, she awoke
and ambulated with her [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 56231**] to breakfast.
However, she became notably unresponsive while waiting for her
breakfast. Her initial BS was 84, SBP 140s-180s, 84% on RA and
withdrew to sternal rub. She appeared to be moving extremities
but was overall unresponsive. EMS was called and pt was
transferred to [**Hospital1 18**] ED.
.
In the ED, initial vs were: T 98.8 P 70 BP 105/56 R 20-24 O2sat
96% on 3L. Pt was noted to desat on 3L but was repositioned and
sats came back up. Pupils were notably pinpoint but reactive.
Head CT was negative for ICH, CTA was negative for PE but
revealed large right pleural effusion. Urine tox screen was
negative. Urine and blood Cx were sent and pt was given
Levofloxacin, Ceftriaxone and Vancomycin for possible PNA.
.
On arrival to the ICU, pt was minimally responsive. She
withdraws to sternal rub but does not respond to verbal stim.
She was given Narcan 0.6mg without any significant
.
Of note, pt ambulates [**Hospital1 56231**] at baseline. She completes
most ADLs [**Hospital1 56231**] and is very hard of hearing. She can
read english but speaks russian. Pt interacts appropriately with
neice but is not oriented at all times. Her baseline is slurred
speach and difficulty swallowing.
.
Review of systems per NH charge nurse:
No fever, chills, night sweats, rhinorrhea or congestion. Denied
cough, shortness of breath. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits.

MEDICAL HISTORY: CHF with EF of 75% from echo
Atrial Fib on coumadin
s/p PCM
CAD s/p MI in 79
DM II (diet controlled )
Multiple CVA
PVD s/p femoral embolectomy

MEDICATION ON ADMISSION: Medication list sent from nursing home:
Digoxin 125 mcg every other day
Amlodipine 2.5 mg daily
Cozaar 50 mg daily
Furosemide 20mg daily
Multivitamin daily
Vitamin B-12 1,000 mcg daily
Vitamin C 500 mg daily
Metoprolol Tartrate 25 mg Q8h
Isordil 40mg TID
Docusate Sodium 100 mg TID
Simvastatin 10 mg QHS
Bisacodyl 10 mg PR prn
Albuterol inhaled
Atrovent inhaled
Coumadin dose unconfirmed
Tylenol 650mg prn
Lactulose prn
Fleets enema prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Discharge Physical Exam:
Vitals: T: 98.4 BP: 133/62 P: 71 R: 18 O2: 94% on 6L NC
General: alert, communicating with staff
HEENT: skin break down on bridge of nose
Neck: supple,
Lungs: diffuse crackles and wheezes
CV: Regular rate and rhythm, normal S2, no m/r/g
Abdomen: soft, NT/ND, bowel sounds present, no rebound or
guarding
Ext: Warm, well perfused, no clubbing or edema

FAMILY HISTORY: NC

SOCIAL HISTORY: Pt lives in [**Location **] and is independant of ADLs 

### Response:
{"Urinary tract infection, site not specified,Acute on chronic diastolic heart failure,Primary pulmonary hypertension,Unspecified pleural effusion,Atrial fibrillation,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Cardiac pacemaker in situ"}
