CHIEF COMPLAINT: SOB, altered mental status

PRESENT ILLNESS: 76-year-old male with hx CAD s/p IMI [**2189**], CHF with EF 15%, PVD,
CRI (on Epo) recently admitted for LGIB who presents from [**Hospital1 1501**]
(after [**Hospital 5610**] Rehab) with increased SOB/DOE and decreased
mental status.
.
On [**12-28**], patient was admitted to [**Hospital6 **] for three
to four days of progressive weakness and fatigue, was found to
have a hematocrit of 26 and was transfused and transferred to
[**Hospital1 18**]. At [**Hospital1 18**], had an endoscopy as well as colonoscopy, which
were unremarkable. He was discharged to [**Hospital1 **] on [**12-31**],
subsequently had an outpatient small bowel capsule study, which
showed an AVM at 2.5 hours into the jejunum suggesting that it
is beyond the reach of the endoscope. He has been receiving [**12-3**]
transfusion every month when these are needed for coronary
event. Pt has been seen by Dr [**Last Name (STitle) 2161**] who recommended a
double-balloon enteroscopy by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10395**] at [**Hospital1 498**],
[**Hospital1 1559**]. He was discharged from [**Hospital1 **] on [**1-21**] to a [**Hospital1 1501**].
.
He comes back today for increased fatigue, SOB/DOE, and
decreased mental status. HCT today is 33.8 form 33.4. Pt poor
historian non conversant.
.
In ED, T 101.2 HR 68  BP 115/54  RR 26 O2 sat 92-93% on 5LNC,
then 97% on NRB. CXR suggestive of severe pulm edema/CHF, and he
was given lasix 40 IV, guaiac positive, Hct 34 so no [**Hospital1 **]
transfused, protonix 40IV, Vanc 1gm IV, Ceftriaxone 1gm IV. He
was transferred to the MICU for closer monitoring.
.
He denies any fever, chills, chest pain, hematemesis, nausea,
vomting, abdominal pain, but does relate an approximate 20 pound

MEDICAL HISTORY: Past Medical History:
--CAD s/p MI in '[**89**] and CABG [**2189**] (LIMA-LAD, SVG-OM1 occluded,
SVG-OM2 patent, SVG-PDA patent) status post cath [**5-6**] revealing
3vd but patent LIMA and SVGs
--CHF w/ EF 10-15%, followed by Dr. [**First Name (STitle) 437**] in [**Hospital 1902**] clinic, status
post
thoracentesis in [**7-7**]
--Atrial tachycardia failed ablation, status post ICD implant in
[**2198-5-2**]
--Diabetes Type II (last HgbA1c 6.8 in [**2199-4-1**])
--PVD status post L subclavian stent [**5-6**]
--Bilateral carotid occlusion, [**Doctor First Name 3098**] 100%, [**Country **] about 90-95%
status post [**Country **] stent on [**5-6**]
--Hypertension
--Hyperlipidemia
--History of anemia
--Polymyalgia rheumatica
--Gout
--Chronic Renal Insufficiency (baseline Cr 2.5-3.0)
--History of guaiac positive stools baseline Hct ~30
--History of hypercoagulable state
--Depression
--Status post MVA associated with CVA
--Home oxygen 2-3L NC

MEDICATION ON ADMISSION: ASA 81 mg daily
plavix 75 mg daily
metoprolol 12.5 mg po bid
lisinopril 5 mg  po qd
hydralazine 50 mg po q8h
imdur 30 mg po qd
lasix 40 mg po daily
amiodarone 200 mg po qd
zocor 40 mg po qd
allopurinol 100 mg po qd
celexa 20 mg po qd
lantus 20 units sq qam
flomax 0.4 po qd
protonix 40 mg iv bid
risperdal 0.25 mg po qam, 0.375 mg po qhs
ferrous sulfate 325 po bid
phenergan prn
tylenol prn
metamucil po qd

ALLERGIES: Diltiazem

PHYSICAL EXAM: PE: 100.0   104/41   72   93% on RA O2 Sats
Gen: conversant but slightly antagonistic
HEENT: Clear OP, MM dry
NECK: Supple, No LAD, JVP 8 cm
CV: RR, NL rate. No murmurs, rubs or [**Last Name (un) 549**]
LUNGS: very minimal air movementl coarse crackles [**1-4**]
ABD: Soft, NT, but slightly distended. NL BS.
EXT: No edema. 2+ DP pulses BL
SKIN: No lesions
NEURO: CN 2-12 grossly intact.

FAMILY HISTORY: .
Family History:
Non-contributory
.

SOCIAL HISTORY: .
Social History:
Reports he quit smoking cigarettes 2 months ago after smoking 2
ppd for over 50 years. He drinks alcohol occasionally. He denies
Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Angiodysplasia of intestine with hemorrhage,Other primary cardiomyopathies,Atrial fibrillation,Diabetes with unspecified complication, type II or unspecified type, uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Anemia of other chronic disease,Polymyalgia rheumatica,Gout, unspecified,Dysthymic disorder,Other chronic pulmonary heart diseases,Peripheral vascular disease, unspecified,Personal history of tobacco use
CHF NOS,Obs chr bronc w(ac) exac,Acute kidney failure NOS,Chronic kidney dis NOS,Angio intes w hmrhg,Prim cardiomyopathy NEC,Atrial fibrillation,DMII unspf uncntrld,Hy kid NOS w cr kid I-IV,Pure hypercholesterolem,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Anemia-other chronic dis,Polymyalgia rheumatica,Gout NOS,Dysthymic disorder,Chr pulmon heart dis NEC,Periph vascular dis NOS,History of tobacco use
Admission Date:  [**2200-1-23**]              Discharge Date:   [**2200-2-3**]

Date of Birth:  [**2124-1-3**]             Sex:   M

Service: MEDICINE

Allergies:
Diltiazem

Attending:[**First Name3 (LF) 5301**]
Chief Complaint:
SOB, altered mental status

Major Surgical or Invasive Procedure:
None.

History of Present Illness:
76-year-old male with hx CAD s/p IMI [**2189**], CHF with EF 15%, PVD,
CRI (on Epo) recently admitted for LGIB who presents from [**Hospital1 1501**]
(after [**Hospital 5610**] Rehab) with increased SOB/DOE and decreased
mental status.
.
On [**12-28**], patient was admitted to [**Hospital6 **] for three
to four days of progressive weakness and fatigue, was found to
have a hematocrit of 26 and was transfused and transferred to
[**Hospital1 18**]. At [**Hospital1 18**], had an endoscopy as well as colonoscopy, which
were unremarkable. He was discharged to [**Hospital1 **] on [**12-31**],
subsequently had an outpatient small bowel capsule study, which
showed an AVM at 2.5 hours into the jejunum suggesting that it
is beyond the reach of the endoscope. He has been receiving [**12-3**]
transfusion every month when these are needed for coronary
event. Pt has been seen by Dr [**Last Name (STitle) 2161**] who recommended a
double-balloon enteroscopy by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10395**] at [**Hospital1 498**],
[**Hospital1 1559**]. He was discharged from [**Hospital1 **] on [**1-21**] to a [**Hospital1 1501**].
.
He comes back today for increased fatigue, SOB/DOE, and
decreased mental status. HCT today is 33.8 form 33.4. Pt poor
historian non conversant.
.
In ED, T 101.2 HR 68  BP 115/54  RR 26 O2 sat 92-93% on 5LNC,
then 97% on NRB. CXR suggestive of severe pulm edema/CHF, and he
was given lasix 40 IV, guaiac positive, Hct 34 so no [**Hospital1 **]
transfused, protonix 40IV, Vanc 1gm IV, Ceftriaxone 1gm IV. He
was transferred to the MICU for closer monitoring.
.
He denies any fever, chills, chest pain, hematemesis, nausea,
vomting, abdominal pain, but does relate an approximate 20 pound

weight loss over the past three months.


Past Medical History:
Past Medical History:
--CAD s/p MI in '[**89**] and CABG [**2189**] (LIMA-LAD, SVG-OM1 occluded,
SVG-OM2 patent, SVG-PDA patent) status post cath [**5-6**] revealing
3vd but patent LIMA and SVGs
--CHF w/ EF 10-15%, followed by Dr. [**First Name (STitle) 437**] in [**Hospital 1902**] clinic, status
post
thoracentesis in [**7-7**]
--Atrial tachycardia failed ablation, status post ICD implant in
[**2198-5-2**]
--Diabetes Type II (last HgbA1c 6.8 in [**2199-4-1**])
--PVD status post L subclavian stent [**5-6**]
--Bilateral carotid occlusion, [**Doctor First Name 3098**] 100%, [**Country **] about 90-95%
status post [**Country **] stent on [**5-6**]
--Hypertension
--Hyperlipidemia
--History of anemia
--Polymyalgia rheumatica
--Gout
--Chronic Renal Insufficiency (baseline Cr 2.5-3.0)
--History of guaiac positive stools baseline Hct ~30
--History of hypercoagulable state
--Depression
--Status post MVA associated with CVA
--Home oxygen 2-3L NC


Social History:
.
Social History:
Reports he quit smoking cigarettes 2 months ago after smoking 2
ppd for over 50 years. He drinks alcohol occasionally. He denies

illicit drugs. He lives in [**Hospital3 400**] in [**Location (un) 87405**] in
[**Hospital1 392**].  Single, with no children.
.


Family History:
.
Family History:
Non-contributory
.

Physical Exam:
PE: 100.0   104/41   72   93% on RA O2 Sats
Gen: conversant but slightly antagonistic
HEENT: Clear OP, MM dry
NECK: Supple, No LAD, JVP 8 cm
CV: RR, NL rate. No murmurs, rubs or [**Last Name (un) 549**]
LUNGS: very minimal air movementl coarse crackles [**1-4**]
ABD: Soft, NT, but slightly distended. NL BS.
EXT: No edema. 2+ DP pulses BL
SKIN: No lesions
NEURO: CN 2-12 grossly intact.


Pertinent Results:
CHEST (PORTABLE AP)

Reason: r/o CHF, pna

[**Hospital 93**] MEDICAL CONDITION:
75 year old man with crackles, hypoxia
REASON FOR THIS EXAMINATION:
r/o CHF, pna
HISTORY: 75-year-old male with hypoxia and concern for CHF or
pneumonia.

COMPARISON: [**2199-12-29**].

FINDINGS: Single frontal view of the chest demonstrates stable
moderate cardiomegaly with unchanged mediastinal contours. The
patient is status post sternotomy. Sternal sutures and
left-sided transvenous pacemaker leads are unchanged. Again
noted is fracture of the most inferior sternal suture. The
pulmonary vasculature is engorged, and peripheral Kerley B lines
are noted. There are small bilateral pleural effusions and
associated bibasilar atelectasis. There is no pneumothorax. The
bones are demineralized.

IMPRESSION: Congestive heart failure.


Brief Hospital Course:
A/P: The patient is a 76 y/o M with significant cardiac hx, EF
15%, smoking hx who presents with SOB
.
# Resp distress: Most likely [**1-3**] early pneumonia (? aspiration)
as well as CHF exacerbation. Given low EF, he has very poor
forward flow and may be total body depleted, but still have pulm
edema. A BNP was [**Numeric Identifier 17514**], consistent with an element of CHF, and
cardiac enzymes were slightly elevated to 0.11. However, in the
context of elevated creatinine, likely does not reflect ACS. He
was diuresed with standing lasix and fluid restricted. He was
started on vanc/cefepime to cover for aspiration and hospital
acquired pathogens. Standing nebs and mucinex were used to
improve air intake and secretions. He was started on a
prednisone taper. Upon transfer to the [**Hospital1 **] medicine service, he
was felt unlikely to have a pneumonia and antibiotics were
discontinued. The patient was seen by the renal consult team. He
was felt to be significantly volume overloaded and was
aggressively diuresed.  He initially was diuresed with a
thiazide-lasix IV combination, but was on a po combination by
discharge. The patient was discharged on 100 mg po Lasix alone,
after being stable on this dose for several days, 500-1 L neg.
He was off oxygen at discharge, but likely to require some
during exertion given his deconditioning.
.
# Lower GI bleed: The patient has a known AVM seen on capsule
endoscopy thought distal to enteroscopy capabilities. He is a
chronic, low volume GI bleeder. He is a poor operative
candidate, at this point he is not profusely bleeding and does
not need emergent surgery. His hcts were maintained above 28
with one unit pRBCs. His plavix and asa were held. He was also
maintained on a ppi. The patient may consider outpatient
follow-up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10395**] at [**Hospital1 498**] [**Hospital1 1559**] for
double-balloon enteroscopy as recommended by Dr. [**Last Name (STitle) 2161**] at a
prior evaluation.  His hematocrit was stable throughout the
hospitalization.
.
# Leukocytosis. Etiology unclear. [**Name2 (NI) **] cultures were without
growth, stool culture and C Diff toxin assay were also negative.
The patient's leukocytosis resolved and was taken off of empiric
pneumonia antibiotics as above.
.
# CRI/Uremia. The patient was near his baseline Cr, though with
a BUN >100. On transfer to the Medicine floor service, the
patient was evaluated by renal. He was felt likely to be uremic
with asterixis on exam and a question of mental status changes.
The most likely etiology of his renal failure was felt due to
chronic CHF. The patient was aggressively diuresed.  He
underwent renal artery ultrasound to rule out renal artery
stenosis, which was negative. The patient also had an echo for
rule out pericardial effusion in the setting of uremia and a
question of a rub (though without pulsus), which was also
negative. All meds were renally dosed. The renal team thought
there were no acute indications for hemodialysis given that he
was responsive to diuretics.  At discharge, the renal team
recommended that the patient be titrated for a fluid balance of
negative 1 liter daily.  It is likely that in the future, the
patient will require hemodialysis.
.
# CAD. Stable. No signs of acute MI and with negative cardiac
enzymes. The patient was continued on metoprolol, hydral, imdur,
zocor. His lisinopril was held in the setting of renal failure
and uremia. His aspirin and plavix were held in the setting of
known recent GI bleeding.
.
# Diabetes type II. The patient was continued on home lantus
with four times daily fingersticks, and insulin sliding scale.
His Lantus was titrated by the [**Last Name (un) **] attending consult. During
his steroid taper, his [**Last Name (un) **] glucose was elevated. It is likely
that he will require LESS lantus as his steroids are tapered
off, this decrease can be done at the discretion of the rehab
physicians. Pre-meal and pre-bedtime finger sticks should be
monitored.
.
# Depression. Continued on Celexa and Risperdal
.
# Atrial tachycardia: the patient was paced during the admission
and continued on his outpatient amiodarone.
.
# Gout. Continued on allopurinol.
.
# CODE:  DNR, but pt OK to intubate if temporary to help
overcome [**Hospital 93071**] medical problems. Pt also OK for central
lines, pressors. Discussed with his HCP, his brother [**Name (NI) **]
.
# COMM:  [**Name (NI) **] [**Name (NI) **] (brother) and HCP

Medications on Admission:
ASA 81 mg daily
plavix 75 mg daily
metoprolol 12.5 mg po bid
lisinopril 5 mg  po qd
hydralazine 50 mg po q8h
imdur 30 mg po qd
lasix 40 mg po daily
amiodarone 200 mg po qd
zocor 40 mg po qd
allopurinol 100 mg po qd
celexa 20 mg po qd
lantus 20 units sq qam
flomax 0.4 po qd
protonix 40 mg iv bid
risperdal 0.25 mg po qam, 0.375 mg po qhs
ferrous sulfate 325 po bid
phenergan prn
tylenol prn
metamucil po qd


Discharge Medications:


1. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
2. Hydralazine 25 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8
hours).
3. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
4. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO EVERY OTHER
DAY (Every Other Day).
7. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Risperidone 0.25 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
9. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
10. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
11. Ipratropium Bromide 0.02 % Solution Sig: One (1) inh
Inhalation Q6H (every 6 hours).
12. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours).
13. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
14. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
15. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day).

16. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
17. Lantus 100 unit/mL Solution Sig: Thirty (30) units
units Subcutaneous qam.
18. Risperdal 0.25 mg Tablet Sig: 1.5 Tablets PO at bedtime.
19. Lasix 20 mg Tablet Sig: Five (5) Tablet PO once a day.
20. Protonix 20 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
21. Insulin Regular Human 300 unit/3 mL Insulin Pen Sig: per
sliding scale  Subcutaneous four times a day.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 23095**] - [**Location 8391**]

Discharge Diagnosis:
CHF exacerbation
COPD exacerbation
Acute renal failure on chronic renal insufficiency
Lower GI bleed from jejunal AVM
Hypertension
Hyperlipidemia
Diabetes Type II
CAD s/p MI and s/p CABG
Atrial tachycardia
PVD
Anemia of chronic disease
Polymyalgia rheumatica
Gout
Hypercoagulablility
Depression
Appendectomy
Oxygen dependence


Discharge Condition:
Stable, on 2L oxygen, to rehab


Discharge Instructions:
-Please return to the ED if you develop worsening shortness of
breath, chest pain, fevers, chills, or diarrhea.

Followup Instructions:
Dr. [**Last Name (STitle) 2903**] [**2200-2-18**], 2:15 pm. Phone [**Telephone/Fax (1) 2936**]
.
Renal follow up: Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD
Phone:[**Telephone/Fax (1) 435**] Date/Time:[**2200-2-25**] 4:00
.
Provider: [**First Name8 (NamePattern2) 1903**] [**Last Name (NamePattern1) 1904**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 3512**]
Date/Time:[**2200-3-25**] 1:30
{'Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Angiodysplasia of intestine with hemorrhage,Other primary cardiomyopathies,Atrial fibrillation,Diabetes with unspecified complication, type II or unspecified type, uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Anemia of other chronic disease,Polymyalgia rheumatica,Gout, unspecified,Dysthymic disorder,Other chronic pulmonary heart diseases,Peripheral vascular disease, unspecified,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: SOB, altered mental status

PRESENT ILLNESS: 76-year-old male with hx CAD s/p IMI [**2189**], CHF with EF 15%, PVD,
CRI (on Epo) recently admitted for LGIB who presents from [**Hospital1 1501**]
(after [**Hospital 5610**] Rehab) with increased SOB/DOE and decreased
mental status.
.
On [**12-28**], patient was admitted to [**Hospital6 **] for three
to four days of progressive weakness and fatigue, was found to
have a hematocrit of 26 and was transfused and transferred to
[**Hospital1 18**]. At [**Hospital1 18**], had an endoscopy as well as colonoscopy, which
were unremarkable. He was discharged to [**Hospital1 **] on [**12-31**],
subsequently had an outpatient small bowel capsule study, which
showed an AVM at 2.5 hours into the jejunum suggesting that it
is beyond the reach of the endoscope. He has been receiving [**12-3**]
transfusion every month when these are needed for coronary
event. Pt has been seen by Dr [**Last Name (STitle) 2161**] who recommended a
double-balloon enteroscopy by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10395**] at [**Hospital1 498**],
[**Hospital1 1559**]. He was discharged from [**Hospital1 **] on [**1-21**] to a [**Hospital1 1501**].
.
He comes back today for increased fatigue, SOB/DOE, and
decreased mental status. HCT today is 33.8 form 33.4. Pt poor
historian non conversant.
.
In ED, T 101.2 HR 68  BP 115/54  RR 26 O2 sat 92-93% on 5LNC,
then 97% on NRB. CXR suggestive of severe pulm edema/CHF, and he
was given lasix 40 IV, guaiac positive, Hct 34 so no [**Hospital1 **]
transfused, protonix 40IV, Vanc 1gm IV, Ceftriaxone 1gm IV. He
was transferred to the MICU for closer monitoring.
.
He denies any fever, chills, chest pain, hematemesis, nausea,
vomting, abdominal pain, but does relate an approximate 20 pound

MEDICAL HISTORY: Past Medical History:
--CAD s/p MI in '[**89**] and CABG [**2189**] (LIMA-LAD, SVG-OM1 occluded,
SVG-OM2 patent, SVG-PDA patent) status post cath [**5-6**] revealing
3vd but patent LIMA and SVGs
--CHF w/ EF 10-15%, followed by Dr. [**First Name (STitle) 437**] in [**Hospital 1902**] clinic, status
post
thoracentesis in [**7-7**]
--Atrial tachycardia failed ablation, status post ICD implant in
[**2198-5-2**]
--Diabetes Type II (last HgbA1c 6.8 in [**2199-4-1**])
--PVD status post L subclavian stent [**5-6**]
--Bilateral carotid occlusion, [**Doctor First Name 3098**] 100%, [**Country **] about 90-95%
status post [**Country **] stent on [**5-6**]
--Hypertension
--Hyperlipidemia
--History of anemia
--Polymyalgia rheumatica
--Gout
--Chronic Renal Insufficiency (baseline Cr 2.5-3.0)
--History of guaiac positive stools baseline Hct ~30
--History of hypercoagulable state
--Depression
--Status post MVA associated with CVA
--Home oxygen 2-3L NC

MEDICATION ON ADMISSION: ASA 81 mg daily
plavix 75 mg daily
metoprolol 12.5 mg po bid
lisinopril 5 mg  po qd
hydralazine 50 mg po q8h
imdur 30 mg po qd
lasix 40 mg po daily
amiodarone 200 mg po qd
zocor 40 mg po qd
allopurinol 100 mg po qd
celexa 20 mg po qd
lantus 20 units sq qam
flomax 0.4 po qd
protonix 40 mg iv bid
risperdal 0.25 mg po qam, 0.375 mg po qhs
ferrous sulfate 325 po bid
phenergan prn
tylenol prn
metamucil po qd

ALLERGIES: Diltiazem

PHYSICAL EXAM: PE: 100.0   104/41   72   93% on RA O2 Sats
Gen: conversant but slightly antagonistic
HEENT: Clear OP, MM dry
NECK: Supple, No LAD, JVP 8 cm
CV: RR, NL rate. No murmurs, rubs or [**Last Name (un) 549**]
LUNGS: very minimal air movementl coarse crackles [**1-4**]
ABD: Soft, NT, but slightly distended. NL BS.
EXT: No edema. 2+ DP pulses BL
SKIN: No lesions
NEURO: CN 2-12 grossly intact.

FAMILY HISTORY: .
Family History:
Non-contributory
.

SOCIAL HISTORY: .
Social History:
Reports he quit smoking cigarettes 2 months ago after smoking 2
ppd for over 50 years. He drinks alcohol occasionally. He denies 

### Response:
{'Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Angiodysplasia of intestine with hemorrhage,Other primary cardiomyopathies,Atrial fibrillation,Diabetes with unspecified complication, type II or unspecified type, uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Anemia of other chronic disease,Polymyalgia rheumatica,Gout, unspecified,Dysthymic disorder,Other chronic pulmonary heart diseases,Peripheral vascular disease, unspecified,Personal history of tobacco use'}
