CHIEF COMPLAINT: Right AVF thrombosis

PRESENT ILLNESS: 86M with ESRD on HD admitted for fistula thrombectomy, which
occurred yesterday, now with systolic BP in 70s at dialysis,
chest pain, EKG changes with ST depressions in V3-V5. SBP rose
to 100s after IVF. At HD, 1L taken off, BP dropped to 70s,
fistula was used. CP started at noon, didn't resolve after 2
hours. Cards did a bedside echo which showed normal wall motion,
rec no need for CCU. Pt still having L arm numbness. Per renal,
ok to use HD catheter as fistula is now working for HD.
.
Pt states that chest pain is substernal, worse with deep
inspiration, feels like a hammer pounding into his chest. Does
have some numbness in his L arm which he says is intermittent.
Chest pain has stayed constant since its onset around noon. Pt's
BP dropped at HD last Saturday to 60s-70s [**Name8 (MD) **] RN (per records,
in 80s) but he did not have any chest pain. Feels that his chest
pain is similar to chest pain in past that resulted in CABG x4.
The most exertion pt performs at home is climbing a flight of
stairs, which results in no chest pressure but he has been
getting more short of breath.
.
Per cards, no evidence of CHF and no regional wall motion
abnormalities on echo - appears dry. Rec rate control and
heparin for a fib. Pt also has h/o NHL, s/p chemo and rituxan,
and per oncologist is not active.
.
Access includes 1 peripheral, R AV fistula, groin HD catheter.
Pt also has not had BM x3 days, concern for gastric dilatation.

MEDICAL HISTORY: CAD s/p CABG x4 [**2128**]
ESRD with R AVF
HTN
Hyperlipidemia
Non-Hodgkin's lymphoma
Prostate Ca
Seizure d/o
PVD
Lumbar stenosis and disk herniation

MEDICATION ON ADMISSION: doxepin 25mg qHS
lisinopril 10mg [**Hospital1 **]
omeprazole 20mg [**Hospital1 **]
phenytoin 100mg [**Hospital1 **]
simvastatin 20mg daily
pentoxifylline 400mg daily
quinine 260mg daily
temazepam 15mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T- 98.9, Tmx: 99.1
BP: 118/35 113-132/59-86
HR: 71
RR: 13-18 O2: 97-100% on 2L NC
I/O: 690/140 LOS: +5229
.
General: Patient is an elderly male, + chronic sun
exposure/hyperpigmented skin, pleasant, tired, in NAD
HEENT: NCAT, EOMI. OP: + upper dentures. MMM, no lesions
Neck: JVP visible, approximately 6cm
Chest: Mild course expiratory breath sounds, no focal rhonchi,
wheezes, crackles anterior or laterally. Posterior exam limited
secondary to lying flat on back s/p removal of groin line
Cor: RRR, normal S1/S2. II/VI systolic murmur, loudest at RUSB
Abdomen: Mildly distended, mildly tender diffusely but without
rebound or guarding. Notable abdominal "fullness", particularly
periumbilical
Extremity:
RUE: Dressing over fistula, C/D/I. Sutures intact, no erythema.
+Thrill
LE: Venodynes in place, [**1-29**]+ pedal edema

FAMILY HISTORY: Patient currently lives with his wife.
[**Name (NI) 1139**]: Previous, quit 20 years ago.
ETOH: None
Illicits: None

SOCIAL HISTORY: Patient currently lives with his wife.
[**Name (NI) 1139**]: Previous, quit 20 years ago.
ETOH: None
Illicits: None
Other complications due to renal dialysis device, implant, and graft,Subendocardial infarction, initial episode of care,Atrial fibrillation,Chronic kidney disease, Stage V,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Hypotension of hemodialysis,Anemia in chronic kidney disease,Other and unspecified hyperlipidemia,Epilepsy, unspecified, without mention of intractable epilepsy,Peripheral vascular disease, unspecified,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status
Comp-ren dialys dev/grft,Subendo infarct, initial,Atrial fibrillation,Chron kidney dis stage V,Hyperpotassemia,Hyp kid NOS w cr kid V,Oth lymp unsp xtrndl org,Hemododialysis hypotensn,Anemia in chr kidney dis,Hyperlipidemia NEC/NOS,Epilep NOS w/o intr epil,Periph vascular dis NOS,Crnry athrscl natve vssl,Aortocoronary bypass
Admission Date:  [**2137-2-16**]              Discharge Date:   [**2137-2-27**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
Right AVF thrombosis

Major Surgical or Invasive Procedure:
AVF revision/thrombectomy

History of Present Illness:
86M with ESRD on HD admitted for fistula thrombectomy, which
occurred yesterday, now with systolic BP in 70s at dialysis,
chest pain, EKG changes with ST depressions in V3-V5. SBP rose
to 100s after IVF. At HD, 1L taken off, BP dropped to 70s,
fistula was used. CP started at noon, didn't resolve after 2
hours. Cards did a bedside echo which showed normal wall motion,
rec no need for CCU. Pt still having L arm numbness. Per renal,
ok to use HD catheter as fistula is now working for HD.
.
Pt states that chest pain is substernal, worse with deep
inspiration, feels like a hammer pounding into his chest. Does
have some numbness in his L arm which he says is intermittent.
Chest pain has stayed constant since its onset around noon. Pt's
BP dropped at HD last Saturday to 60s-70s [**Name8 (MD) **] RN (per records,
in 80s) but he did not have any chest pain. Feels that his chest
pain is similar to chest pain in past that resulted in CABG x4.
The most exertion pt performs at home is climbing a flight of
stairs, which results in no chest pressure but he has been
getting more short of breath.
.
Per cards, no evidence of CHF and no regional wall motion
abnormalities on echo - appears dry. Rec rate control and
heparin for a fib. Pt also has h/o NHL, s/p chemo and rituxan,
and per oncologist is not active.
.
Access includes 1 peripheral, R AV fistula, groin HD catheter.
Pt also has not had BM x3 days, concern for gastric dilatation.

.


Past Medical History:
CAD s/p CABG x4 [**2128**]
ESRD with R AVF
HTN
Hyperlipidemia
Non-Hodgkin's lymphoma
Prostate Ca
Seizure d/o
PVD
Lumbar stenosis and disk herniation


Social History:
Patient currently lives with his wife.
[**Name (NI) 1139**]: Previous, quit 20 years ago.
ETOH: None
Illicits: None


Family History:
Patient currently lives with his wife.
[**Name (NI) 1139**]: Previous, quit 20 years ago.
ETOH: None
Illicits: None


Physical Exam:
Vitals: T- 98.9, Tmx: 99.1
BP: 118/35 113-132/59-86
HR: 71
RR: 13-18 O2: 97-100% on 2L NC
I/O: 690/140 LOS: +5229
.
General: Patient is an elderly male, + chronic sun
exposure/hyperpigmented skin, pleasant, tired, in NAD
HEENT: NCAT, EOMI. OP: + upper dentures. MMM, no lesions
Neck: JVP visible, approximately 6cm
Chest: Mild course expiratory breath sounds, no focal rhonchi,
wheezes, crackles anterior or laterally. Posterior exam limited
secondary to lying flat on back s/p removal of groin line
Cor: RRR, normal S1/S2. II/VI systolic murmur, loudest at RUSB
Abdomen: Mildly distended, mildly tender diffusely but without
rebound or guarding. Notable abdominal "fullness", particularly
periumbilical
Extremity:
RUE: Dressing over fistula, C/D/I. Sutures intact, no erythema.
+Thrill
LE: Venodynes in place, [**1-29**]+ pedal edema


Pertinent Results:
Admission Labs:
[**2137-2-16**] 01:33PM BLOOD WBC-5.1 RBC-3.45* Hgb-11.3* Hct-33.7*
MCV-98 MCH-32.8* MCHC-33.6 RDW-15.6* Plt Ct-158
[**2137-2-17**] 02:05AM BLOOD PT-12.3 PTT-150* INR(PT)-1.1
[**2137-2-16**] 01:24PM BLOOD Glucose-75 UreaN-120* Creat-10.2*# Na-135
K-7.8* Cl-97 HCO3-20* AnGap-26*
[**2137-2-16**] 05:30PM BLOOD Calcium-8.4 Phos-8.2*# Mg-2.4
[**2137-2-16**] 05:30PM BLOOD CK(CPK)-55
Pertinent Labs/Studies:
[**2137-2-19**]  CT Chest/Abdomen/Pelvis
1. Hyperenhancing left renal mass, which may represent lymphoma
or RCC.
2. Multiple new pulmonary nodules in the left lung as described.
A three- month followup CT is recommended for assessment of
stability.
3. Left adrenal mass.
4. Small bilateral pleural effusions
.
[**2137-2-19**]  Echo: Conclusions:
The left atrium is moderately dilated. No atrial septal defect
is seen by 2D or color Doppler. Due to suboptimal technical
quality, a focal wall motion abnormality cannot be fully
excluded. The right ventricular cavity is dilated. Right
ventricular systolic function appears to be normal but views
were technically limited. The aortic root is mildly dilated at
the sinus level. The number of aortic valve leaflets cannot be
determined. The aortic valve leaflets are mildly thickened.
There is no aortic valve stenosis. No aortic regurgitation is
seen. The mitral valve appears structurally normal with trivial
mitral regurgitation. The pulmonary artery systolic pressure
could not be determined. There is no pericardial effusion.
IMPRESSION:
Technically limited study due to poor acoustic windows.
Preserved
global/regional left ventricular systolic function. Right
ventricle may be dilated but function appears normal. No
structural valve disease. No
pericardial effusion.
.
[**2137-2-20**]: Chest Pa/Lat - FINDINGS:  Compared to [**2137-2-19**], allowing
for differences in technique and rotation, no acute process or
significant interval change identified.
.
Troponin: 0.56 ([**2137-2-21**]) -> 0.38 ([**2137-2-23**])
Dilantin: ([**2137-2-25**]) 2.9 - dilantin increased to 200mg [**Hospital1 **] after
this level
Discharge Labs
.
[**2137-2-27**] 06:05AM BLOOD WBC-6.2 RBC-3.23* Hgb-10.3* Hct-30.8*
MCV-95 MCH-31.9 MCHC-33.6 RDW-16.5* Plt Ct-202
[**2137-2-27**] 06:05AM BLOOD Glucose-87 UreaN-29* Creat-6.5*# Na-141
K-3.8 Cl-102 HCO3-30 AnGap-13

Brief Hospital Course:
Prior to floor transfer: Patient is a 86M with ESRD on HD
admitted for fistula thrombectomy, which occurred [**2136-2-21**],
admitted to the MICU after devloping systolic BP in 70s at
dialysis, chest pain, EKG changes with ST depressions in V3-V5.
This was thought possibly to occur in the setting of blood loss
related to AV fistula thrombectoy. SBP rose to 100s after IVF.
At HD, 1L taken off, BP dropped to 70s, fistula was used. CP
started at noon, didn't resolve after 2 hours. Cards did a
bedside echo which showed normal wall motion, rec no need for
CCU and to medically manage. The patient was initially covered
with broad spectrum antibiotics including amp, cipro, flagyl
which were eventually D/C given no evidence for infectious
etiology of hypotension.
.
[**Hospital 38133**] hospital course also notable for abdominal pain. Given
Hct drop, CT C/A/P performed. No leaking AAA or similar seen,
but a left renal mass was observed, possible concerning for
recurrent lymphoma vs. RCC. Per MICU team, discussion with Onc
attending revealed that patient was likely not a candidate for
further treatment at this time.
.
On the floor:
1. Hypotension - As above, the likely etiology of the patient's
hypotension was bleed from surgery.  He was covered with
antibiotics in the Micu, but did not exhibit infection.  On the
floor the patient remained normotensive and eventally a low dose
beta-blocker was added given his recent NSTEMI which he
tolerated well. This was then changed to long acting Toprol.
Patient would likely ultimately benefit from addition of an ACE
inhibitor as pressures allow. This can be added as an outpatient
at the discretion of the patient's PCP.
.
2. NSTEMI - As above, the patient experienced an NSTEMI in the
setting of hypotension and Hct drop. Per cardiology, the patient
was medically managed with ASA, Plavix, and statin without plan
for acute intervention given the [**Hospital 228**] medical
comorbidities. Given his hypotension and bleed a beta-blocker
and heparin drip were held.  His blood pressure improved on the
floor and he was started on a BB.  He had no further events on
the floor.  Consideration for follow-up with cardiology and
potential stress test can be made as on outpatient.  However,
multiple co-morbidities may defer further evaluation or invasive
procedures regardless. As above, the patient may additionally
benefit from addition of an ACE if his BP remains WNL. This may
be started as an outpatient at the discretion of the patient's
PCP and other treaters.
.
2A. PAfib - patient with history of pafib. Patient is currently
on Toprol XL with normal heart rates. Patient was not initiated
on anti-coagulation given Hct drop, and hypotension earlier this
admission. Consideration towards initiation of anti-coagulation
should be performed as an outpatient after acute illness
resolved with consideration towards embolic risk as well as
malignancy and recent bleeding event, although this likely
occurred in the setting of surgical procedure.
.
3. Anemia - The patient received 3U PRBCs during the MICU
course, after his thrombectomy.  On the floor his hematocrit
remained stable and was closely followed and his iron studies
revealed a component of anemia of chronic disease.  His
stabilized by the time of discharge.
.
4. Renal Mass - The patient's renal mass is concerning for
recurrent lymphoma vs. RCC. Per conversation with MICU team, the
patient's treating Oncologist is aware of the renal mass and is
being followed. Pulmonary and Liver nodules, on CT are new
however since last imaging. Unfortunately, given multiple
medical comorbidities, patient not thought to be a likely
candidate for therapy regardless of etiology.  He will have
ongoing follow-up with his oncologist as an outpatient.
.
5. ESRD on HD - The patient received dialysis with his new
fistula with no complications.  He remained stable at dialysis
and had close care by the renal team.  He will continue to
receive dialysis as scheduled on MWF.
.
6. Seizure disorder - The patient was continued on Phenytoin per
outpatient regimen.  His levels were sub-therapuetic with
adjustment this admission. The patient should have levels
repeated during his rehab stay with goal [**11-11**]. If patient
remains sub-therapeutic, his Dilantin should be titrated as
appropriate.   He remained seizure free during his course.
Continuation of this medication can be re-addressed as an
outpatient given notes which indicate thoughts towards
discontinuing this medication.
.
7. Dispo: the patient was discharged to nursing facility for
ongoing rehabilitation
.
8. Code status: patient is DNR/DNI, this was confirmed with the
patient and his wife [**Name (NI) 382**] this admission

Medications on Admission:
doxepin 25mg qHS
lisinopril 10mg [**Hospital1 **]
omeprazole 20mg [**Hospital1 **]
phenytoin 100mg [**Hospital1 **]
simvastatin 20mg daily
pentoxifylline 400mg daily
quinine 260mg daily
temazepam 15mg



Discharge Medications:
1. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
2. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2) Capsule
PO BID (2 times a day).
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Pentoxifylline 400 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO Q24H (every 24 hours).
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for prn pain.
Disp:*30 Tablet(s)* Refills:*0*
6. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day).
Disp:*45 Tablet(s)* Refills:*2*
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
8. Aspirin, Buffered 325 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
Disp:*90 Capsule(s)* Refills:*2*
11. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed for nausea.
12. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**1-29**]
Drops Ophthalmic PRN (as needed).
13. Metoprolol Succinate 25 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
14. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for chest pain:
may repeat upto 3 times every 5 minutes.
15. Prochlorperazine 10 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed for nausea.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 38**] Rehab Hospital

Discharge Diagnosis:
Primary:
1. RUE AV fistula thrombosis.
2. NSTEMI
3. Hypotension NOS.
4. New 4.6 x 4.8 cm left renal mass.
5. New 3.5 x 3 cm left adrenal mass.
6. Multiple new left pulmonary nodules.
7. CKD Stage V on HD
8. Blood loss anemia.

Secondary:
1. Low grade NHL.
2. Seizure D/O NOS.
3. CAD s/p CABG.
4. HTN.
5. Prostate CA


Discharge Condition:
Stable. tolerating oral medications and nutrition


Discharge Instructions:
1. Call Transplant office [**Telephone/Fax (1) 673**] if fever, chills, nausea,
vomiting, decreased urine output, diarrhea, weight gain of 3
pounds in a day, edema or redness/bleeding/pain at incision.
Malfunction of AV fistula, bleeding/redness/increased drainage
at fistula or numbness/discoloration or increased swelling in
right arm
Continue HD M-W-F.
.
Please take all medications as directed.
.
Please make and attend the recommended follow-up appointments

Followup Instructions:
Scheduled Appointments :
.
Please call the office of your primary care physician to make an
[**Telephone/Fax (1) 648**] to be seen within one to two weeks.
.
You have an [**Telephone/Fax (1) 648**] with your Oncologist, Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **], MD. [**First Name (Titles) 2172**] [**Last Name (Titles) 648**] is on [**2137-3-12**] at 09:30, located
on [**Hospital Ward Name 23**] 9. Please call his office at [**0-0-**] at your
convenience if you have any scheduling needs or questions.
.
You have an [**Year (4 digits) 648**] with Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] from the
division of Transplant Surgery. Your [**Last Name (NamePattern4) 648**] is on [**2137-3-7**]
at 3:00. Please call his office at [**Telephone/Fax (1) 673**] with any
questions or scheduling needs.
.
Please call the office of your Nephrologist, Dr. [**Last Name (STitle) 12596**] E. Reyad
to make an [**Last Name (STitle) 648**] for follow up.
{'Other complications due to renal dialysis device, implant, and graft,Subendocardial infarction, initial episode of care,Atrial fibrillation,Chronic kidney disease, Stage V,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Hypotension of hemodialysis,Anemia in chronic kidney disease,Other and unspecified hyperlipidemia,Epilepsy, unspecified, without mention of intractable epilepsy,Peripheral vascular disease, unspecified,Coronary atherosclerosis of native coronary artery,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: Right AVF thrombosis

PRESENT ILLNESS: 86M with ESRD on HD admitted for fistula thrombectomy, which
occurred yesterday, now with systolic BP in 70s at dialysis,
chest pain, EKG changes with ST depressions in V3-V5. SBP rose
to 100s after IVF. At HD, 1L taken off, BP dropped to 70s,
fistula was used. CP started at noon, didn't resolve after 2
hours. Cards did a bedside echo which showed normal wall motion,
rec no need for CCU. Pt still having L arm numbness. Per renal,
ok to use HD catheter as fistula is now working for HD.
.
Pt states that chest pain is substernal, worse with deep
inspiration, feels like a hammer pounding into his chest. Does
have some numbness in his L arm which he says is intermittent.
Chest pain has stayed constant since its onset around noon. Pt's
BP dropped at HD last Saturday to 60s-70s [**Name8 (MD) **] RN (per records,
in 80s) but he did not have any chest pain. Feels that his chest
pain is similar to chest pain in past that resulted in CABG x4.
The most exertion pt performs at home is climbing a flight of
stairs, which results in no chest pressure but he has been
getting more short of breath.
.
Per cards, no evidence of CHF and no regional wall motion
abnormalities on echo - appears dry. Rec rate control and
heparin for a fib. Pt also has h/o NHL, s/p chemo and rituxan,
and per oncologist is not active.
.
Access includes 1 peripheral, R AV fistula, groin HD catheter.
Pt also has not had BM x3 days, concern for gastric dilatation.

MEDICAL HISTORY: CAD s/p CABG x4 [**2128**]
ESRD with R AVF
HTN
Hyperlipidemia
Non-Hodgkin's lymphoma
Prostate Ca
Seizure d/o
PVD
Lumbar stenosis and disk herniation

MEDICATION ON ADMISSION: doxepin 25mg qHS
lisinopril 10mg [**Hospital1 **]
omeprazole 20mg [**Hospital1 **]
phenytoin 100mg [**Hospital1 **]
simvastatin 20mg daily
pentoxifylline 400mg daily
quinine 260mg daily
temazepam 15mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T- 98.9, Tmx: 99.1
BP: 118/35 113-132/59-86
HR: 71
RR: 13-18 O2: 97-100% on 2L NC
I/O: 690/140 LOS: +5229
.
General: Patient is an elderly male, + chronic sun
exposure/hyperpigmented skin, pleasant, tired, in NAD
HEENT: NCAT, EOMI. OP: + upper dentures. MMM, no lesions
Neck: JVP visible, approximately 6cm
Chest: Mild course expiratory breath sounds, no focal rhonchi,
wheezes, crackles anterior or laterally. Posterior exam limited
secondary to lying flat on back s/p removal of groin line
Cor: RRR, normal S1/S2. II/VI systolic murmur, loudest at RUSB
Abdomen: Mildly distended, mildly tender diffusely but without
rebound or guarding. Notable abdominal "fullness", particularly
periumbilical
Extremity:
RUE: Dressing over fistula, C/D/I. Sutures intact, no erythema.
+Thrill
LE: Venodynes in place, [**1-29**]+ pedal edema

FAMILY HISTORY: Patient currently lives with his wife.
[**Name (NI) 1139**]: Previous, quit 20 years ago.
ETOH: None
Illicits: None

SOCIAL HISTORY: Patient currently lives with his wife.
[**Name (NI) 1139**]: Previous, quit 20 years ago.
ETOH: None
Illicits: None 

### Response:
{'Other complications due to renal dialysis device, implant, and graft,Subendocardial infarction, initial episode of care,Atrial fibrillation,Chronic kidney disease, Stage V,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Hypotension of hemodialysis,Anemia in chronic kidney disease,Other and unspecified hyperlipidemia,Epilepsy, unspecified, without mention of intractable epilepsy,Peripheral vascular disease, unspecified,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status'}
