CHIEF COMPLAINT: transfer from [**Hospital3 **] hospital for cardiac catherization and
management of chst pain

PRESENT ILLNESS: 55 yo female with type I diabetes on NPH, Ultralente, and RISS,
complicated by retinopathy (blindness), nephropathy, neuropathy,
and gastroparesis, with long standing dyspnea on exertion was
transferred tonight from [**Hospital3 **] hospital where she was
admitted on [**2188-3-20**] for SOB at rest and midsternal chest
pressure, and found to have CHF and HTN (240/120).  She had
negative cardiac enzymes and was diuresed.  She had a an
elevated d-dimer, but negative LENIs and negative v/q scan.  She
was continued on her come BP regimen but was also started on
norvasc 10mg.  Her lisinopril and HCTZ are being held in
anticipation of dye load for cath and she started on mucomyst.
She asked to be transferred to [**Hospital1 18**] because her nephrologist is
Dr. [**First Name (STitle) 10083**].  She was unaware that she was transferred for
cardiac catherization/renal arteriogram.  Today given Kayexelate
for k6.0, that supposedly came down to 5.2, although not
included in data sent over.
.
She was hospitalized [**12-24**] for hypertensive emergency, found to
have encephalopathy that rapidly imrpoved (had word finding
difficulty, nausea, and vomiting).  She was started on diltiazem
which was titrated over the past month to 240mg daily.
.
ROS:
She denies PND and orthopnea.  Has DOE with stairs.  Ambulates
without assistance.  She has noticed that her pants have been
alittle tighter recently.  Dry weight around 157.  Has had b/l
le edema for a few months.  Her fingersticks normally are around
150 but in the past few weeks have been 200s and uncontrolled
since admission to [**Hospital3 **].

MEDICAL HISTORY: Type One diabetes- nephropathy, retinopathy, neuropathy,
gastroparesis.
Cataract- left eye- 2 recent surgeries
Blindness in right eye
Spina Bifida- back pain when laying down for long periods,
difficulty with bending
Chronic anemia- on procrit in past (rash), hct stable in high
20s, low 30s
CRI: cr baseline (2)
HTN: recently hard to control- see HPI

MEDICATION ON ADMISSION: meds on transfer:
lisinopril 20 mg [**Hospital1 **] (being held)
cardizem CD 240 mg daily
cozaar 100 mg qhs
hctz 25 mg daily (being held)
relgan 10 mh po qid
magnesium oxide 200 mg daily
protonix 40 mg daily
nph- 15 units qam
Ultralente- 10 units qam
RISS
Aspirin 81 mg daily
norvasc 10 mg daily (just started)
nitropaste [**11-19**] inch in am
mucomyst 600 mg [**Hospital1 **] (started pm of [**3-22**])
timolol 0.5% one drop to left eye [**Hospital1 **]
prenisolone 1% 1 drop to left eye daily

ALLERGIES: Procrit

PHYSICAL EXAM: 98.9, 142/60, 90, 16, 92% ra, fs 222
NAD.  Middle aged white female.  NC/AT.
Perrl.  Left eye with mild pstosis.
MMM.  Neck supple.  JVP @7cm.
Tachy s1/s2, no murmurs.
Rales b/l bases.
Abd: soft- ntnd, +bs
Ext- b/l mild edema, worse distally, right calf slightly more
prominent than left- no calf tenderness (no change according to
pt)
[**Name (NI) 8259**] symmetric

FAMILY HISTORY: 

SOCIAL HISTORY: Lives with husband.
Independent ADLs.
No tobacco history.
No etoh.
Follows low salt diet, very compliant with meds.
Coronary atherosclerosis of native coronary artery,Diastolic heart failure, unspecified,Acute kidney failure with lesion of tubular necrosis,Chronic kidney disease, unspecified,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Spina bifida without mention of hydrocephalus, lumbar region,Hypovolemia,Unspecified essential hypertension,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Polyneuropathy in diabetes,Gastroparesis,Profound impairment, one eye, impairment level not further specified,Unspecified glaucoma,Anemia in chronic kidney disease
Crnry athrscl natve vssl,Diastolc hrt failure NOS,Ac kidny fail, tubr necr,Chronic kidney dis NOS,DMI renl nt st uncntrld,Spina bifida-lumbar,Hypovolemia,Hypertension NOS,Nephritis NOS in oth dis,Diabetic retinopathy NOS,Neuropathy in diabetes,Gastroparesis,Blindness, one eye,Glaucoma NOS,Anemia in chr kidney dis
Admission Date:  [**2188-1-22**]              Discharge Date:   [**2188-2-12**]

Date of Birth:  [**2132-8-26**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Procrit

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
transfer from [**Hospital3 **] hospital for cardiac catherization and
management of chst pain

Major Surgical or Invasive Procedure:
[**2188-2-1**] - Cardiac Catheterization
[**2188-2-5**] - CABGx4 (LIMA->LAD, SVG->Diagonal, SVG->Obtuse
Marginal, SVG->Right Coronary Artery)


History of Present Illness:
55 yo female with type I diabetes on NPH, Ultralente, and RISS,
complicated by retinopathy (blindness), nephropathy, neuropathy,
and gastroparesis, with long standing dyspnea on exertion was
transferred tonight from [**Hospital3 **] hospital where she was
admitted on [**2188-3-20**] for SOB at rest and midsternal chest
pressure, and found to have CHF and HTN (240/120).  She had
negative cardiac enzymes and was diuresed.  She had a an
elevated d-dimer, but negative LENIs and negative v/q scan.  She
was continued on her come BP regimen but was also started on
norvasc 10mg.  Her lisinopril and HCTZ are being held in
anticipation of dye load for cath and she started on mucomyst.
She asked to be transferred to [**Hospital1 18**] because her nephrologist is
Dr. [**First Name (STitle) 10083**].  She was unaware that she was transferred for
cardiac catherization/renal arteriogram.  Today given Kayexelate
for k6.0, that supposedly came down to 5.2, although not
included in data sent over.
.
She was hospitalized [**12-24**] for hypertensive emergency, found to
have encephalopathy that rapidly imrpoved (had word finding
difficulty, nausea, and vomiting).  She was started on diltiazem
which was titrated over the past month to 240mg daily.
.
ROS:
She denies PND and orthopnea.  Has DOE with stairs.  Ambulates
without assistance.  She has noticed that her pants have been
alittle tighter recently.  Dry weight around 157.  Has had b/l
le edema for a few months.  Her fingersticks normally are around
150 but in the past few weeks have been 200s and uncontrolled
since admission to [**Hospital3 **].

Nephrologist: [**First Name5 (NamePattern1) 10083**]
[**Last Name (NamePattern1) 5370**]: [**Doctor Last Name **]/ [**Last Name (un) **]
Endocrinologist: seen by [**Last Name (un) **] before, but now has not chosen
new doctor.
PCP: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 41195**] on [**Hospital3 **]

Past Medical History:
Type One diabetes- nephropathy, retinopathy, neuropathy,
gastroparesis.
Cataract- left eye- 2 recent surgeries
Blindness in right eye
Spina Bifida- back pain when laying down for long periods,
difficulty with bending
Chronic anemia- on procrit in past (rash), hct stable in high
20s, low 30s
CRI: cr baseline (2)
HTN: recently hard to control- see HPI


Social History:
Lives with husband.
Independent ADLs.
No tobacco history.
No etoh.
Follows low salt diet, very compliant with meds.

Physical Exam:
98.9, 142/60, 90, 16, 92% ra, fs 222
NAD.  Middle aged white female.  NC/AT.
Perrl.  Left eye with mild pstosis.
MMM.  Neck supple.  JVP @7cm.
Tachy s1/s2, no murmurs.
Rales b/l bases.
Abd: soft- ntnd, +bs
Ext- b/l mild edema, worse distally, right calf slightly more
prominent than left- no calf tenderness (no change according to
pt)
[**Name (NI) 8259**] symmetric

Pertinent Results:
GLUCOSE-189* UREA N-43* CREAT-2.0* SODIUM-137 POTASSIUM-4.9
CHLORIDE-106 TOTAL CO2-20*
WBC-7.2 RBC-2.38* HGB-7.9* HCT-23.6* MCV-99* MCH-33.1* MCHC-33.5
RDW-13.5 PLT COUNT-330
  - NEUTS-72.7* LYMPHS-15.5* MONOS-7.5 EOS-3.3 BASOS-1.0

At [**Hospital3 **] Hospital:
BLE U/S- negative for DVT
VQ scan- negative
CXR - c/w CHR (repeated here similarly c/w CHF with no
infiltrates noted)

EKG:
OSH echo [**2188-1-1**]: mild LV dysfunction, mild LVH

PMIBI:
1. No ischemic symptoms or ECG changes. She had an appropriate
hemodynamic response. Image quality is adequate but limited due
to breast attenuation, left arm attenuation, and patient motion.

2. The left ventricular cavity size is increased with stress
compared to rest. The right ventricle appears normal. Stress
perfusion images show a moderate reduction in photon counts
involving the mid and distal anterior wall. Rest perfusion
images show that this defect is reversible.
3. Stress perfusion images also show a moderate reduction in
photon counts involving the entire inferior wall and the basal
inferolateral wall. Rest perfusion images show that this defect
is reversible.
4. Gated images show mild global hypokinesis. The calculated
left ventricular ejection fraction was 45%.
   IMPRESSION:
1. Reversible, small, moderate intensity perfusion defect
involving the LAD (diagonal) territory.
2. Reversible, medium sized, moderate intensity perfusion defect

involving the PDA territory.
3. Transient left ventricular cavity dilation consistent with
multi-vessel disease.
4. Mild left ventricular systolic dysfunction with mild global
hypokinesis.
5. suggestive of three-vessel disease.

MRI/MRA kidneys: no RAS or other masses.

cardiac catheterization [**2188-2-1**]: 1.  Selective coronary
angiography of this right dominant system demonstrated three (3)
vessel coronary artery disease.  The right coronary artery had a
proximal 70% lesion along with a mid vessel 50% lesion.  The
RPDA had a 50% lesion at the origin.  The left main demonstrated
no angiographic evidence of any flow limiting lesions.  The left
anterior descending artery was heavily calcified with a 90% mid
vessel stenosis partially involving the 2nd diagonal.  The left
circumflex demonstrated an OM1 with a 70% tubular lesion.
2.  Selective angiography of the renal arteries demonstrated a
30%
ostial lesion in the left renal artery along with a normal right
renal
artery.
3.  LV ventriculography was deferred due to concerns of her
renal
function and recent echocardiogram.
4.  Limited hemodynamics demonstrated elevated right and left
heart
filling pressures.  No significant pressure gradient recorded
across the
aortic valve upon pullback from the left ventricle to the aorta.

5.  Elevated central pressure (186/80 mm Hg).
     FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Diastolic congestive heart failure by recent echocardiogram.

[**2188-2-5**] ECHO
PRE-CPB There is mild symmetric left ventricular hypertrophy
with normal
cavity size and systolic function (LVEF>55%). Right ventricular
chamber size and free wall motion are normal. There are simple
atheroma in the descending thoracic aorta. There are three
aortic valve leaflets. The aortic valve leaflets are mildly
thickened. No aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. Physiologic mitral regurgitation
is seen (within normal limits). There is a trivial/physiologic
pericardial effusion.

POST-CPB There is low normal RV systolic function. Global LV
systolic function is also low normal - EF = 50-55%. There is
mild apical and septal hypokinesis. Trivial MR. [**Name13 (STitle) **] other changes
from pre-CPB.

[**2188-2-7**] Chest X-Ray
The patient is status post median sternotomy and CABG recently.
The appearance of the heart and mediastinum are satisfactory for
recent aspiration. The lung volumes are low. No evidence of
significant amount of pleural fluid or congestive heart failure
is present. No evidence of pneumothorax is seen. The patient's
ET tube, Swan-Ganz catheter, NG tube, and two left chest tubes
were removed.


Brief Hospital Course:
Ms. [**Known lastname 12262**] is a 55 yo woman with DM and poorly controlled HTN,
admitted with HTN urgency and transferred for cardiac evaluation
and renal artery evaluation.  On arrival to the outside hospital
her BP was found to be 240/120.  She was continued there on her
usual 5 drug regimen with adequate control. She was subsequently
transferred to the [**Hospital1 18**] for further management. Her blood
pressure remained relatively easy to control, even after holding
her [**Last Name (un) **] and ACE inhibitor.  Workup for secondary causes of
hypertension was negative for renin/aldosterone and renal artery
stenosis. Urine free cortisol was still pending on discharge.
After treating her hypertension, however, we believe the she
more likely has essential hypertension and may have been
noncompliant with her medications, as she was well controlled
with no change in her medial regimen.  In fact, at one point she
developed ATN likely secondary to low blood pressures and her
pressure goal was increased with good renal response. The
patient's anemia is at her baseline and low retic index confirms
that this is likely secondary to her renal disease. She was seen
by her outpatient nephrologist, Dr. [**First Name (STitle) 10083**], upon arrival, who
confirmed her procrit allergy and states that he is working on
making Aranesp available for the patient as an outpatient.

A cardiac catheterization was performed on [**2188-2-1**] which
revealed severe three vessel disease with a preserved ejection
fraction. Given the severity of her disease, the cardiac
surgical service was consulted for surgical management. Mrs.
[**Known lastname 12262**] was worked-up in the usual preoperative manner and found
to be suitable for surgery. On [**2188-2-5**], Mrs. [**Known lastname 12262**] was taken to
the operating room where she underwent four vessel coronary
artery bypass grafting by Dr. [**Last Name (STitle) **]. Please see operative note
for further detail. Postoperatively she was taken to the cardiac
surgical intensive care unit. On postoperative day one, Mrs.
[**Known lastname 12262**] awoke neurologically intact and was extubated. Beta
blockade, a statin and aspirin were resumed. Her glucose levels
remained elevated and thus stayed in the intensive care unit for
three days for intravenous insulin. A PICC line was placed as
she had difficult venous access. The [**Last Name (un) 387**] diabetes service
made changes to her diabetes regimen with stabilization of her
blood sugars. On postoperative day four, Mrs. [**Known lastname 12262**] was
transferred to the cardiac surgical step down unit for further
recovery. She was gently diuresed towards her preoperative
weight. The physical therapy service was consulted for
assistance with her postoperative strength and mobility. She
remained hemodynamically stable in a normal sinus rhythm
throughout her postoperative course. Lisinopril was resumed at
half her preoperative dose when her creatinine dropped below her
baseline of 2.0 for hypertension and history of proteinuria.
Renal function studies will be performed when she follow-s up
with her cardiologist in a week. As her potassium was on the
high side of normal without potassium supplementation, thus she
was discharged on 5 days of lasix without potassium as her
weight was still up from her preoperative baseline. Mrs. [**Known lastname 12262**]
continued to make steady progress and was discharged home with a
visiting nurse and physical therapist on postoperative day
seven. She will follow-up with Dr. [**Last Name (STitle) **], her cardiologist, her
nephrologist and her primary care physician as an outpatient.

** Discharge summary should be sent to outpt cardiologist Dr.
[**Last Name (STitle) 41196**] [**Name (STitle) **] in [**Location (un) 9101**] [**Telephone/Fax (1) 34149**], fax [**Telephone/Fax (1) 41167**].**

Medications on Admission:
meds on transfer:
lisinopril 20 mg [**Hospital1 **] (being held)
cardizem CD 240 mg daily
cozaar 100 mg qhs
hctz 25 mg daily (being held)
relgan 10 mh po qid
magnesium oxide 200 mg daily
protonix 40 mg daily
nph- 15 units qam
Ultralente- 10 units qam
RISS
Aspirin 81 mg daily
norvasc 10 mg daily (just started)
nitropaste [**11-19**] inch in am
mucomyst 600 mg [**Hospital1 **] (started pm of [**3-22**])
timolol 0.5% one drop to left eye [**Hospital1 **]
prenisolone 1% 1 drop to left eye daily

Allergies: procrit- rash

Discharge Medications:
1. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4
times a day (before meals and at bedtime)).
Disp:*120 Tablet(s)* Refills:*2*
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*4*
3. Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic  [**Hospital1 **]
(2 times a day): 1 drop OS [**Hospital1 **].
Disp:*1 1 months supply* Refills:*2*
4. Prednisolone Acetate 1 % Drops, Suspension Sig: One (1) Drop
Ophthalmic  DAILY (Daily): 1 drop OS QD.
Disp:*1 1 Months supply* Refills:*2*
5. insulin
Please continue your usual insulin regimen as instuccted. Please
keep a log of your blood sugars for your Doctor.
6. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
8. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 1 months.
Disp:*60 Tablet(s)* Refills:*0*
9. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 1 months.
Disp:*30 Tablet(s)* Refills:*0*
10. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
12. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3-4H (Every 3
to 4 Hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
13. Insulin Glargine 100 unit/mL Cartridge Sig: Twenty (20)
Units Subcutaneous QAM at breakfast.
Disp:*1 Months supply* Refills:*0*
14. Insulin Regular Human 100 unit/mL Cartridge Sig: Sliding
Scale Sliding Scale Injection QACHS: Please see sliding scale.
Disp:*1 1months supply/Sliding Scale* Refills:*0*
15. Insulin Syringes (Disposable)     Syringe Sig: One (1) Box
Miscell.  As Instructed.
Disp:*1 Box* Refills:*0*
16. Alcohol Prep Pads     Pads, Medicated Sig: One (1) Box
Topical  Use on skin prior to fingersticks and Insulin
injections. .
Disp:*1 Box* Refills:*0*
17. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
18. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 5
days.


Discharge Disposition:
Home With Service

Facility:
Gentiva

Discharge Diagnosis:
Type I diabetes 44 years
Retinopathy
Nephropathy
Neuropathy
Gastroparesis
Spina bifida
Glaucoma
Anemia
Right eye blindness
CRI
CAD
s/p CABG


Discharge Condition:
Good


Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain.
2) Report any fever greater then 100.5.
3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in
1 week.
4) You may wash you incision and pat dry. No swimming or bathing
until it has healed.
5) No lotions, creams or powders to wound until it has healed.
6) No lifting greater then 10 pounds for 10 weeks.
7) No driving for 1 month.
8) Please continue your regular insulin sliding scale with figer
sticks before meals and at bedtime. Copy of sliding scale
provided. Please continue your daily morning glargine dose of 20
Units. If your blood sugar is below 80, please drink some [**Location (un) 2452**]
juice or inject [**11-19**] ampule of D50 and call your physician. [**Name10 (NameIs) **]
your Blood sugar is greater then 360, please call your
physician.
9) Take all medications a prescribed.
10) An ace inhibitor has been resumed at half the original dose
for hypertension and proteinuria. Please have creatinine checked
in 1 week when seen by cardiologist. Baseline creatinine is 2.0.
Todays creatinine is 1.8.
11) Take lasix 20mg tiwce daily for five days, then stop.
12) Please call with any questions or concerns.

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) 3278**] in 2 weeks.
Follow-up with Dr. [**First Name (STitle) 10083**] in [**11-19**] weeks.
Follow-up with Dr. [**First Name (STitle) **] in [**11-19**] weeks [**Telephone/Fax (1) 34149**]
[**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2334**], M.D. Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2188-3-14**] 2:30
[**Last Name (LF) **],[**First Name3 (LF) 1112**] W.  [**Telephone/Fax (1) 170**]  Follow-up appointment should be
in 1 month.
Please call all providers for appointments.



Completed by:[**2188-2-12**]
{'Coronary atherosclerosis of native coronary artery,Diastolic heart failure, unspecified,Acute kidney failure with lesion of tubular necrosis,Chronic kidney disease, unspecified,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Spina bifida without mention of hydrocephalus, lumbar region,Hypovolemia,Unspecified essential hypertension,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Polyneuropathy in diabetes,Gastroparesis,Profound impairment, one eye, impairment level not further specified,Unspecified glaucoma,Anemia in chronic kidney disease'}


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: transfer from [**Hospital3 **] hospital for cardiac catherization and
management of chst pain

PRESENT ILLNESS: 55 yo female with type I diabetes on NPH, Ultralente, and RISS,
complicated by retinopathy (blindness), nephropathy, neuropathy,
and gastroparesis, with long standing dyspnea on exertion was
transferred tonight from [**Hospital3 **] hospital where she was
admitted on [**2188-3-20**] for SOB at rest and midsternal chest
pressure, and found to have CHF and HTN (240/120).  She had
negative cardiac enzymes and was diuresed.  She had a an
elevated d-dimer, but negative LENIs and negative v/q scan.  She
was continued on her come BP regimen but was also started on
norvasc 10mg.  Her lisinopril and HCTZ are being held in
anticipation of dye load for cath and she started on mucomyst.
She asked to be transferred to [**Hospital1 18**] because her nephrologist is
Dr. [**First Name (STitle) 10083**].  She was unaware that she was transferred for
cardiac catherization/renal arteriogram.  Today given Kayexelate
for k6.0, that supposedly came down to 5.2, although not
included in data sent over.
.
She was hospitalized [**12-24**] for hypertensive emergency, found to
have encephalopathy that rapidly imrpoved (had word finding
difficulty, nausea, and vomiting).  She was started on diltiazem
which was titrated over the past month to 240mg daily.
.
ROS:
She denies PND and orthopnea.  Has DOE with stairs.  Ambulates
without assistance.  She has noticed that her pants have been
alittle tighter recently.  Dry weight around 157.  Has had b/l
le edema for a few months.  Her fingersticks normally are around
150 but in the past few weeks have been 200s and uncontrolled
since admission to [**Hospital3 **].

MEDICAL HISTORY: Type One diabetes- nephropathy, retinopathy, neuropathy,
gastroparesis.
Cataract- left eye- 2 recent surgeries
Blindness in right eye
Spina Bifida- back pain when laying down for long periods,
difficulty with bending
Chronic anemia- on procrit in past (rash), hct stable in high
20s, low 30s
CRI: cr baseline (2)
HTN: recently hard to control- see HPI

MEDICATION ON ADMISSION: meds on transfer:
lisinopril 20 mg [**Hospital1 **] (being held)
cardizem CD 240 mg daily
cozaar 100 mg qhs
hctz 25 mg daily (being held)
relgan 10 mh po qid
magnesium oxide 200 mg daily
protonix 40 mg daily
nph- 15 units qam
Ultralente- 10 units qam
RISS
Aspirin 81 mg daily
norvasc 10 mg daily (just started)
nitropaste [**11-19**] inch in am
mucomyst 600 mg [**Hospital1 **] (started pm of [**3-22**])
timolol 0.5% one drop to left eye [**Hospital1 **]
prenisolone 1% 1 drop to left eye daily

ALLERGIES: Procrit

PHYSICAL EXAM: 98.9, 142/60, 90, 16, 92% ra, fs 222
NAD.  Middle aged white female.  NC/AT.
Perrl.  Left eye with mild pstosis.
MMM.  Neck supple.  JVP @7cm.
Tachy s1/s2, no murmurs.
Rales b/l bases.
Abd: soft- ntnd, +bs
Ext- b/l mild edema, worse distally, right calf slightly more
prominent than left- no calf tenderness (no change according to
pt)
[**Name (NI) 8259**] symmetric

FAMILY HISTORY: 

SOCIAL HISTORY: Lives with husband.
Independent ADLs.
No tobacco history.
No etoh.
Follows low salt diet, very compliant with meds. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Diastolic heart failure, unspecified,Acute kidney failure with lesion of tubular necrosis,Chronic kidney disease, unspecified,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Spina bifida without mention of hydrocephalus, lumbar region,Hypovolemia,Unspecified essential hypertension,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Polyneuropathy in diabetes,Gastroparesis,Profound impairment, one eye, impairment level not further specified,Unspecified glaucoma,Anemia in chronic kidney disease'}
