CHIEF COMPLAINT: Atrial fibrillation

PRESENT ILLNESS: Ms. [**Known lastname 110101**] is a 67 year old female with history of paroxysmal
atrial fibrillation on coumadin, CAD, HTN, prior CVA ([**10-17**]),
asthma, DM2 who awoke with acute onset of stabbing chest pain,
shortness of breath, and presyncopal this AM. She had some
associated pain in her bilateral shoulders and throat. The pain
came in three discreet episodes lasting 1.5hrs total, unclear
how long for each episode. She denied any palpitations at the
time and states that she is unable to feel her atrial
fibrillation at baseline. She presents with a detailed medical
record of HR and BPs and appears that baseline HR is 50-60s,
likely sinus (last [**11-22**]).

MEDICAL HISTORY: 1) ?Sjogrens syndrome-being worked up by PCP
2) Spinal stenosis
3) Hypothyroidism on levoxyl
4) Type 2 DM
5) CAD
6) Atrial fibrillation on coumadin
7) Hypertension
8) Mitral valve regurgitation
9) Neuropathy
10) s/p R TKR
11) s/p R cataract and retinal surgery
[**07**]) Arthritis
13) Asthma
14) Acne
15) CVA: [**10/2103**] with some residual stutter and left sided
weakness.

MEDICATION ON ADMISSION: Glipizide 5mg daily
Advair diskus 250/50 1 puff [**Hospital1 **]
Lanoxin 0.25mg tablets daily
Lasix 20mg daily
Hydroxyzine PRN
Metoprolol 25mg [**Hospital1 **]
Aspirin 81mg daily
Levoxyl 50mcg daily
Vitamin D daily
Omeprazole 20mg [**Hospital1 **]
Colace 100mg [**Hospital1 **]
Tylenol PRN
Coumadin 5mg on Tu/Th, 6mg on MWF
Sertraline 50mg daily
Flonase 1 spray NU daily

ALLERGIES: Bactrim / Tetracyclines / Erythromycin Base / Optiray 350 /
Lisinopril / Diltiazem / Bee Sting Kit / Citrus Derived / Fish
Product Derivatives / Shellfish Derived / Iodine Containing
Agents Classifier

PHYSICAL EXAM: VS T 98.6, BP 114/76, HR 72, RR 18, O2sat 99% on 2L.
Gen: WDWN elderly female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. The patient lives alone and tends to own ADLs.
Wheelchair bound.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. She has never smoked. There is no history of alcohol abuse.
Atrial fibrillation,Pneumonia, organism unspecified,Acute myocardial infarction of other specified sites, initial episode of care,Urinary tract infection, site not specified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Mitral valve disorders,Long-term (current) use of anticoagulants,Coronary atherosclerosis of native coronary artery,Asthma, unspecified type, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Phlebitis and thrombophlebitis of upper extremities, unspecified,Other specified diseases of hair and hair follicles,Pressure ulcer, buttock
Atrial fibrillation,Pneumonia, organism NOS,AMI NEC, initial,Urin tract infection NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Hypothyroidism NOS,Mitral valve disorder,Long-term use anticoagul,Crnry athrscl natve vssl,Asthma NOS,Enterococcus group d,Phlbts vn NOS up extrm,Hair diseases NEC,Pressure ulcer, buttock
Admission Date:  [**2104-12-2**]              [**Month/Day/Year **] Date:   [**2104-12-10**]

Date of Birth:  [**2037-3-8**]             Sex:   F

Service: MEDICINE

Allergies:
Bactrim / Tetracyclines / Erythromycin Base / Optiray 350 /
Lisinopril / Diltiazem / Bee Sting Kit / Citrus Derived / Fish
Product Derivatives / Shellfish Derived / Iodine Containing
Agents Classifier

Attending:[**First Name3 (LF) 4975**]
Chief Complaint:
Atrial fibrillation

Major Surgical or Invasive Procedure:
DC cardioversion x1

History of Present Illness:
Ms. [**Known lastname 110101**] is a 67 year old female with history of paroxysmal
atrial fibrillation on coumadin, CAD, HTN, prior CVA ([**10-17**]),
asthma, DM2 who awoke with acute onset of stabbing chest pain,
shortness of breath, and presyncopal this AM. She had some
associated pain in her bilateral shoulders and throat. The pain
came in three discreet episodes lasting 1.5hrs total, unclear
how long for each episode. She denied any palpitations at the
time and states that she is unable to feel her atrial
fibrillation at baseline. She presents with a detailed medical
record of HR and BPs and appears that baseline HR is 50-60s,
likely sinus (last [**11-22**]).

In the ED, vital signs were T 101.5, BP 149/84, HR 170s
irregular, O2sat 96% on RA. EMS gave 5mg IV lopressor x 2 and
325mg aspirin. In the ED, patient was given metoprolol 10mg IV x
1, metoprolol 25mg PO x 1 in ED with IVF (approx 1.5L), rate
improved to 130-150 with stable BP. However, given that patient
had persistent chest pain decision was to cardiovert patient.
Cardioversion was successful, and patient is now in NSR 60-70s.
BPs 100-110 systolic. CXR unremarkable. Vitals prior to transfer
were 105/53, 60s, 19, 97% 2L.

On arrival to the floor the patient is complaining of chest pain
worse with movement. She no longer has any jaw, shoulder or neck
pain. Breathing is improved.


Past Medical History:
1) ?Sjogrens syndrome-being worked up by PCP
2) Spinal stenosis
3) Hypothyroidism on levoxyl
4) Type 2 DM
5) CAD
6) Atrial fibrillation on coumadin
7) Hypertension
8) Mitral valve regurgitation
9) Neuropathy
10) s/p R TKR
11) s/p R cataract and retinal surgery
[**07**]) Arthritis
13) Asthma
14) Acne
15) CVA: [**10/2103**] with some residual stutter and left sided
weakness.


Social History:
Social history is significant for the absence of current tobacco
use. She has never smoked. There is no history of alcohol abuse.


Family History:
There is no family history of premature coronary artery disease
or sudden death. The patient lives alone and tends to own ADLs.
Wheelchair bound.

Physical Exam:
VS T 98.6, BP 114/76, HR 72, RR 18, O2sat 99% on 2L.
Gen: WDWN elderly female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

Neck: Supple with JVP of 3-4cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Crackles appreciated at
right base, no wheezes or rhonchi. Reproducible chest wall
tenderness below left breast.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Neuro: CN II-XII intact, L sided weakness 4/5 upper and lower
extremities, [**4-14**] on right.
.
Pulses:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+


Pertinent Results:
Labs on Admission:
[**2104-12-2**] 09:15AM BLOOD WBC-14.4*# RBC-4.73 Hgb-14.3 Hct-39.7
MCV-84 MCH-30.1 MCHC-35.9* RDW-13.9 Plt Ct-152
[**2104-12-2**] 09:15AM BLOOD Neuts-88.0* Lymphs-7.9* Monos-3.2 Eos-0.5
Baso-0.4
[**2104-12-2**] 09:15AM BLOOD PT-32.9* PTT-39.1* INR(PT)-3.4*
[**2104-12-2**] 09:15AM BLOOD Plt Ct-152
[**2104-12-2**] 09:15AM BLOOD Glucose-157* UreaN-15 Creat-1.0 Na-140
K-4.1 Cl-103 HCO3-26 AnGap-15
[**2104-12-2**] 09:15AM BLOOD ALT-28 AST-27 CK(CPK)-139 AlkPhos-84
TotBili-0.4
[**2104-12-2**] 09:15AM BLOOD Lipase-26
[**2104-12-2**] 09:15AM BLOOD CK-MB-5 proBNP-6416*
[**2104-12-2**] 09:15AM BLOOD cTropnT-0.01
[**2104-12-2**] 05:20PM BLOOD CK-MB-4 cTropnT-0.01
[**2104-12-3**] 12:40AM BLOOD CK-MB-4 cTropnT-0.06*
[**2104-12-3**] 09:10AM BLOOD Calcium-8.9 Phos-3.0 Mg-1.9
[**2104-12-2**] 09:15AM BLOOD TSH-4.0
[**2104-12-2**] 09:15AM BLOOD Digoxin-0.9
[**2104-12-2**] 10:38AM BLOOD Lactate-2.1*

Studies:
[**12-2**] CXR: FINDINGS: The lungs are clear with no signs of
pneumonia or congestive heart failure. No pleural effusions or
pneumothorax is seen. The cardiac and mediastinal contours are
stable in appearance with the heart appearing top normal in
size. The visualized osseous structures are stable with thoracic
spondylolysis again observed.
FINDINGS: No acute intrathoracic process.

[**12-3**] VQ scan:INTERPRETATION:
Ventilation images obtained with Tc-[**Age over 90 **]m aerosol in 8 views
demonstrate a small nonsegmental ventilation defect at the right
base on the right posterior oblique image.
Perfusion images in the same 8 views show a small matched
nonsegmental defect at the right base. Perfusion is otherwise
normal.
Chest x-ray shows mild hydrostatic edema and patchy bibasilar
opacities.
IMPRESSION: Very low probability for pulmonary embolus.

[**12-3**] CXR:
Portable AP chest radiograph: mild increase in cardiomegaly,
prominent
pulmonary vasculature, perihilar haziness, Kerley B lines are
all findings
suggestive of increased fluid overload. Retrocardiac opacity
likely
represent atelectasis.

[**12-5**] KUB: No evidence of bowel obstruction.

[**12-5**] TTE:
The left atrium is elongated. The right atrium is moderately
dilated. There is mild symmetric left ventricular hypertrophy
with normal cavity size. Due to suboptimal technical quality, a
focal wall motion abnormality cannot be fully excluded. There is
mild global left ventricular hypokinesis (LVEF = 40-45%). Right
ventricular chamber size is normal with mild global free wall
hypokinesis. The diameters of aorta at the sinus, ascending and
arch levels are normal. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. Trace aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. Mild (1+) mitral
regurgitation is seen. The estimated pulmonary artery systolic
pressure is normal. There is a trivial/physiologic pericardial
effusion.
IMPRESSION: Mild global biventricular systolic dysfunction.


Brief Hospital Course:
Ms. [**Known lastname 110101**] is a 67 year old female with history of paroxysmal
atrial fibrillation on coumadin, CAD, HTN, prior CVA ([**10-17**]),
asthma, DM2 who awoke with acute onset of stabbing chest pain
and shortness of breath on [**12-2**] and presented to ED.  In the ED
she was found to be in AF with RVR (ventricular rates in the
150s-160s).  They attempted to treat her with beta blockers
without success.  Given persistent chest discomfort the decision
was made to cardiovert her in the ED.  She arrived to the floor
in NSR.

# Rhythm: History of AF on coumadin.  INR on admission was 3.4.
On arrival to the floor the patient was in NSR.  Initially there
was an unclear precipitant for AF - TSH 4.0, CXR without acute
process.  She was maintained on her home dose of Metoprolol 25mg
[**Hospital1 **], titrated up to 50mg [**Hospital1 **] and coumadin was continued at 5mg
daily.  Of note, she did have some elevation in CK and troponin
however this was attributed to cardioversion and not felt likely
related to ischemia.  However, on the morning of [**12-4**] she went
back into atrial fibrillation with ventricular rates in the
150s.  She was given IV metoprolol and increased doses of PO
metoprolol without improvement in rate.  She was then started on
a diltiazem gtt, however it was later noted that this is an
allergy for her.  She complained of scratchy throat and was
given IV benadryl and prednisone.  The AM of [**12-4**] rates
persisted in the 150s-160s, BP stable and pt reported no
symptoms.  She was started on IV amiodarone 150mg bolus followed
by 1mg/min x 6 hours and 0.5mg/min for 18hours with plan for
cardioversion as she was still in AF with rapid response on
[**12-5**] AM.  Digoxin was discontinued.  An echo was ordered for
evaluation of valvular abnormalities and chamber size however
this was deferred on [**12-5**] due to rapid rates and therefore
likely poor image quality.  She developed hypotension on [**12-5**]
and was transferred to the unit for closer monitoring.  It was
decided not to acutely cardiovert her as it was felt that her
hypotension was related to an infectious source and not related
to atrial fibrillation. In the ICU, beta blocker was titrated up
for improved rate control.  Her HR continued to range into the
130s at times, particularly with movement.  Her BB was increased
to 100mg tid and her amio was increased to 400mg tid.  She was
given a trial of verapamil 5mg IV x1 while in the ICU which she
tolerated (had ? allergy to dilt) and was then started on PO
verapamil.  She was transferred back to the floor given she
remained hemodynamically stable in the ICU.  On the floor her
verapamil was uptitrated to 80mg tid.  She remained in afib on
tele, however her rate was much better controlled at 80s-110s
with activity.  The patient's INR remained supratherapeutic and
was 4.2 on he day of [**Month/Year (2) **].  Her coumadin was held during
this time. Her elevated INR was felt to be [**1-12**] antibiotic and
poor nutrition.  Her INR should be monitored on [**Month/Day (2) **] and
her coumadin can be restarted when her INR is < 2.5.  She had no
evidence of bleeding during her stay.  Her amiodarone will need
to be tapered. She should continue on 400mg [**Hospital1 **] for a week, then
this should be decreased to 400mg daily.  She will follow up
with her cardiologist in 2 weeks.

# Hypotension: On the morning of [**12-5**] the patient became
hypotensive with SBPs in the 70s and HR remained stable in the
110s-140s range. She received 1L IVF with improvement in her BP
to 90s which then drifted down to the 80s. Although she was
febrile on presentation to the ED, she has had only low grade
temps on the floor to 100.4. WBC count had risen to 21K. Urine
culture from [**12-2**] showed 1000 enterococcus. Blood cultures were
neg. CXR from [**12-3**] shows volume overload but no infiltrate,
however levofloxacin was started on [**12-3**] out of concern for new
O2 requirement (had been on 3L NC since admission). In the
setting of her new O2 requirement, V/Q scan was performed which
showed low prob for PE, also INR has been
therapeutic-supratherapeutic since presentation. Lactate was
mildly elevated to 2.1.  She was transferred to the ICU, however
she did not require pressors and her BP quickly stabilized.
Etiology was felt to be multifactorial with increasing
beta-blockade, tachyarrythmia and infection contributing. She
was also amio loaded which may have contributed as well. All
blood cx neg. thus far. CXR was concerning for LLL and right
middle lobe opacification concerning for pneumonia; ? aspiration
during cardioversion. She was treated with levofloaxacin for a
10 day course and is currently day 9. During time of ICU
transfer the patient was complaining of RUQ pain, however LFTs
were normal and KUB was negative for obstruction. Her BP has
remained stable with systolics in 100-110 range since tranfer to
the floor.

# Coronaries: Patient with history of CAD per medical records
but no documentation of prior stress or cath.  She presented
with chest pain on admission which was initially attributed to
atrial fibrillation.  She was continued on aspirin.  She
triggered on [**12-3**] for [**8-20**] acute onset crushing chest pain.
ECG was unchanged.  A VQ scan was ordered for ? PE and was very
low probability.  Enzymes were borderline and likely related to
DCCV.  Plan was for pMIBI for evaluation of ischemia as etiology
however this was also deferred given rapid rates.  Exam also
notable for reproducible chest wall tenderness s/p
cardioversion.

# Pump: EF normal in [**2102**] however with elevated BNP and O2
requirement on presentation.  Likely volume overloaded and was
given IV lasix on [**12-3**] with good output.  She had a repeat TTE
on [**12-5**] which showed decreased EF of 45%.  She appeared
euvolemic and did not require additional diuresis.  her home
dose of lasix was held while in the hospital and can be
restarted as an outpatient as needed.

# Pneumonia: Patient had a temperature of 101.5 in the ED with
elevated WBC count.  Blood and urine cultures obtained were
without growth.  LFTs within normal limits on admission.  She
was treated with Levofloxacin empirically for PNA for fever and
O2 requirement.  She has remained afebrile since the day of
admission.

# Musculoskeletal chest pain: The patient developed reproducible
chest pain during admission that initially involved the left and
right chest and was aggravated with motion and palpation.  It
was not thought to be related to cardiac ischemia, given its
positional qualities and the absence of EKG changes or cardiac
enzyme elevation.  The left sided chest pain gradually resolved
and the patient's right sided chest pain was still present on
the day of [**Month/Year (2) **] but improving.

# Folliculitis and right wrist thrombophlebitis with overlying
cellulitis:  Patient was found to have small, pustular lesions
on the right side of her back that were initially concerning for
zoster.  She was started on acyclovir but this was discontinued
as her lesions were not felt to be consistent with zoster.  She
was then treated with vancomycin for presumed folliculitis.
Vancomycin was discontinued because MRSA was not a concern and
she was transitioned to cephalexin.  She will complete a five
day course of antibiotics.  Cephalexin is also being used to
treat overlying cellulitis in the patient's left wrist, which
developed after thrombophlebitis from peripheral IV insertion.

# Diabetes mellitus type 2: Patient's oral hypoglycemics were
held and she was maintained on an insulin sliding scale and a
diabetic diet.  Her oral hypoglycemics can be restarted at
rehabilitation.  Of note, she should be on an angiotensin
receptor blocker but is not currently (allergy to lisinopril).
Initiation of this is deferred to the outpatient setting.

# Hypertension: Patient had episodes of hypotension, as
described above.  She remains on metoprolol and verapamil.

# Asthma: Patient was continued on advair and nebs prn.

# CVA:  Patient has a history of CVA but had a stable neuro
exam, with chronic left-sided weakness.

# Hypothyroidism: Patient was continued on levoxyl and had a TSH
of 4.0.


Medications on Admission:
Glipizide 5mg daily
Advair diskus 250/50 1 puff [**Hospital1 **]
Lanoxin 0.25mg tablets daily
Lasix 20mg daily
Hydroxyzine PRN
Metoprolol 25mg [**Hospital1 **]
Aspirin 81mg daily
Levoxyl 50mcg daily
Vitamin D daily
Omeprazole 20mg [**Hospital1 **]
Colace 100mg [**Hospital1 **]
Tylenol PRN
Coumadin 5mg on Tu/Th, 6mg on MWF
Sertraline 50mg daily
Flonase 1 spray NU daily


[**Hospital1 **] Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - [**Location (un) 550**]

[**Location (un) **] Diagnosis:
Primary:
Atrial fibrillation with rapid ventricular response
Pneumonia
Thrombophlebitis
Musculoskeletal chest pain

Secondary:
Hypertension
Diabetes
Hypothyroidism


[**Location (un) **] Condition:
Good


[**Location (un) **] Instructions:
You were admitted because of chest pain.  We diagnosed you with
atrial fibrillation and a rapid heart rate.  To treat you for
this, we shocked your heart, which was only briefly successful,
and then started you on medications to control your heart rate.
We also diagnosed you with pneumonia and an infection of your
skin, for which we treated you with antibiotics.

You were started on two new medications to help control your
heart rate, amiodarone and verapamil.  The amiodarone will be
tapered by your doctors [**First Name (Titles) **] [**Last Name (Titles) **].

Please take all of your medications as prescribed. Please keep
all of your follow-up appointments.

Please call your doctor or return to the hospital if you
experience fevers, chills, sweats, chest pain, shortness of
breath or anything else of concern.

Followup Instructions:
Scheduled Appointments :
Provider [**Name6 (MD) 251**] [**Last Name (NamePattern4) 252**], M.D. Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2104-12-19**] 10:45

Provider [**Name6 (MD) 251**] [**Last Name (NamePattern4) 677**], M.D. Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2104-12-24**] 2:20

Provider [**First Name8 (NamePattern2) 2890**] [**Last Name (NamePattern1) 2889**], [**Name Initial (PRE) **].D. Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2105-1-7**] 8:30

Test for consideration post-[**Month/Day/Year **]: Tryptase



Completed by:[**2104-12-10**]
{'Atrial fibrillation,Pneumonia, organism unspecified,Acute myocardial infarction of other specified sites, initial episode of care,Urinary tract infection, site not specified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Mitral valve disorders,Long-term (current) use of anticoagulants,Coronary atherosclerosis of native coronary artery,Asthma, unspecified type, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Phlebitis and thrombophlebitis of upper extremities, unspecified,Other specified diseases of hair and hair follicles,Pressure ulcer, buttock'}


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 fibrillation

PRESENT ILLNESS: Ms. [**Known lastname 110101**] is a 67 year old female with history of paroxysmal
atrial fibrillation on coumadin, CAD, HTN, prior CVA ([**10-17**]),
asthma, DM2 who awoke with acute onset of stabbing chest pain,
shortness of breath, and presyncopal this AM. She had some
associated pain in her bilateral shoulders and throat. The pain
came in three discreet episodes lasting 1.5hrs total, unclear
how long for each episode. She denied any palpitations at the
time and states that she is unable to feel her atrial
fibrillation at baseline. She presents with a detailed medical
record of HR and BPs and appears that baseline HR is 50-60s,
likely sinus (last [**11-22**]).

MEDICAL HISTORY: 1) ?Sjogrens syndrome-being worked up by PCP
2) Spinal stenosis
3) Hypothyroidism on levoxyl
4) Type 2 DM
5) CAD
6) Atrial fibrillation on coumadin
7) Hypertension
8) Mitral valve regurgitation
9) Neuropathy
10) s/p R TKR
11) s/p R cataract and retinal surgery
[**07**]) Arthritis
13) Asthma
14) Acne
15) CVA: [**10/2103**] with some residual stutter and left sided
weakness.

MEDICATION ON ADMISSION: Glipizide 5mg daily
Advair diskus 250/50 1 puff [**Hospital1 **]
Lanoxin 0.25mg tablets daily
Lasix 20mg daily
Hydroxyzine PRN
Metoprolol 25mg [**Hospital1 **]
Aspirin 81mg daily
Levoxyl 50mcg daily
Vitamin D daily
Omeprazole 20mg [**Hospital1 **]
Colace 100mg [**Hospital1 **]
Tylenol PRN
Coumadin 5mg on Tu/Th, 6mg on MWF
Sertraline 50mg daily
Flonase 1 spray NU daily

ALLERGIES: Bactrim / Tetracyclines / Erythromycin Base / Optiray 350 /
Lisinopril / Diltiazem / Bee Sting Kit / Citrus Derived / Fish
Product Derivatives / Shellfish Derived / Iodine Containing
Agents Classifier

PHYSICAL EXAM: VS T 98.6, BP 114/76, HR 72, RR 18, O2sat 99% on 2L.
Gen: WDWN elderly female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. The patient lives alone and tends to own ADLs.
Wheelchair bound.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. She has never smoked. There is no history of alcohol abuse. 

### Response:
{'Atrial fibrillation,Pneumonia, organism unspecified,Acute myocardial infarction of other specified sites, initial episode of care,Urinary tract infection, site not specified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Mitral valve disorders,Long-term (current) use of anticoagulants,Coronary atherosclerosis of native coronary artery,Asthma, unspecified type, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Phlebitis and thrombophlebitis of upper extremities, unspecified,Other specified diseases of hair and hair follicles,Pressure ulcer, buttock'}
