CHIEF COMPLAINT: midsternal chest pain

PRESENT ILLNESS: Ms. [**Known lastname 8260**] is a 77 y/o F with PMH of CAD s/p CABG in [**2098**] (LIMA to
LAD, SVG to PDA, SVG to OM, SVG to diag), ESRD s/p renal
transplant ([**2100**]), and IDDM who presents in transfer from [**Hospital **]. The patient has felt quite tired for the past several
days while visiting her daughter; on routine labs (due for INR),
the patient was found to have a Hct of 18 with INR of 6. She was
admitted to [**Hospital3 8544**] for further evaluation; there, she
received 3 U PRBCs (by report). Hematocrit after her 2nd unit of
PRBCs was 21.9. Her INR was reversed with FFP and vitamin K with
repeat INR 2.6 from 6. Overnight, the patient had the acute
onset of midsternal chest pain with radiation to the back at the
OSH. This was not associated with diaphoresis, shortness of
breath, or palpitations. The patient was nauseous and vomited
once. The pain is a "steady, sharp" pain per her report; at its
worst, the pain was [**5-5**]. Now, the pain is [**2114-2-28**] and actually
resolved completely. She noted some improvement with
administration of labetalol gtt; she also received morphine and
nitroglycerin without much relief. She states that the pain is
improved with sitting up. It is not pleuritic. She has no cough.
She denies orthopnea and PND. She has left > right lower
extremity edema which is chronic.
.
She tells me that she had a low blood count one month ago that
required a transfusion of 1 U PRBCs; she subsequently was placed
on aranesp. At that time, she also experienced substernal chest
pain, much like her current pain, for which an answer was not
found (per her report). At the current time, she is on a
nitroglycerin gtt and without pain. Her stool is trace guaiac
positive.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. She denies recent fevers, chills or
rigors. She denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

MEDICAL HISTORY: PMH: Renal artery stent on [**2110-12-27**]; surveillance U/S [**4-23**]
(+)in-stent stenosis/hydronephrosis; ESRD s/p CRT'[**99**], RUE AVF,
CAD s/p CABGx4(LGSV)'[**98**], cAF, HTN, IDDM2, gout, CCY, zoster

MEDICATION ON ADMISSION: Home MEDICATIONS (per recent nephrology note, patient unsure of
medications)
coumadin
norvasc 10 mg daily
diovan 80 mg [**Hospital1 **]
prednisone 5 mg daily
clonidine 0.1 mg [**Hospital1 **]
Labetalol 50 mg [**Hospital1 **]
colace 100 mg daily
amiodarone 100 mg every other day
lasix 60 mg [**Hospital1 **]
lipitor 20 mg daily
calcitriol 0.25 mcg daily
allopurinol 100 mg every other day
aspirin 81 mg daily
prograf 2 mg [**Hospital1 **]
levothyroxine 100 mcg daily

ALLERGIES: Percocet / Codeine / Hydrochlorothiazide / Percodan / Cardizem

PHYSICAL EXAM: VS: T 96.9, BP 144/42, HR 66, RR 12, O2 100% on 4L NC
Gen: WDWN elderly woman in NAD, resp or otherwise. Oriented x3.
Mood, affect appropriate. Pleasant and able to speak in full
sentences.
HEENT: NCAT. Left conjunctiva injected. PERRL, EOMI. MM somewhat
dry.
Neck: Supple with JVP of 8 cm.
CV: Irregularly irregular rhythm, normal S1, S2. No S4, no S3.
2/6 systolic murmur at the apex.
Chest: Prior CABG sternotomy scar. No chest wall deformities,
scoliosis or kyphosis. Resp were unlabored, no accessory muscle
use. Occasional crackles at the bases; no wheezes or rhonchi.
Abd: soft, hypoactive bowel sounds, NTND, No HSM or tenderness.
No abdominial bruits.
Rectal: firm stool in the vault, trace guaiac positive
Ext: 1+ left lower extremity edema with overlying erythema.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+; DP dopplerable
Left: Carotid 2+ without bruit; Femoral 2+; DP dopplerable

FAMILY HISTORY: No hx of premature coronary artery disease

SOCIAL HISTORY: Widowed and lives with her son. She is a nonsmoker. She denies
alcohol use.
Diverticulosis of colon with hemorrhage,Acute posthemorrhagic anemia,Atrial fibrillation,Urinary tract infection, site not specified,Intermediate coronary syndrome,Complications of transplanted kidney,Other drugs and medicinal substances causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Angiodysplasia of intestine (without mention of hemorrhage),Gout, unspecified,Unspecified acquired hypothyroidism,Constipation, unspecified,Conjunctival hemorrhage,Edema,Hypertensive retinopathy,Unspecified essential hypertension,Hematoma complicating a procedure,Aortocoronary bypass status
Dvrtclo colon w hmrhg,Ac posthemorrhag anemia,Atrial fibrillation,Urin tract infection NOS,Intermed coronary synd,Compl kidney transplant,Adv eff medicinal NEC,DMII wo cmp uncntrld,Angio intes w/o hmrhg,Gout NOS,Hypothyroidism NOS,Constipation NOS,Conjunctival hemorrhage,Edema,Hypertensive retinopathy,Hypertension NOS,Hematoma complic proc,Aortocoronary bypass
Name:  [**Known lastname **],[**Known firstname 6310**] J.                 Unit No:   [**Numeric Identifier 17582**]

Admission Date:  [**2111-8-6**]              Discharge Date:   [**2111-8-25**]

Date of Birth:  [**2033-11-9**]             Sex:   F

Service: SURGERY

Allergies:
Percocet / Codeine / Hydrochlorothiazide / Percodan / Cardizem

Attending:[**First Name3 (LF) 852**]
Addendum:
Patient initially scheduled for discharge on [**8-24**], but stayed
overnight due to complaints of nausea. She will be discharged
[**8-25**]. She is tolerating a regular diet and denies nausea. No
changes from previous discharge summary dated [**2111-8-24**].

Discharge Disposition:
Home With Service

Facility:
Community VNA

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 853**] MD [**MD Number(2) 854**]

Completed by:[**2111-8-25**]

Admission Date:  [**2111-8-6**]              Discharge Date:   [**2111-8-25**]

Date of Birth:  [**2033-11-9**]             Sex:   F

Service: SURGERY

Allergies:
Percocet / Codeine / Hydrochlorothiazide / Percodan / Cardizem

Attending:[**First Name3 (LF) 3127**]
Chief Complaint:
midsternal chest pain

Major Surgical or Invasive Procedure:
[**8-14**]: Extended right hemicolectomy


History of Present Illness:
Ms. [**Known lastname 8260**] is a 77 y/o F with PMH of CAD s/p CABG in [**2098**] (LIMA to
LAD, SVG to PDA, SVG to OM, SVG to diag), ESRD s/p renal
transplant ([**2100**]), and IDDM who presents in transfer from [**Hospital **]. The patient has felt quite tired for the past several
days while visiting her daughter; on routine labs (due for INR),
the patient was found to have a Hct of 18 with INR of 6. She was
admitted to [**Hospital3 8544**] for further evaluation; there, she
received 3 U PRBCs (by report). Hematocrit after her 2nd unit of
PRBCs was 21.9. Her INR was reversed with FFP and vitamin K with
repeat INR 2.6 from 6. Overnight, the patient had the acute
onset of midsternal chest pain with radiation to the back at the
OSH. This was not associated with diaphoresis, shortness of
breath, or palpitations. The patient was nauseous and vomited
once. The pain is a "steady, sharp" pain per her report; at its
worst, the pain was [**5-5**]. Now, the pain is [**2114-2-28**] and actually
resolved completely. She noted some improvement with
administration of labetalol gtt; she also received morphine and
nitroglycerin without much relief. She states that the pain is
improved with sitting up. It is not pleuritic. She has no cough.
She denies orthopnea and PND. She has left > right lower
extremity edema which is chronic.
.
She tells me that she had a low blood count one month ago that
required a transfusion of 1 U PRBCs; she subsequently was placed
on aranesp. At that time, she also experienced substernal chest
pain, much like her current pain, for which an answer was not
found (per her report). At the current time, she is on a
nitroglycerin gtt and without pain. Her stool is trace guaiac
positive.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. She denies recent fevers, chills or
rigors. She denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

Past Medical History:
PMH: Renal artery stent on [**2110-12-27**]; surveillance U/S [**4-23**]
(+)in-stent stenosis/hydronephrosis; ESRD s/p CRT'[**99**], RUE AVF,
CAD s/p CABGx4(LGSV)'[**98**], cAF, HTN, IDDM2, gout, CCY, zoster

Social History:
Widowed and lives with her son. She is a nonsmoker. She denies
alcohol use.

Family History:
No hx of premature coronary artery disease

Physical Exam:
VS: T 96.9, BP 144/42, HR 66, RR 12, O2 100% on 4L NC
Gen: WDWN elderly woman in NAD, resp or otherwise. Oriented x3.
Mood, affect appropriate. Pleasant and able to speak in full
sentences.
HEENT: NCAT. Left conjunctiva injected. PERRL, EOMI. MM somewhat
dry.
Neck: Supple with JVP of 8 cm.
CV: Irregularly irregular rhythm, normal S1, S2. No S4, no S3.
2/6 systolic murmur at the apex.
Chest: Prior CABG sternotomy scar. No chest wall deformities,
scoliosis or kyphosis. Resp were unlabored, no accessory muscle
use. Occasional crackles at the bases; no wheezes or rhonchi.
Abd: soft, hypoactive bowel sounds, NTND, No HSM or tenderness.
No abdominial bruits.
Rectal: firm stool in the vault, trace guaiac positive
Ext: 1+ left lower extremity edema with overlying erythema.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+; DP dopplerable
Left: Carotid 2+ without bruit; Femoral 2+; DP dopplerable


Pertinent Results:
On admission, Hg 7.7, Hct 23.5.

[**2111-8-6**].  AXR. moderate-to-severe amount of stool within the
descending colon and rectal vault consistent with
constipation/impaction.
.
[**2111-8-6**].  Conclusions:
The left atrium is elongated. The right atrium is markedly
dilated. The
estimated right atrial pressure is 0-5mmHg. There is mild
symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Overall  left ventricular systolic function is normal
(LVEF>55%). Cannot exclude mild focal distal septal hypokinesis.
Tissue Doppler imaging suggests an increased left ventricular
filling pressure (PCWP>18mmHg). Transmitral Doppler and tissue
velocity imaging are consistent with Grade II (moderate) LV
diastolic dysfunction. Right ventricular chamber size and free
wall motion are normal.  The ascending aorta is mildly dilated.
The aortic valve leaflets are moderately thickened. There is
mild aortic valve stenosis (area 1.2-1.9cm2).  Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are moderately
thickened. Mild (1+) mitral regurgitation is seen. The tricuspid
 valve leaflets are mildly thickened. There is mild pulmonary
artery systolic hypertension. There is a trivial/very small
pericardial effusion.
.
Compared with the prior study (images reviewed) of [**2110-12-25**],
previously
noted regional wall motion is now improved.
.
[**2111-8-6**].  CXR.  No evidence of acute change.
[**2111-8-6**] 10:23PM   HCT-29.1*
[**2111-8-6**] 07:50AM   GLUCOSE-434* UREA N-95* CREAT-1.7* SODIUM-139
POTASSIUM-3.5 CHLORIDE-108 TOTAL CO2-22 ANION GAP-13
[**2111-8-6**] 07:50AM   ALT(SGPT)-22 AST(SGOT)-20 LD(LDH)-238
CK(CPK)-47 ALK PHOS-96 TOT BILI-0.4
[**2111-8-6**] 07:50AM   CK-MB-NotDone cTropnT-0.06*
[**2111-8-6**] 07:50AM   ALBUMIN-2.9* CALCIUM-7.2* PHOSPHATE-3.5
MAGNESIUM-2.4 CHOLEST-135
[**2111-8-6**] 07:50AM   HAPTOGLOB-155
[**2111-8-6**] 07:50AM   %HbA1c-6.1*
[**2111-8-6**] 07:50AM   TRIGLYCER-179* HDL CHOL-48 CHOL/HDL-2.8
LDL(CALC)-51
[**2111-8-6**] 07:50AM   FK506-4.9*
[**2111-8-6**] 07:50AM   WBC-11.1*# RBC-2.57* HGB-7.7* HCT-23.5*
MCV-91 MCH-30.0 MCHC-32.8 RDW-17.0*
[**2111-8-6**] 07:50AM   PT-27.1* PTT-39.9* INR(PT)-2.8*

Brief Hospital Course:
In summary, Ms. [**Known lastname 8260**] is a 77 y/o F with ESRD s/p renal
transplant, CAD s/p CABG, and IDDM admitted with demand ischemia
and profound anemia from likely GI bleed.
.
Chest pain.  Initially concerning for aortic dissection because
report from outside hospital stated that there was unequal blood
pressures in L and R arms, though patient has an AV fistula on
the right which ws clotted. The chest pain was thought to be due
to demand ischemia from profound anemia.  Cardiac enzymes were
negative.  She reports three prior episodes of chest pain over
the past two years that resolved with blood transfusions.  She
was treated with a nitroglycerin drip and had resolution of
chest pain. Also given aspirin, statin, metoprolol.  An echo
showed an EF of 55%.  Uremic pericarditis may also have
contributed to chest pain, as patient was found to have elevated
BUN and pericardial friction rub.
.
Anemia.  Her hematocrit was 18 with INR of 6 at an outside
hospital. She was transfused at the outside hospital.  Upon
arrival, her Hct was 23.5, but rose to 29.1 with transfusion of
two units of PRBCs on [**8-6**].  There is concern GI blood loss
given trace guaiac positive stools with supratherapeutic INR. GI
team was consulted on [**8-6**] and an EGD was done - mucosal
biopsies of antrum and duodenum revealed no diaagnostic
abnormalities in fundic mucosa and chronic inactive duodenitis
in duodenum. Next, she underwent 2 tagged red blood cell scans
which both showed active bleeding localized to the hepatic
flexure of the colon. Both of the scans were followed by an
angiogram which was negative on 2 occasions. She underwent
colonoscopy which again showed bright red blood in the right
colon and diverticula throughout the entire colon. The
colonoscopy failed to localize the site of bleeding and the
patient was taken to the operating room where an extended right
hemicolectomy was done. Hemicolectomy pathology revealed a
single tiny area of dilated venules in the mucosa, consistent
with vascular ectasia (angiodysplasia), and no erosion and
multiple diverticula of the colon. Post-operatively, staples
were removed from a 2x2 cm area of inferior wound due to
fluctuance and erythema. Wet to dry dressing changes were
started, and erythema since decreased. She received 1U pRBCs on
[**8-18**] and [**8-24**] for Hct<30%, asymptomatic.
.
Constipation.  KUB showed stool in colon and rectum.  Was
started on Milk of magnesia in addition to senna, colace and prn
Dulcolax and lactulose.
.
L LE edema: Problem appears chronic (mentioned in last renal
note from [**Month (only) 547**]) and likely due to prior vein harvesting for
CABG. L femoral US on [**8-11**] revealed L inguinal hematoma. No
pseudoaneurysm or fistula involving the left common femoral and
iliac arteries.
.
L UE erythema: patient was noted to have L arm swelling /
erythema at PICC site which prompted LUE U/S on [**8-15**] - found 6x4
fluid collection, no DVT. Double lumen PICC line via left
basilic venous approach by placed by IR on [**8-12**] due to poor
peripheral access.
.
CRI s/p renal transplant: The patient's creatinine appears to be
at baseline. Tacrolimus level was 4.9 on admission. Discharge
dose 1mg po q12h. Lasix was administered during hospital stay to
regulate fluid balance. Patient will be discharged on Lasix 40mg
po daily.
.
Hypertension: Holding home antihypertensives while in CCU. While
in the CCU, patient was on a nitroglycerin drip initially, but
weaned off after a couple of hours with plans to restart
antihypertensives slowly.  Her blood pressure was monitored and
remained stable. Upon transfer to the floor she was placed on
Metoprolol 12mg po bid.
.
IDDM: Outside regimen unclear. [**Name2 (NI) **] verify with patient this
morning. SSI for now. HgA1c found to be 6.1 on admission. She
was followed by [**Last Name (un) **] during her stay, was continued on SSI.
.
UTI: Urine culture on [**8-15**] revealed >100,000 EColi. Cefepime was
started and then changed to Ceftriaxone for total of 7day of
antiobiotic therapy. ID was consulted for recommendations
regarding therapy.
.
Hypothyroidism. Continue levothyroxine 100 mcg daily
.
Gout. Renally-dosed allopurinol.
.
Dispo VNA services arranged for wound cares. PT cleared patient
for stair climbing. Patient was determined stable to be
discharged home vs rehabilitation center.
.
Proph: INR therapeutic was therapeutic on admission, so heparin
SQ was initally not started, but began post-operatively on [**8-14**].
She was given a PPI due to concern for upper GI bleed.


Medications on Admission:
Home MEDICATIONS (per recent nephrology note, patient unsure of
medications)
coumadin
norvasc 10 mg daily
diovan 80 mg [**Hospital1 **]
prednisone 5 mg daily
clonidine 0.1 mg [**Hospital1 **]
Labetalol 50 mg [**Hospital1 **]
colace 100 mg daily
amiodarone 100 mg every other day
lasix 60 mg [**Hospital1 **]
lipitor 20 mg daily
calcitriol 0.25 mcg daily
allopurinol 100 mg every other day
aspirin 81 mg daily
prograf 2 mg [**Hospital1 **]
levothyroxine 100 mcg daily

Discharge Medications:
1. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Amiodarone 200 mg Tablet Sig: 0.5 Tablet PO Q48H (every 48
hours).
4. Epoetin Alfa 4,000 unit/mL Solution Sig: Two (2)  Injection
QMOWEFR (Monday -Wednesday-Friday).
5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
6. Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO Q12H (every
12 hours) for 2 doses.
7. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Eighteen
(18) units Subcutaneous once a day.
8. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Twenty
(20) units Subcutaneous at bedtime.
9. Insulin Regular Human 100 unit/mL Solution Sig: follow
sliding scale  Injection four times a day.
10. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day.
11. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q3H (every
3 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
13. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**1-27**]
Drops Ophthalmic PRN (as needed).
14. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Four (4) Capsule, Sustained Release PO BID (2 times a day).


Discharge Disposition:
Home With Service

Facility:
Community VNA

Discharge Diagnosis:
ESRD h/o renal transplant, s/p extended right hemicolectomy for
diverticular bleed


Discharge Condition:
stable


Discharge Instructions:
Please call Dr[**Name (NI) 4838**] office at [**Telephone/Fax (1) 673**] if you experience

fever > 101.5, chills, nausea, vomiting diarrhea, constipation,
blood in stool, inability to take or keep down medications.
Monitor wound for redness, swelling, tenderness, or drainage
No heavy lifting
Stay on Lasix 40mg po daily until told otherwise
Wet to dry dressings twice daily on open wound site with home
nursing.
Continue Colace and do NOT drive as long as you are taking
narcotics

Followup Instructions:
[**Name6 (MD) 1344**] [**Last Name (NamePattern4) 3125**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2111-8-31**] 10:20
[**Name6 (MD) **] [**Last Name (NamePattern4) 11082**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2111-9-1**] 10:50
{'Diverticulosis of colon with hemorrhage,Acute posthemorrhagic anemia,Atrial fibrillation,Urinary tract infection, site not specified,Intermediate coronary syndrome,Complications of transplanted kidney,Other drugs and medicinal substances causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Angiodysplasia of intestine (without mention of hemorrhage),Gout, unspecified,Unspecified acquired hypothyroidism,Constipation, unspecified,Conjunctival hemorrhage,Edema,Hypertensive retinopathy,Unspecified essential hypertension,Hematoma complicating a procedure,Aortocoronary bypass 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: midsternal chest pain

PRESENT ILLNESS: Ms. [**Known lastname 8260**] is a 77 y/o F with PMH of CAD s/p CABG in [**2098**] (LIMA to
LAD, SVG to PDA, SVG to OM, SVG to diag), ESRD s/p renal
transplant ([**2100**]), and IDDM who presents in transfer from [**Hospital **]. The patient has felt quite tired for the past several
days while visiting her daughter; on routine labs (due for INR),
the patient was found to have a Hct of 18 with INR of 6. She was
admitted to [**Hospital3 8544**] for further evaluation; there, she
received 3 U PRBCs (by report). Hematocrit after her 2nd unit of
PRBCs was 21.9. Her INR was reversed with FFP and vitamin K with
repeat INR 2.6 from 6. Overnight, the patient had the acute
onset of midsternal chest pain with radiation to the back at the
OSH. This was not associated with diaphoresis, shortness of
breath, or palpitations. The patient was nauseous and vomited
once. The pain is a "steady, sharp" pain per her report; at its
worst, the pain was [**5-5**]. Now, the pain is [**2114-2-28**] and actually
resolved completely. She noted some improvement with
administration of labetalol gtt; she also received morphine and
nitroglycerin without much relief. She states that the pain is
improved with sitting up. It is not pleuritic. She has no cough.
She denies orthopnea and PND. She has left > right lower
extremity edema which is chronic.
.
She tells me that she had a low blood count one month ago that
required a transfusion of 1 U PRBCs; she subsequently was placed
on aranesp. At that time, she also experienced substernal chest
pain, much like her current pain, for which an answer was not
found (per her report). At the current time, she is on a
nitroglycerin gtt and without pain. Her stool is trace guaiac
positive.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. She denies recent fevers, chills or
rigors. She denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

MEDICAL HISTORY: PMH: Renal artery stent on [**2110-12-27**]; surveillance U/S [**4-23**]
(+)in-stent stenosis/hydronephrosis; ESRD s/p CRT'[**99**], RUE AVF,
CAD s/p CABGx4(LGSV)'[**98**], cAF, HTN, IDDM2, gout, CCY, zoster

MEDICATION ON ADMISSION: Home MEDICATIONS (per recent nephrology note, patient unsure of
medications)
coumadin
norvasc 10 mg daily
diovan 80 mg [**Hospital1 **]
prednisone 5 mg daily
clonidine 0.1 mg [**Hospital1 **]
Labetalol 50 mg [**Hospital1 **]
colace 100 mg daily
amiodarone 100 mg every other day
lasix 60 mg [**Hospital1 **]
lipitor 20 mg daily
calcitriol 0.25 mcg daily
allopurinol 100 mg every other day
aspirin 81 mg daily
prograf 2 mg [**Hospital1 **]
levothyroxine 100 mcg daily

ALLERGIES: Percocet / Codeine / Hydrochlorothiazide / Percodan / Cardizem

PHYSICAL EXAM: VS: T 96.9, BP 144/42, HR 66, RR 12, O2 100% on 4L NC
Gen: WDWN elderly woman in NAD, resp or otherwise. Oriented x3.
Mood, affect appropriate. Pleasant and able to speak in full
sentences.
HEENT: NCAT. Left conjunctiva injected. PERRL, EOMI. MM somewhat
dry.
Neck: Supple with JVP of 8 cm.
CV: Irregularly irregular rhythm, normal S1, S2. No S4, no S3.
2/6 systolic murmur at the apex.
Chest: Prior CABG sternotomy scar. No chest wall deformities,
scoliosis or kyphosis. Resp were unlabored, no accessory muscle
use. Occasional crackles at the bases; no wheezes or rhonchi.
Abd: soft, hypoactive bowel sounds, NTND, No HSM or tenderness.
No abdominial bruits.
Rectal: firm stool in the vault, trace guaiac positive
Ext: 1+ left lower extremity edema with overlying erythema.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+; DP dopplerable
Left: Carotid 2+ without bruit; Femoral 2+; DP dopplerable

FAMILY HISTORY: No hx of premature coronary artery disease

SOCIAL HISTORY: Widowed and lives with her son. She is a nonsmoker. She denies
alcohol use. 

### Response:
{'Diverticulosis of colon with hemorrhage,Acute posthemorrhagic anemia,Atrial fibrillation,Urinary tract infection, site not specified,Intermediate coronary syndrome,Complications of transplanted kidney,Other drugs and medicinal substances causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Angiodysplasia of intestine (without mention of hemorrhage),Gout, unspecified,Unspecified acquired hypothyroidism,Constipation, unspecified,Conjunctival hemorrhage,Edema,Hypertensive retinopathy,Unspecified essential hypertension,Hematoma complicating a procedure,Aortocoronary bypass status'}
