CHIEF COMPLAINT: Missed dialysis/Respiratory distress

PRESENT ILLNESS: 63 y/o F w/ ESRD [**2-21**] IgA nephropathy s/[**Name Initial (MD) **] failed CRT [**2173**] on HD
(MWF) through LUE AVF since [**2193**], p/t ED w/ n/v/diarrhea and at
least one episode of bloody stools and ILI Sx w/ worsening SOB x
2-3d. Because she was not feeling well, she missed HD today. She
was unable to provide further hx in ED.

MEDICAL HISTORY: 1. Atrial fibrillation/flutter: first diagnosed in [**Month (only) **]
[**2195**].
2. End-stage renal disease on hemodialysis secondary to IgA
nephropathy s/p cadaveric kidney transplant in [**2173**] which has
eventually failed, and started on hemodialysis in [**2193**].
3. History of upper GI bleeding on [**2195-2-20**] with evidence
of
esophagitis, gastric ulcer, and bleeding duodenal vessel s/p
clipping, cauterization and PPI.
4. Diastolic heart failure supported by an echocardiography from

MEDICATION ON ADMISSION: 1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Calcium Acetate 667 mg Capsule Sig: Three (3) Capsule PO TID

ALLERGIES: Dilantin Kapseal

PHYSICAL EXAM: On Admission:
Vitals: Tm 99.1 Tcurr 97.2 BP: 154/65 P: 62 R: 18 O2: 98% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP 8 cm, no LAD
Lungs: Soft, dry inspiratory crackles on right, no wheezes,
rales, ronchi
CV: Regular rate and rhythm, Loud AV fistula thrill heard across
precordium
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: warm, well perfused, 1+ pitting edema to mid-shin
Neuro: CNs2-12 intact, motor function grossly normal

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory. Her father
died at the age of 80. Her mother died at the age of 64 from
lung CA. She has a sister with breast CA. MI in uncle in his
60s.

SOCIAL HISTORY: Single, lives by herself in [**Location (un) 686**], and has no children. She
quit smoking 25 years ago (10-pack-years). She rarely drinks
alcohol, and denies illicit drug use. She used to work part-time
in a coffee shop, but currently does not work.
Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,End stage renal disease,Acute on chronic diastolic heart failure,Bacterial pneumonia, unspecified,Complications of transplanted kidney,Hyperpotassemia,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease,Other primary cardiomyopathies,Paroxysmal ventricular tachycardia,Hematoma complicating a procedure,Compression of vein,Depressive disorder, not elsewhere classified,Personal history of tobacco use,Renal dialysis status,Long-term (current) use of anticoagulants,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Acute respiratry failure,Food/vomit pneumonitis,End stage renal disease,Ac on chr diast hrt fail,Bacterial pneumonia NOS,Compl kidney transplant,Hyperpotassemia,Ben hyp kid w cr kid V,Prim cardiomyopathy NEC,Parox ventric tachycard,Hematoma complic proc,Compression of vein,Depressive disorder NEC,History of tobacco use,Renal dialysis status,Long-term use anticoagul,Abn react-org transplant,Abn react-procedure NEC
Admission Date:  [**2198-3-5**]              Discharge Date:   [**2198-3-11**]

Date of Birth:  [**2134-9-9**]             Sex:   F

Service: MEDICINE

Allergies:
Dilantin Kapseal

Attending:[**First Name3 (LF) 1943**]
Chief Complaint:
Missed dialysis/Respiratory distress

Major Surgical or Invasive Procedure:
IV Fistulagram
Intubation

History of Present Illness:
63 y/o F w/ ESRD [**2-21**] IgA nephropathy s/[**Name Initial (MD) **] failed CRT [**2173**] on HD
(MWF) through LUE AVF since [**2193**], p/t ED w/ n/v/diarrhea and at
least one episode of bloody stools and ILI Sx w/ worsening SOB x
2-3d. Because she was not feeling well, she missed HD today. She
was unable to provide further hx in ED.

Initial ED VS: T 97.8 HR 80 170/78 18 94 % 2L

Exam was notable for tachypenic ill-appearing F w/ nonfocal abd
tenderness L basilar crackles and an irregularly irregular
tachycardic heart rate to 145. CXR was consistent with B/L
patchy infiltrates concerning for PNA vs. volume overload. Labs
showed K of 6.5, Cr 8.6. Telemetry showed several runs of NSVTs
and pt was symptomatic w/ nausea. She then began to have
sustained runs of VTs; EKG showed hyperacute T waves in V3-V5,
wide complex tachycardia, and LBBB w/ poor R-wave progression.
She received a total of 5g IV calcium gluconate, 10u regular SC
insulin, kayexalate and 1 amp IV glucose. Cardiology was
consulted and felt arrhythmia was [**2-21**] hyperkalemia and renal was
consulted for stat hemodialysis given hyperkalemia and VT. She
did not become pulseless, but as she had increasing tachycardia
and tachypnea, rapid sequence intubation with rocuronium
(instead of succinylcholine given hyperkalemia) and etomidate
was performed in the ED. As EJ blew during intubation, R-
femoral CVL was placed for access. Pt was initially placed on
lidocaine gtt for tachycardia which was changed to esmolol gtt.
Pt also received CTX for presumed PNA on CXR.

VS: afebrile, 145, 145/66 100% on AC 350 x 20,PEEP 5 FiO2 50%

In the MICU, emergent HD was initiated.

Past Medical History:
1. Atrial fibrillation/flutter: first diagnosed in [**Month (only) **]
[**2195**].
2. End-stage renal disease on hemodialysis secondary to IgA
nephropathy s/p cadaveric kidney transplant in [**2173**] which has
eventually failed, and started on hemodialysis in [**2193**].
3. History of upper GI bleeding on [**2195-2-20**] with evidence
of
esophagitis, gastric ulcer, and bleeding duodenal vessel s/p
clipping, cauterization and PPI.
4. Diastolic heart failure supported by an echocardiography from

[**2195-12-21**]. Clinically asx.
5. History of malignant hypertension, which was complicated by
seizure on [**2193-5-20**]. Not on antiepileptic meds. Denies h/o CVA.

6. Depression.
7. Rheumatic fever in childhood

Social History:
Single, lives by herself in [**Location (un) 686**], and has no children. She
quit smoking 25 years ago (10-pack-years). She rarely drinks
alcohol, and denies illicit drug use. She used to work part-time
in a coffee shop, but currently does not work.

Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory. Her father
died at the age of 80. Her mother died at the age of 64 from
lung CA. She has a sister with breast CA. MI in uncle in his
60s.

Physical Exam:
On Admission:
Vitals: Tm 99.1 Tcurr 97.2 BP: 154/65 P: 62 R: 18 O2: 98% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP 8 cm, no LAD
Lungs: Soft, dry inspiratory crackles on right, no wheezes,
rales, ronchi
CV: Regular rate and rhythm, Loud AV fistula thrill heard across
precordium
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: warm, well perfused, 1+ pitting edema to mid-shin
Neuro: CNs2-12 intact, motor function grossly normal

Pertinent Results:
ADMISSION LABS:
[**2198-3-5**] 01:20PM   WBC-5.0 RBC-3.87* HGB-11.9* HCT-35.1* MCV-91
MCH-30.7 MCHC-33.9 RDW-18.3*
[**2198-3-5**] 01:20PM   NEUTS-86.5* LYMPHS-7.9* MONOS-4.4 EOS-0.4
BASOS-0.7
[**2198-3-5**] 01:20PM   PLT COUNT-275
[**2198-3-5**] 01:20PM   GLUCOSE-124* UREA N-81* CREAT-8.6* SODIUM-137
POTASSIUM-6.5* CHLORIDE-92* TOTAL CO2-23 ANION GAP-29*
[**2198-3-5**] 01:20PM   PT-21.3* PTT-27.3 INR(PT)-2.0*
[**2198-3-5**] 03:10PM   proBNP->[**Numeric Identifier **]
[**2198-3-5**] 04:17PM   freeCa-1.34*
[**2198-3-5**] 03:17PM   K+-6.5*
[**2198-3-5**] 04:25PM   TYPE-ART PO2-86 PCO2-59* PH-7.25* TOTAL
CO2-27 BASE XS-2
[**2198-3-5**] 10:35PM   TSH-4.5*

Micro:
[**3-5**] Blood Culture x 2- NGTD
[**2198-3-6**] 2:40 am CATHETER TIP-IV      Source: Rt Femoral.
   WOUND CULTURE (Final [**2198-3-8**]):    No significant growth.
[**2198-3-5**] 11:27 pm SPUTUM      Source: Endotracheal.
   GRAM STAIN (Final [**2198-3-6**]):
      >25 PMNs and <10 epithelial cells/100X field.
      NO MICROORGANISMS SEEN.

   RESPIRATORY CULTURE (Final [**2198-3-8**]):
      SPARSE GROWTH Commensal Respiratory Flora.
[**2198-3-5**] 11:27 pm Rapid Respiratory Viral Screen & Culture
      Source: Nasopharyngeal swab.
                            **FINAL REPORT [**2198-3-8**]**

   Respiratory Viral Culture (Final [**2198-3-8**]):
      No respiratory viruses isolated.
      Culture screened for Adenovirus, Influenza A & B,
Parainfluenza type
      1,2 & 3, and Respiratory Syncytial Virus..
      Detection of viruses other than those listed above will
only be
      performed on specific request. Please call Virology at
[**Telephone/Fax (1) 6182**]
      within 1 week if additional testing is needed.

   Respiratory Viral Antigen Screen (Final [**2198-3-6**]):
      Negative for Respiratory Viral Antigen.
      Specimen screened for: Adeno, Parainfluenza 1, 2, 3,
Influenza A, B,
      and RSV by immunofluorescence.
      Refer to respiratory viral culture for further
information.

[**2198-3-6**] Blood culture- NGTD

STUDIES:
[**2198-3-5**] EKG: Baseline artifact. Possible atrial flutter with
variable block,  predominantly 3:1. Leftward axis. Left
bundle-branch block. Prominent precordial T waves. Since the
previous tracing of [**2196-12-17**] the atrial tachyarrhythmia is new.
The QRS complex is wider. Left bundle-branch block pattern is
new. Clinical correlation is suggested.

[**2198-3-5**] CXR: Portable upright AP chest radiograph is obtained.
There is central pulmonary vascular congestion and mild
pulmonary edema. Small right pleural effusion is noted. No
pneumothorax is seen.

IMPRESSION: Findings compatible with congestive heart
failure/fluid overload.

[**2198-3-6**] Echo: The left atrium is mildly dilated. There is mild
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Overall left ventricular systolic
function is normal (LVEF 65%). Tissue Doppler imaging suggests
an increased left ventricular filling pressure (PCWP>18mmHg).
Right ventricular chamber size and free wall motion are normal.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic stenosis. Mild (1+) aortic
regurgitation is seen. Mild (1+) mitral regurgitation is seen.
[Due to acoustic shadowing, the severity of mitral regurgitation
may be significantly UNDERestimated.] There is a
trivial/physiologic pericardial effusion. There are no
echocardiographic signs of tamponade.
Compared with the findings of the prior study (images reviewed)
of [**2195-12-22**], the findings are similar. The acoustic
texture of the left ventricular myocardium suggests an
amyloid-type infiltration, as does the stiffness of the
myocardium. Findings consistent with restrictive cardiomyopathy.


[**2198-3-7**] R Neck Ultrasound: No focal fluid collection or abscess.
Expansion and increased echogenicity of the right
sternocleidomastoid muscle relative to the left, which may
reflect myositis, of indeterminate etiology. Adjacent prominent
cervical nodes may be reactive. However, followup imaging
following resolution of symptoms is suggested to ensure
resolution of findings.

[**2198-3-9**] CXR: Small bilateral pleural effusions have both
decreased. Substantial residual consolidation is present at the
left lung base, and although there is no pulmonary edema, there
is mild cardiomegaly and persistent, though improved, pulmonary
vascular congestion.

Brief Hospital Course:
63 F w/ ESRD [**2-21**] IgA nephropathy s/[**Name Initial (MD) **] failed CRT [**2173**] on HD (MWF)
through LUE AVF since [**2193**], here w/ n/v/diarrhea and severe
volume overload after missing session of HD from viral
gastrointestinal illness..

1. RESPIRATORY [**Name (NI) **] Pt was intubated [**2-21**] tachypnea and her
increased WOB. Her respiratory failure was attributed to a
likely viral illness with superimposed volume overload. She
underwent emergent dialysis on [**3-5**] and again on [**3-6**] (removal
of appx 3L of fluid) and was extubated on [**3-6**]. She was spiking
temperatures and her CXR on [**3-7**] showed a new infiltrate and
thus cefepime was added to her vancomycin for coverage of HCAP
given her exposures at dialysis sessions. She was [**Month/Year (2) 20003**] out for
flu with a viral respiratory panel. Her respiratory status
improved greatly after several days of dialysis.  Treatment for
health-care associated pneumonia with vancomycin/cefepime was
completed for 7 day course through [**3-11**] (and one more dose of
Vanco on [**3-12**] during HD).

2. ESRD/HYPERKALEMIA- Patient presented w/ hyperkalemia [**2-21**] ESRD
and her missed dialysis session. Her hyperkalemia did not
improve w/ calcium gluconate, insulin, kayexalate, but improved
after HD. Patien had underlying swelling of her left UE near the
site of her AVF and had planned for a fistulogram as an
outpatient. This was scheduled for her as inpatient prior to
transfer to the floor. She received two dialysis sessions with
3L removed before being transferred to the floor with
improvement in respiratory status.  She had an IV fistulagram,
and her fistula was dilated with a balloon.  She will return to
her normal dialysis schedule upon discharge.

3. Atrial fibrillation: Patient presented with AF with aberrancy
in the 110s-130s in the ED. She was initially continued on the
esmolol drip but this was weaned soon after she arrived on the
floor. She was continued on her home amiodarone with good rate
control. She underwent a TTE to rule out structural abnormality
which showed a question of restrictive cardiomyopathy/stiffened
myocardium suggestive of amyloidosis. Her coumadin was held as
she was going for IR fistulogram with likely dilation planned.
Once dilation was completes, she was restarted on coumadin per
her home dosing with instructions to have INR checked the day
after discharge.

4. Hypertension

Medications on Admission:
1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Calcium Acetate 667 mg Capsule Sig: Three (3) Capsule PO TID

W/MEALS (3 TIMES A DAY WITH MEALS).
3. Citalopram 40 mg Tablet Sig: One (1) Tablet PO once a day.
4. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Sevelamer Carbonate 800 mg Tablet Sig: Three (3) Tablet PO
TID W/MEALS (3 TIMES A DAY WITH MEALS).
7. Norvasc 10 mg Tablet Sig: One (1) Tablet PO once a day.
8. Sensipar 60 mg Tablet Sig: One (1) Tablet PO twice a day.
9. Coumadin 2 mg Tablet Sig: ASDIR Tablet PO ASDIR: 4mg on
Monday and Friday, 2mg all other days.
10. Kayexalate Powder Sig: One (1) dose PO ASDIR: Take every
Sunday and Monday.

Discharge Medications:
1. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. warfarin 2 mg Tablet Sig: One (1) Tablet PO TUESWEDTHURSATSUN
().
3. warfarin 2 mg Tablet Sig: Two (2) Tablet PO MONFRI ().
4. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
5. calcium acetate 667 mg Capsule Sig: Three (3) Capsule PO TID
W/MEALS.
6. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO  M W F SUN)
Hold on dialysis days .
7. Sensipar 60 mg Tablet Sig: One (1) Tablet PO twice a day.
8. citalopram 40 mg Tablet Sig: 1.5 Tablets PO once a day.
9. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
10. sevelamer carbonate 800 mg Tablet Sig: Three (3) Tablet PO
TID W/MEALS (3 TIMES A DAY WITH MEALS).
11. sodium polystyrene sulfonate     Powder Sig: Fifteen (15)
grams PO every SUN MON.
12. vancomycin in D5W 1 gram/200 mL Piggyback Sig: 1000 (1000)
mg Intravenous HD PROTOCOL (HD Protochol) for 1 days.
Disp:*1000 mg* Refills:*0*
13. carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO twice a
day.
Disp:*60 Tablet(s)* Refills:*2*

Discharge Disposition:
Home

Discharge Diagnosis:
- End-stage renal disease
- Pneumonia

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

Discharge Instructions:
Ms. [**Known lastname 101213**],

You were seen in the hospital because of shortness of breath.
This shortness of breath was likely secondary to volume overload
from missing dialysis.  You had a breathing tube placed in the
emergency room to help your breathing.  Once the fluid was
removed from your lungs with several days of dialysis, the
breathing tube was able to be safely removed.

While you were in the hospital, you also were treated for a
pneumonia with IV antibiotics.  You will receive Vancomycin for
one more day (Monday [**2198-3-12**]) during your dialysis session.

We made the following changes to your medications:
- Started IV Vancomycin as above.  You will receive this one
more time with HD.
- Started Carvedilol 3.125mg daily for your high blood pressure.
- Increased your Citalopram from 40 mg daily to 60 mg daily.

Please note that we discharged you on the same coumadin dose you
were taking before you arrived. However, your INR is only 1.3 on
discharge. You should call you [**Hospital 263**] clinic at [**Company 191**] on Monday ASAP
at [**Telephone/Fax (1) 101218**] to get your INR checked and your coumadin dose
adjusted.

Because of your renal disease and heart failure, you should
weigh yourself every morning, and call your doctor if weight
goes up more than 3 lbs.

It was a pleasure taking care of you during your hospital stay.

Followup Instructions:
Department: [**Hospital3 249**] POST [**Hospital 894**] CLINIC
When: THURSDAY [**2198-3-15**] at 8:40 AM
With: Dr [**First Name4 (NamePattern1) 1060**] [**Last Name (NamePattern1) 1520**]  [**Telephone/Fax (1) 250**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
This appointment is with a hospital-based doctor as part of your
transition from the hospital back to your primary care provider.
 [**Name10 (NameIs) 616**] this visit, you will see your regular primary care doctor
in follow up.

Department: COGNITIVE NEUROLOGY UNIT
When: FRIDAY [**2198-3-16**] at 1 PM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], PHD [**Telephone/Fax (1) 1690**]
Building: Ks [**Hospital Ward Name 860**] Building ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **]
Campus: EAST     Best Parking: Main Garage

Department: CARDIAC SERVICES
When: WEDNESDAY [**2198-6-13**] at 9:40 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage




Name:  [**Known lastname 16262**],[**Known firstname **]                   Unit No:   [**Numeric Identifier 16263**]

Admission Date:  [**2198-3-5**]              Discharge Date:   [**2198-3-11**]

Date of Birth:  [**2134-9-9**]             Sex:   F

Service: MEDICINE

Allergies:
Dilantin Kapseal

Attending:[**First Name3 (LF) 11437**]
Addendum:
ISSUES FOR FOLLOW-UP:
[] Patient to get reconnected with [**Hospital3 1946**] on
Tuesday, [**3-13**].
[] F/u symptoms of shortness of breath
[] F/u SPEP [**3-8**] for restrictive cardiomyopathy workup to r/o
Amyloidosis
[] F/u Blood cultures 2/14 and [**3-6**]

Discharge Disposition:
Home

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 11438**] MD [**MD Number(2) 11439**]

Completed by:[**2198-3-12**]
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,End stage renal disease,Acute on chronic diastolic heart failure,Bacterial pneumonia, unspecified,Complications of transplanted kidney,Hyperpotassemia,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease,Other primary cardiomyopathies,Paroxysmal ventricular tachycardia,Hematoma complicating a procedure,Compression of vein,Depressive disorder, not elsewhere classified,Personal history of tobacco use,Renal dialysis status,Long-term (current) use of anticoagulants,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: Missed dialysis/Respiratory distress

PRESENT ILLNESS: 63 y/o F w/ ESRD [**2-21**] IgA nephropathy s/[**Name Initial (MD) **] failed CRT [**2173**] on HD
(MWF) through LUE AVF since [**2193**], p/t ED w/ n/v/diarrhea and at
least one episode of bloody stools and ILI Sx w/ worsening SOB x
2-3d. Because she was not feeling well, she missed HD today. She
was unable to provide further hx in ED.

MEDICAL HISTORY: 1. Atrial fibrillation/flutter: first diagnosed in [**Month (only) **]
[**2195**].
2. End-stage renal disease on hemodialysis secondary to IgA
nephropathy s/p cadaveric kidney transplant in [**2173**] which has
eventually failed, and started on hemodialysis in [**2193**].
3. History of upper GI bleeding on [**2195-2-20**] with evidence
of
esophagitis, gastric ulcer, and bleeding duodenal vessel s/p
clipping, cauterization and PPI.
4. Diastolic heart failure supported by an echocardiography from

MEDICATION ON ADMISSION: 1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Calcium Acetate 667 mg Capsule Sig: Three (3) Capsule PO TID

ALLERGIES: Dilantin Kapseal

PHYSICAL EXAM: On Admission:
Vitals: Tm 99.1 Tcurr 97.2 BP: 154/65 P: 62 R: 18 O2: 98% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP 8 cm, no LAD
Lungs: Soft, dry inspiratory crackles on right, no wheezes,
rales, ronchi
CV: Regular rate and rhythm, Loud AV fistula thrill heard across
precordium
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: warm, well perfused, 1+ pitting edema to mid-shin
Neuro: CNs2-12 intact, motor function grossly normal

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory. Her father
died at the age of 80. Her mother died at the age of 64 from
lung CA. She has a sister with breast CA. MI in uncle in his
60s.

SOCIAL HISTORY: Single, lives by herself in [**Location (un) 686**], and has no children. She
quit smoking 25 years ago (10-pack-years). She rarely drinks
alcohol, and denies illicit drug use. She used to work part-time
in a coffee shop, but currently does not work. 

### Response:
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,End stage renal disease,Acute on chronic diastolic heart failure,Bacterial pneumonia, unspecified,Complications of transplanted kidney,Hyperpotassemia,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease,Other primary cardiomyopathies,Paroxysmal ventricular tachycardia,Hematoma complicating a procedure,Compression of vein,Depressive disorder, not elsewhere classified,Personal history of tobacco use,Renal dialysis status,Long-term (current) use of anticoagulants,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
