CHIEF COMPLAINT: Atrial thrombus seen on echocardiogram

PRESENT ILLNESS: 79F w/recent diagnosis afib presents from cardiology clinic for
workup of possible left atrial thrombus visualized on routine
office TTE.

MEDICAL HISTORY: Atrial fibrillation [**1-/2200**] (diagnosed [**2-/2200**])
Idiopathic Cardiomyopathy, LVEF 45% (diagnosed [**2-/2200**])
OSTEOPENIA
ESOPHAGEAL REFLUX
BENIGN POSITIONAL VERTIGO

MEDICATION ON ADMISSION: dabigatran etexilate (PRADAXA) 150 mg [**Hospital1 **] (started 10d ago)
Sotalol 160 mg [**Hospital1 **] (increased 10d ago)
Fluticasone (FLOVENT HFA) 220 mcg [**Hospital1 **] (not using)
Omeprazole 20 mg daily
Meclizine 12.5 mg daily PRN (not taking)
Fluocinonide 0.05 % Topical Cream [**Hospital1 **] (uses rarely)

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM
VS: 97.9 98/71 HR 129 RR 20 98/RA
GENERAL: thin elderly female resting in bed in NAD. Oriented x3.

FAMILY HISTORY: Mother with MI at age 85, son with Afib, daughter with breast CA

SOCIAL HISTORY: Lives alone, son [**Name (NI) **] involved in care.
-Tobacco history: Smoked 1 pack/two weeks x8 years, quit [**2174**]
-ETOH: Lifetime drinker (1 [**Location (un) 21601**]/day with 2 shots of whisky)
until 3-4 weeks ago she stopped due to concern for ETOH
cardiomyopathy.
-Illicit drugs: Denies
Malignant carcinoid tumor of the bronchus and lung,Acute respiratory failure following trauma and surgery,Acute on chronic diastolic heart failure,Alcoholic cardiomyopathy,Acute posthemorrhagic anemia,Atrial flutter,Stricture and stenosis of esophagus,Other diseases of respiratory system, not elsewhere classified,Enlargement of lymph nodes,Personal history of tobacco use
Mal carcinoid bronc/lung,Ac resp flr fol trma/srg,Ac on chr diast hrt fail,Alcoholic cardiomyopathy,Ac posthemorrhag anemia,Atrial flutter,Esophageal stricture,Resp system disease NEC,Enlargement lymph nodes,History of tobacco use
Admission Date:  [**2200-4-21**]              Discharge Date:   [**2200-4-30**]

Date of Birth:  [**2121-1-6**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 602**]
Chief Complaint:
Atrial thrombus seen on echocardiogram

Major Surgical or Invasive Procedure:
1. Endobronchial biopsy (EBUS)
2. Endobronchial resection of neoplasm invading right bronchus
intermedius


History of Present Illness:
79F w/recent diagnosis afib presents from cardiology clinic for
workup of possible left atrial thrombus visualized on routine
office TTE.

  Patient was diagnosed with atrial fibrillation 2 mos ago, when
she saw her physician for complaining of feeling her heart
fluttering and ongoing fatigue for 3 weeks. EKG showed atrial
fibrillation, TTE at that time showed LVEF 45%. Cardiomyopathy
was attributed to alcohol use because she drinks 2 shots whiskey
nightly in her [**Location (un) **] nightly. She stopped drinking entirely
about 1.5 months ago. Atrial fibrillation has been difficult to
control medically: she was started on sotalol 120 [**Hospital1 **], then
switched to dronedarone 400 [**Hospital1 **], then back to 160 mg sotalol [**Hospital1 **]
about 10 days prior to admission. She had episodes of atrial
fibrillation near daily which she feels and documents by
self-pulse checks. She started pradaxa about 10 days prior to
admission when she called her cardiologist to report  an episode
of atrial fibrillation lasting >48h.

  About 10 days prior to admission she also noted new bilateral
leg edema. No chest pain, pressure, SOB; no nausea/vomiting. She
does describe early satiety/food intolerance (gags on small
amounts of food due to distaste) ongoing for ~2 months. Weight
loss of 14 lbs ([**5-8**] lbs voluntarily before [**Holiday **], 10 lbs
involuntarily since then). She noted no improvement in fatigue
symptoms, also no improvement in dry cough which predated her
fatigue and palpitations by ~1 year and was nonresponsive to
antibiotics (azithromycin) as recently as 2 mos ago.

  On the day of admission her cardiologist performed a repeat
TTE to evaluate for any interval improvement since ETOH
cessation. TTE showed possible [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 2966**] or external mass
compressing LA. Patient has been compliant with Pradaxa since
prescribed 10 days prior to admission. She had no neurologic
symptoms - no change speech, vision, hearing, motor, sensation,
concentration or memory. Patient was sent to [**Hospital1 18**] to further
evaluate these TTE findings.

Past Medical History:
Atrial fibrillation [**1-/2200**] (diagnosed [**2-/2200**])
Idiopathic Cardiomyopathy, LVEF 45% (diagnosed [**2-/2200**])
OSTEOPENIA
ESOPHAGEAL REFLUX
BENIGN POSITIONAL VERTIGO

Social History:
Lives alone, son [**Name (NI) **] involved in care.
-Tobacco history: Smoked 1 pack/two weeks x8 years, quit [**2174**]
-ETOH: Lifetime drinker (1 [**Location (un) 21601**]/day with 2 shots of whisky)
until 3-4 weeks ago she stopped due to concern for ETOH
cardiomyopathy.
-Illicit drugs: Denies


Family History:
Mother with MI at age 85, son with Afib, daughter with breast CA

Physical Exam:
ADMISSION EXAM
VS: 97.9 98/71 HR 129 RR 20 98/RA
GENERAL: thin elderly female resting in bed in NAD. Oriented x3.

HEENT: NCAT, PERRL, EOMI, MMM, + gingival ulcer R upper gums and
along toothline. OP otherwise clear.
NECK: Supple, JVP 5 above sternal angle, no cervical LAD
CARDIAC: irregular rate, normal S1/S2, no mrg
LUNGS: No chest wall deformities. Resp unlabored, no accessory
muscle use. CTAB, no crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. No abdominial bruits.
EXTREMITIES: symmetric bilateral 2+ nonpitting edema to thighs,
pulses easily palpable
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas
NEURO: AOX3, CN intact, strength 5/5 throughout, gait narrow &
stable

DISCHARGE EXAM
Vital signs: T(98.0F-97.6F); [109-124/64-72], HR 52-74, rr 18,
94% RA.
General: Alert, oriented, sitting up in bed, appears tired.
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: Supple, JVP not elevated, no LAD
CV: regular rythm, normal S1,S2. no murmurs, rubs, gallops
Lungs: CTABL, no rhonchi or wheezes
Abdomen: soft, non-tender, non-distended, bowel sounds present
[**Location (un) **]: Warm, well perfused, 2+ pulses, no clubbing, cyanosis. No
lower extremity edema.
Neuro: CN III-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation and strength

Pertinent Results:
I) ADMISSION LABS

CBC
[**2200-4-25**] 11:20AM BLOOD WBC-9.7 RBC-4.52 Hgb-11.8* Hct-39.4
MCV-87 MCH-26.1* MCHC-29.9* RDW-18.2* Plt Ct-377
[**2200-4-24**] 06:34AM BLOOD WBC-8.3 RBC-4.36 Hgb-11.8* Hct-38.0
MCV-87 MCH-27.0 MCHC-31.0 RDW-17.5* Plt Ct-414
[**2200-4-23**] 07:05AM BLOOD WBC-8.4 RBC-4.14* Hgb-11.0* Hct-36.1
MCV-87 MCH-26.5* MCHC-30.4* RDW-17.4* Plt Ct-414
[**2200-4-22**] 07:50AM BLOOD WBC-7.8 RBC-4.12* Hgb-10.9* Hct-36.1
MCV-88 MCH-26.5* MCHC-30.2* RDW-17.9* Plt Ct-376
[**2200-4-21**] 03:40PM BLOOD WBC-8.9 RBC-4.46 Hgb-12.0 Hct-39.0 MCV-87
MCH-26.8* MCHC-30.7* RDW-17.7* Plt Ct-451*

Differential
[**2200-4-23**] 07:05AM BLOOD Neuts-73.3* Lymphs-20.4 Monos-4.7 Eos-1.2
Baso-0.5

Coags:

[**2200-4-21**] 03:40PM BLOOD PT-14.3* PTT-29.2 INR(PT)-1.3*
[**2200-4-22**] 07:50AM BLOOD PT-14.8* PTT-34.0 INR(PT)-1.4*
[**2200-4-22**] 07:50AM BLOOD Plt Ct-376
[**2200-4-23**] 07:05AM BLOOD PT-13.5* PTT-29.8 INR(PT)-1.3*

CHEM

[**2200-4-23**] 07:05AM BLOOD Glucose-80 UreaN-6 Creat-0.6 Na-135 K-4.2
Cl-97 HCO3-32 AnGap-10
[**2200-4-22**] 07:50AM BLOOD Glucose-78 UreaN-7 Creat-0.6 Na-135 K-4.6
Cl-97 HCO3-32 AnGap-11
[**2200-4-21**] 03:40PM BLOOD Glucose-102* UreaN-9 Creat-0.7 Na-136
K-4.2 Cl-96 HCO3-29 AnGap-15
[**2200-4-21**] 03:40PM BLOOD Calcium-9.0 Phos-3.2 Mg-1.9
[**2200-4-22**] 07:50AM BLOOD Calcium-8.7 Phos-3.8 Mg-2.0

Cardiac Enzymes:

[**2200-4-26**] 03:49AM BLOOD CK-MB-3 cTropnT-<0.01
[**2200-4-25**] 07:13PM BLOOD CK-MB-3 cTropnT-<0.01

II) MICROBIOLOGY
  BRONCHIAL WASHINGS      BRONCHUS INTERREDIUS WASHING.

                            **FINAL REPORT [**2200-4-27**]**

   GRAM STAIN (Final [**2200-4-25**]):
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.

   RESPIRATORY CULTURE (Final [**2200-4-27**]):
      ~6OOO/ML Commensal Respiratory Flora.

   MRSA SCREEN (Final [**2200-4-28**]):    No MRSA isolated.

   GRAM STAIN (Final [**2200-4-29**]):
      >25 PMNs and >10 epithelial cells/100X field.
      Gram stain indicates extensive contamination with upper
respiratory
      secretions. Bacterial culture results are invalid.
      PLEASE SUBMIT ANOTHER SPECIMEN.

   RESPIRATORY CULTURE (Final [**2200-4-29**]):
      TEST CANCELLED, PATIENT CREDITED.


III) IMAGING
CARDIAC CT
IMPRESSION:

1. A large mass involving the right lower medial lung extending
into the
paraesophageal, subcarinal and right hilar mediastinal regions
with invasion
to the pericardium, right atrium, left atrium and compressing
the right
airways causing complete collapse of the right middle lobe and
partial
collapse of the right lower lobe.

2. Moderate right-sided pleural effusion.

3. Enlarged left supraclavicular lymphnode, 6 x 7 mm solid
nodule in the
right lower lobe and a suspicious lytic area in the left
transverse process of
the D1 vertebra and posterior end of the left second rib are
concerning for
the deposits.

4. Uncharacteristic 16 x 17 mm focal hypodensity in the right
lobe of liver
which is only imaged on the unenhanced series. Ultrasound of
liver is
suggested for further evaluation.

Tissue sample can be easily obtained by transbronchial approach
for tissue
diagnosis.

The study and the report were reviewed by the staff radiologist.

IV) STUDIES: EBUS
Some white-colored mucous plugs were aspirated from the now
visible RML and RLL and sent for culture. RML showed residual
75% obstruction, RLL showed residual 50% obstruction, and the
superior segment RLL was just barely identified. The [**Hospital1 **] had a
residual 40% airway obstruction by extrinsic compression. A
stent was not placed for adequate airway re-canalization. Next,
the flexible scope was removed, then the endobronchial
ultrasound was inserted. A large mediastinal mass was visualized
and sampled from both the right and left carinae, a total of 8
samples with at least 15 passes each was performed for cytology
and flow cytometry. The EBUS was removed, then the flexible
scope re-inserted to suction remaining clot. Scopes were
removed, then the procedure was then completed. The patient
awoke without event.

V)Discharge Labs
CBC
[**2200-4-29**] 06:35AM BLOOD WBC-8.7 RBC-4.14* Hgb-11.2* Hct-36.9
MCV-89 MCH-27.0 MCHC-30.3* RDW-18.9* Plt Ct-337
[**2200-4-28**] 08:44AM BLOOD WBC-10.7 RBC-4.28 Hgb-11.6* Hct-37.8
MCV-88 MCH-27.0 MCHC-30.6* RDW-18.6* Plt Ct-359
[**2200-4-27**] 07:00AM BLOOD WBC-9.4# RBC-4.02* Hgb-10.7* Hct-35.4*
MCV-88 MCH-26.7* MCHC-30.3* RDW-18.7* Plt Ct-336

Coags:
[**2200-4-29**] 06:35AM BLOOD PT-13.4* PTT-103.1* INR(PT)-1.2*
[**2200-4-29**] 06:35AM BLOOD Plt Ct-337
[**2200-4-28**] 08:44AM BLOOD PT-13.3* PTT-127.2* INR(PT)-1.2*

Chem

[**2200-4-29**] 06:35AM BLOOD Glucose-122* UreaN-7 Creat-0.5 Na-133
K-4.3 Cl-96 HCO3-30 AnGap-11
[**2200-4-28**] 08:44AM BLOOD Glucose-133* UreaN-7 Creat-0.5 Na-134
K-4.1 Cl-98 HCO3-28 AnGap-12
[**2200-4-27**] 11:35PM BLOOD Glucose-133* UreaN-7 Creat-0.4 Na-131*
K-3.7 Cl-99 HCO3-25 AnGap-11
[**2200-4-29**] 06:35AM BLOOD Calcium-8.3* Phos-1.8* Mg-2.0

VII) Studies PENDING: To be followed by oncology team.
URINE CULTURE (Pending):
IMMUNOPHENOTYPING - MEDIASTINAL MASS/EBUS TBNA
Report not finalized.
Assigned Pathologist [**Doctor Last Name 7211**],HA T.
Please contact the pathology department, [**Name (NI) **] [**Numeric Identifier 1434**]
PATHOLOGY # [**Numeric Identifier 40353**]
BRONCHUS INTERMEDIUS TUMOR.


Brief Hospital Course:
Ms. [**Known lastname 2643**] is a 79 year old female with recently-diagnosed atrial
fibrillation admitted with pericardiac mass and found to have a
large mediastinal mass concerning for malignancy with
compression of the heart, lung, and esophagus.

Issues addressed during hospitalization:
1. Malignant mediastinal neoplasm
2. Atrial Fibrillation
3. Chronic Cough
4. Chronic systolic heart failure with a left ventricular
ejection fraction of 45%.

  The patient was initially admitted to the cardiology service
after her outpatient cardiologist noticed what was believed at
the time to be a right atrial thrombus. Inpatient cardiology
re-review of this TTE and [**2200-2-2**] TTE showed interval
enlargement of an extra-pericardial mass rather than an
intra-cardiac thrombus, now compressing the left atrium, which
was not clearly apparent by CXR. A chest CT was performed which
showed that there was a large mediastinal mass which was
compressing the right/left atrium, as well as the lower segment
of the right lung, and esophagus. Her symptoms of difficult to
control atrial fibrillation, chronic dry cough, loss of apetite,
mild systolic heart failure as well as loss of appetite were all
felt likely to be the result of the mass effect exerted by the
tumor.

  The patient's heart rate was initially very difficult to
control. She had several episodes of atrial fibrillation with
rapid ventricular rate to the 140s-150s which did not result in
hemodynamic instability or chest pain. Despite large doses of
diltiazem (as high as 360mg per day), she remained in atrial
fibrillation with frequent episodes of rapid ventricular
response. Rate and rythm control was eventually achieved with
oral diltiazem 60mg q6h and metoprolol 37.5 mg TID. Her blood
pressure tolerated this medication regimen and she remained in
normal sinus rhythm with occasional asymptomatic PVCs prior to
discharge. Her anticoagulation, pradaxa, transitioned to UFH in
order to obtain a surgical biopsy and subsequently transistioned
to LMWH (Lovenox) in the event that she would require another
procedure should the pathologic specimen obtained during biopsy
(see below) be insufficient.

  Since the etiology of the patient's problems were secondary to
mass effect caused by the mediastinal neoplasm, tissue biopsy
was necessary to inform future decisions on definitive oncologic
management. Interventional pulmonolgy performed endobronchial
biopsy and exploration of the lung for tissue sampling and
airway management. During the procedure, they found that the
tumor was invading the right lung parenchyma. In addition, there
was extensive neoplastic growth causing occlusion of the right
bronchus intermedius. FNA and tissue biopsy was obtained. In
addition, electrocautery was used to open the occluded airway.
Following the procedure, the patient went into respiratory
failure secondary to atrial fibrillation with rapid ventricular
response, volume overload, and edema secondary to inflamation
from the mechanical instrumentation. She was subsequently
transferred from the PACU to the MICU for NIPPV and aggressive
diuresis. She was promptly stabilized in the MICU and
transferred back to general medicine after approximately 18
hours in the medical ICU.

  When she returned to the floor from the MICU, her heart rate
and rythym remained predominantly in normal sinus rhythm with
stable hemodynamics on diltiazem 60mg q6h and metoprolol 37.5
TID. She remained euvolemic with clear breath sounds, and no
lower extremity edema. The patient was anticoagulated with daily
lovenox once a day 1.5mg/kg rather than resuming Pradaxa on
initiating coumadin given the liklihood of further procedures in
the near future. The patient was also evaluated by medical
oncology who is awaiting final pathology results before
recommending final treatment. They will follow up the biopsy
results and discuss with patient at outpatient follow up
including options for treatment.

Medicine and medical oncology felt that the patient would be
best served by inpatient rehabilitation in the sub-acute setting
while the final pathology was pending. She was subsequently
discharged to rehabilitation.

CODE: FUll
FEN: Cardiac, low salt diet
PPX: Lovenox

Transitional Issues:
1. Tissue histopathology pending.
Medicial oncology will contact the patient while she is at rehab
to coordinate her subsequent treatment for her cancer.

Medications on Admission:
dabigatran etexilate (PRADAXA) 150 mg [**Hospital1 **] (started 10d ago)
Sotalol 160 mg [**Hospital1 **] (increased 10d ago)
Fluticasone (FLOVENT HFA) 220 mcg [**Hospital1 **] (not using)
Omeprazole 20 mg daily
Meclizine 12.5 mg daily PRN (not taking)
Fluocinonide 0.05 % Topical Cream [**Hospital1 **] (uses rarely)

Discharge Medications:
1. DILT-XR 240 mg Capsule,[**Hospital1 **] Release Degradable Sig: One (1)
Capsule,[**Hospital1 **] Release Degradable PO once a day.
Disp:*30 Capsule,[**Hospital1 **] Release Degradable(s)* Refills:*2*
2. Lovenox 100 mg/mL Syringe Sig: One Hundred (100) mg
Subcutaneous once a day.
Disp:*10 Syringe* Refills:*2*
3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
4. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable
Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed
for indigestion.
5. fluocinonide 0.05 % Cream Sig: One (1) application Topical as
needed as needed for itching.
6. metoprolol succinate 100 mg Tablet Extended Release 24 hr
Sig: One (1) Tablet Extended Release 24 hr PO once a day.

The following medications were started on this admission:
1. Diltiazem extended release 240mg once a day
2. Metoprolol XL 100mg once a day
3. Lovenox subcutaneous injection 100mg once a day
4. Calcium carbonate 1000mg QID PRN indigestion

The following medications were discontinued:
1. Pradaxa
2. Sotalol
3. Fluticasone HFA
4. Meclizine


Discharge Disposition:
Extended Care

Facility:
Commons Residence At Orchard - [**Location (un) 2624**] (a.k.a. [**Location (un) 5481**])

Discharge Diagnosis:
1. Mediastinal neoplasm
2. Atrial fibrillation with rapid ventricular response
3. Compensated systolic congestive heart failure

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Dear Ms. [**Known lastname 2643**],

You were admitted for workup and evaluation of your atrial
fibrillation. You were found to have a large tumor extending in
your lung and pressing on your heart. This tumor is also
compressing your esophagus. This tumor is what has been causing
your difficult to control atrial fibrillation, chronic cough,
and loss of appetite. It will most likely take another 4 or 5
days for the final pathology from your biopsy to come back. At
that point, the medical oncologists from [**Hospital1 18**] will arrange your
follow up and coordinate your future treatment. There is a small
chance that you will need a repeat biopsy for a definitive
tissue diagnosis, however, this is unlikely. Until your biopsy
results are availible, we are making the following changes to
your medications.

Please START:
1. Diltiazem extended release 240mg once a day
2. Metoprolol XL 100mg once a day
3. Lovenox subcutaneous injection 100mg once a day
4. Calcium carbonate 1000mg QID PRN indigestion

Please stop:
1. Pradaxa
2. Sotalol
3. Fluticasone HFA
4. Meclizine

Please continue:
1. Omeprazole 20mg once a day.
2. Fluocinonide 0.05 % Topical Cream [**Hospital1 **] prn

If you experience any of the danger signs listed below please
alert your physician and come back to the [**Hospital1 18**] emergency
department.

Followup Instructions:
[**Hospital1 **] [**First Name (Titles) **]
[**Last Name (Titles) 1092**] Oncology
[**0-0-**]
[**Location (un) 86**], [**Numeric Identifier **]
*We are working on a follow up appt in the Thoracic Oncology
Department. If you have not heard or have questions,
please call [**0-0-**].
{'Malignant carcinoid tumor of the bronchus and lung,Acute respiratory failure following trauma and surgery,Acute on chronic diastolic heart failure,Alcoholic cardiomyopathy,Acute posthemorrhagic anemia,Atrial flutter,Stricture and stenosis of esophagus,Other diseases of respiratory system, not elsewhere classified,Enlargement of lymph nodes,Personal history of tobacco use'}


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: Atrial thrombus seen on echocardiogram

PRESENT ILLNESS: 79F w/recent diagnosis afib presents from cardiology clinic for
workup of possible left atrial thrombus visualized on routine
office TTE.

MEDICAL HISTORY: Atrial fibrillation [**1-/2200**] (diagnosed [**2-/2200**])
Idiopathic Cardiomyopathy, LVEF 45% (diagnosed [**2-/2200**])
OSTEOPENIA
ESOPHAGEAL REFLUX
BENIGN POSITIONAL VERTIGO

MEDICATION ON ADMISSION: dabigatran etexilate (PRADAXA) 150 mg [**Hospital1 **] (started 10d ago)
Sotalol 160 mg [**Hospital1 **] (increased 10d ago)
Fluticasone (FLOVENT HFA) 220 mcg [**Hospital1 **] (not using)
Omeprazole 20 mg daily
Meclizine 12.5 mg daily PRN (not taking)
Fluocinonide 0.05 % Topical Cream [**Hospital1 **] (uses rarely)

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM
VS: 97.9 98/71 HR 129 RR 20 98/RA
GENERAL: thin elderly female resting in bed in NAD. Oriented x3.

FAMILY HISTORY: Mother with MI at age 85, son with Afib, daughter with breast CA

SOCIAL HISTORY: Lives alone, son [**Name (NI) **] involved in care.
-Tobacco history: Smoked 1 pack/two weeks x8 years, quit [**2174**]
-ETOH: Lifetime drinker (1 [**Location (un) 21601**]/day with 2 shots of whisky)
until 3-4 weeks ago she stopped due to concern for ETOH
cardiomyopathy.
-Illicit drugs: Denies 

### Response:
{'Malignant carcinoid tumor of the bronchus and lung,Acute respiratory failure following trauma and surgery,Acute on chronic diastolic heart failure,Alcoholic cardiomyopathy,Acute posthemorrhagic anemia,Atrial flutter,Stricture and stenosis of esophagus,Other diseases of respiratory system, not elsewhere classified,Enlargement of lymph nodes,Personal history of tobacco use'}
