CHIEF COMPLAINT: CHF exacerbation

PRESENT ILLNESS: 66M with hx of CHF
(EF10%), CRF (baseline 2.6), CAD s/p CABG, AAA, bilateral renal

MEDICAL HISTORY: * ischemic cardiomyopathy (EF 10-15%)
* CAD s/p CABG in [**2086**] (SVG to PLA, LIMA to LAD)
* s/p BiV AICD at [**Hospital1 18**] in [**2100**]
* s/p PEA arrest in [**11/2102**]
* hx of VT during [**11/2102**] admission now s/p amio load
* 100% Right ICA stenosis
* Left ICA stenosis s/p CEA
* AAA
* bilateral renal artery stenosis s/p stenting by [**Year (4 digits) **] in [**2097**]
and again to the left in [**1-/2103**]
* Chronic renal failure, baseline 2.6-2.9
* COPD
* OA in ankle
* bilateral inguinal hernias
* s/p appy
* hx of remote gastric ulcer

MEDICATION ON ADMISSION: CURRENT MEDICATIONS (on transfer):
* Ampicillin 1gm q8hr (on abx since [**3-16**])
* Lasix gtt 40mg/hr
* Coreg 25mg [**Hospital1 **]
* Amiodarone 200mg [**Hospital1 **]
* Advair 50/250 [**Hospital1 **]
* Spiriva 18mcg qd
* Levoxyl 25mcg qd
* Protonix 40mg qd
* Plavix 75mg qd
* ASA 325mg qd
* Isordil 10mg [**Hospital1 **]
* Zocor 80mg qd
.
HOME MEDS:
* HCTZ 25mg qd
* Lipitor 40mg qd
* Isordil 10mg [**Hospital1 **]
* Lasix 80mg qd
* Trental 40mg qd
* Flovent 220mcg [**Hospital1 **]
* Singulari 10mg qd
* Plavix 75mg qd
* ASA 325mg qd
* Coreg 25mg [**Hospital1 **]
* Amiodarone 200mg [**Hospital1 **]
* Advair 50/250mcg [**Hospital1 **]
* Spiriva 18mcg qd
* Levoxyl 25mcg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pt was afebrile at 96.1. Blood pressure was 113/51 mm Hg while
seated. Pulse was 70 beats/min and regular, respiratory rate was
18 breaths/min and 100% on room air. Weight 65kg on the
bedscale.  Generally the patient was well developed, well
nourished and well groomed. The patient was oriented to person,
place and time. The patient's mood and affect were not
inappropriate.
.
There was no xanthalesma and conjunctiva were pink with no
pallor or cyanosis of the oral mucosa. The neck was supple with
JVP of 14cm. The carotid waveform was normal. There was no
thyromegaly. The were no chest wall deformities, scoliosis or
kyphosis. The respirations were slightly labored and there were

FAMILY HISTORY: NC

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. 2PPD previously, quit 20 years ago. There is previous
history of alcohol abuse.
Acute kidney failure, unspecified,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Acidosis,Bacteremia,Mitral valve disorders,Diseases of tricuspid valve,Thrombocytopenia, unspecified,Automatic implantable cardiac defibrillator in situ,Atherosclerosis of renal artery,Chronic kidney disease, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other specified forms of chronic ischemic heart disease,Aortocoronary bypass status,Nonspecific abnormal results of function study of liver,Candidiasis of other urogenital sites
Acute kidney failure NOS,CHF NOS,Chr airway obstruct NEC,Acidosis,Bacteremia,Mitral valve disorder,Tricuspid valve disease,Thrombocytopenia NOS,Status autm crd dfbrltr,Renal artery atheroscler,Chronic kidney dis NOS,Enterococcus group d,Chr ischemic hrt dis NEC,Aortocoronary bypass,Abn liver function study,Candidias urogenital NEC
Admission Date:  [**2103-3-23**]              Discharge Date:   [**2103-3-30**]

Date of Birth:  [**2036-5-10**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2387**]
Chief Complaint:
CHF exacerbation

Major Surgical or Invasive Procedure:
Right IJ placement

History of Present Illness:
66M with hx of CHF
(EF10%), CRF (baseline 2.6), CAD s/p CABG, AAA, bilateral renal

artery stenosis s/p stenting and COPD who presents from outside

hospital with acute renal failure and CHF exacerbation. Pt
initially presented to [**Hospital6 5016**] on [**3-15**] with chief
complaint of nausea/vomiting and diarrhea associated with
fevers.
On evaluation, pt was thought to be dehydrated given his history

and creatinine of 3.1, up from his baseline of 2.6 so he was
given IVF in the ER. The following day, the creatinine had not
improved and a CXR showed evidence of CHF so pt was started on
lasix. The creatinine continued to rise over his hospital stay
and renal was consulted who thought that his renal failure was
pre-renal [**12-22**] his cardiomyopathy and poor forward flow. He was
started on a lasix drip which was titrated up. His urine output

remained poor and his BUN and creatinine cont to rise, peaking
at
5.6. The renal team discussed dialysis with the patient which he

was very reluctant to start. Pt was transferred to [**Hospital1 18**] for
further evaluation of his worsening renal function and heart
failure
.
Other issues included fever, bacteremia and elevated liver
enzymes. On admission, pt spiked to 101.6 and he was started on

rocephin prophylactically. When blood cultures ([**2-21**]) from
admission grew out Enterococcus casseliflavus, he was started on

vanc on [**3-16**] which was changed to ampicillin on [**3-19**] when
sensitivities returned. ID was consulted and recommended TEE to

rule out vegetations. TEE showed no evidence of vegetations but

did show an EF of [**9-3**]%.He was found to have an elevated
bilirubin and alk phos (to 3.9 and 358 respectively) so the
patient had a workup including GI consult, EGD, ERCP and
ultrasound. ERCP showed normal CBD with no stones and ultrasound

showed enlarged liver and two "suspicious" lesions in the
pancreas possibly adenomyoma vs malignancy. An abdomen/pelvis CT

was also done which showed moderate ascites and gallstones.
.
On admission to the CCU, pt denied any chest pain, shortness of

breath, fevers, chills. His only complaint is that of
constipation.


Past Medical History:
* ischemic cardiomyopathy (EF 10-15%)
* CAD s/p CABG in [**2086**] (SVG to PLA, LIMA to LAD)
* s/p BiV AICD at [**Hospital1 18**] in [**2100**]
* s/p PEA arrest in [**11/2102**]
* hx of VT during [**11/2102**] admission now s/p amio load
* 100% Right ICA stenosis
* Left ICA stenosis s/p CEA
* AAA
* bilateral renal artery stenosis s/p stenting by [**Year (4 digits) **] in [**2097**]
and again to the left in [**1-/2103**]
* Chronic renal failure, baseline 2.6-2.9
* COPD
* OA in ankle
* bilateral inguinal hernias
* s/p appy
* hx of remote gastric ulcer


Social History:
Social history is significant for the absence of current tobacco
use. 2PPD previously, quit 20 years ago. There is previous
history of alcohol abuse.


Family History:
NC

Physical Exam:
Pt was afebrile at 96.1. Blood pressure was 113/51 mm Hg while
seated. Pulse was 70 beats/min and regular, respiratory rate was
18 breaths/min and 100% on room air. Weight 65kg on the
bedscale.  Generally the patient was well developed, well
nourished and well groomed. The patient was oriented to person,
place and time. The patient's mood and affect were not
inappropriate.
.
There was no xanthalesma and conjunctiva were pink with no
pallor or cyanosis of the oral mucosa. The neck was supple with
JVP of 14cm. The carotid waveform was normal. There was no
thyromegaly. The were no chest wall deformities, scoliosis or
kyphosis. The respirations were slightly labored and there were

no use of accessory muscles. The lungs had crackles at the bases
to 1/2way up bilaterally. There were also crackles anteriorly.
.
Palpation of the heart revealed the PMI was not able to be
located. There were no thrills, lifts or palpable S3 or S4. The
heart sounds revealed a normal S1 and the S2 was normal. There
was a soft [**12-26**] early systolic murmur heard best at the LUSB
.
The abdominal aorta was not able to be palpated. There was no
hepatomegaly. The abdomen was soft nontender but moderately
distended with a possible fluid wave. The lower extremities had
no pallor, cyanosis, clubbing or edema and were both warm. There
were no abdominal, femoral or carotid bruits. Inspection and/or

palpation of skin and subcutaneous tissue showed no stasis
dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Right: Carotid 1+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+


Pertinent Results:
EKG demonstrated paced rhythm with occ PVC. No acute changes
when compared to EKG from [**3-15**]
.
TELEMETRY demonstrated: paced beats
.
2D-ECHOCARDIOGRAM performed on [**2103-1-16**] (at [**Hospital1 18**]) demonstrated:

The left atrium is elongated. No atrial septal defect is seen by

2D or color Doppler. Left ventricular wall thicknesses are
normal. The left ventricular cavity is moderately dilated. There

is severe global left ventricular hypokinesis. The delay between

left ventricular and right ventricular ejection is 62 ms (nl
<40ms). Right ventricular systolic function appears depressed.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic regurgitation. The mitral
valve leaflets are mildly thickened. Moderate (2+) mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened. Moderate [2+] tricuspid regurgitation is seen. There

is moderate pulmonary artery systolic hypertension. The end
diastolic pulmonic regurgitation velocity is increased
suggesting
pulmonary artery diastolic hypertension. There is no pericardial

effusion.
.
TEE at OSH [**2103-3-22**]:
1. Mitral annulus is calcified, mild to moderate MR
2. Aortic valve is tricuspid and sclerotic
3. Mild TR with estimated RV systolic pressure of 52mmHg based
on
estimated RA pressure of 10mmHg suggesting pulm HTN
4. LV enlarged [**Last Name (un) **] 6.1cm at end diastole
5. LV is globally hypokinetic with estimated EF of 15%
6. [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 40004**] at 4.6cm
7. RV enlarged
8. no ASD or PFO
9. no pericardial effusion
.
no ETT in system
.
no CARDIAC CATH in system
.
[**2103-3-26**]: Renal U/S:
1. Patent main renal arteries bilaterally with good arterial
upstrokes. Increased echogenicity within the renal cortical
parenchyma is consistent with change related to chronic renal
disease.
2. Ascites.

.
LABORATORY DATA:
.
134 96 74
---|-------|------< 92 6.4 >------< 89 (138 on admission)
3.5 20 5.6 29.4
.
ALT 135
AST 94
LDH 285
ALK PHOS 347
BILI 2.5
ALB 3.3
.
PRO-BNP: [**Numeric Identifier **]
.


Brief Hospital Course:
66M with hx of CAD s/p CABG, ischemic cardiomyopathy (EF
10-15%),
BiV pacer and AICD, [**Hospital **] transferred from OSH with enterococcal
bactermia, unclear source, elevated LFTs, bilirubin, acute on
chronic renal failure with oliguria and CHF exacerbation.
.
1. CHF: EF known to be 10-15% seen on TEE from OSH. Initially,
the patient was thought to be dehydrated in the setting of his
viral gastroenteritis and given fluid at the OSH (unclear how
much). His BNP on admission was markedly elevated at 23,000 and
his JVP is elevated with what appeared to be ascites on exam.
However, he had no oxygen requirement and his lower extremities
were without edema. These findings
pointed towards right heart failure.  His beta blocker was held
in the setting of acute exacerbation as well as his isordil to
give more room for BP.  He was started on dobutamine gtt to
improve pump function and was titrated to UOP>100cc/hr.  The
patient autodiuresed without additional lasix. He was placed on
a low salt diet, daily weights, 1.5L fluid restriction.  Patient
had a significant UOP and became >2L negative over his initial
stay.  He was started on gentle IVF hydration to maintain his
fluid status at slightly negative-even. Next, he was weaned off
the dobutamine drip leading to less UOP. Dobutamine was
restarted later that evening with UOP somewhat improving. UOP
remained stable, allowing Dobutamine to be weaned off.
.
2. CAD: s/p CABG in [**2086**]; no stress tests or cardiac caths in
our system.  There were no signs of active ischemia.  He was
continued on ASA and lipitor. His BB, nitrate, HCTZ were held as
above for more BP room and in setting of acute exacerbation.
Given his episode of epistaxis his ASA was switched to qod.  His
lipitor was then held due to mildly elevated. Upon discharge,
lipitor was restarted.
.
3. Rhythm: BiV pacer and AICD; hx of VT and PEA arrest. Patient
was continued on amiodarone.
.
4. Acute on chronic renal failure: Most likely from poor forward
flow in setting of volume overload and shift down Starling
curve.  He was started on dobutamine as above to improve forward
flow and MAPs >65. His Cr remained elevated but stable and he
had a significant UOP, likely post-ATN diuresis. A renal U/S did
not show any signs of obstruction. His renal artery stents were
patent. His UOP slowed down after dobutamine drip had been
weaned. Dobutamine was restarted and UOP increased to some
extent. Dobutamine was weaned again and urine output remained
acceptable although low. Renal was consulted and also an
outpatient appointment with nephrology was scheduled.
.
5. Gap acidosis: likely from renal failure, closed slowly during
hospitalization.
.
6. Renal Artery stenosis: Patient was continued on ASA, plavix
for his renal artery stents.  His plavix, however, was briefly
held following an episode of epistaxis requiring packing by ENT.
An U/S did not reveal any obstruction of his b/l stents.
.
7. Enterococcal bacteremia: Diagnosed at OSH.  Possible sources
include urine (neg cx), biliary system (ERCP and U/S without
pathology), GI (hx of diarrhea but stool cx negative), pancreas?
(abd CT showed "suspicious" areas of pancreas; could these be
abscesses?) S/p 3 days of vanc and 5 days of ampicillin on
admission. Patient was continued on ampicillin x 14 day course
total (last day [**3-29**]). He was monitored for fevers. Blood
cultures cleared at OSH. They were sent again and were pending
upon discharge. Patient remained afebrile and stable throughout
remainder of hospital stay.
.
8. Elevated LFTs and bili: Initially, a primary bilirubin
elevation but now bili has improved and LFTs have trended
slightly up. ERCP negative for CBD dilatation, + gallstones.
Ultrasound unrevealing. Possibly due to hepatic congestion from

RHF thought would expect more of a transaminitis vs a
cholestatic picture. Statin was discontinued. LFTs were slowly
trending down. Upon discharge, lipitor was restarted.
.
9. Questionable pancreatic lesions: see above
.
10. Funguria: twice urine culture positive for yeast. Pt was
started on fluconazole, renally dose, to be continued for a
total of 7 days, i.e. four more days after discharge.
.
11. Thrombocytopenia: Chronic. plts of 117,000 on admission to
OSH so have not dropped by [**11-21**]. Platelets remained stable.
Heparin products were held.
.
12. COPD: continued home regimen of advair, spiria, montelukast;
prn atrovent and albuterol nebs
.
13. Constipation: bowel regimen
.
14. FEN: low salt diet, 1.5L fluid restriction
.
15. Ppx: boots, PPI
.
16. Access: quad lumen right IJ, placed on [**3-23**]; PIV x 1
.
17. Code: discussed with patient on admission: he would like to
be intubated if the medical team thinks it is a reversible
problem but would not like to be intubated for a prolonged time;
he is agreeable to shocks esp since he has an ICD in place


Medications on Admission:
CURRENT MEDICATIONS (on transfer):
* Ampicillin 1gm q8hr (on abx since [**3-16**])
* Lasix gtt 40mg/hr
* Coreg 25mg [**Hospital1 **]
* Amiodarone 200mg [**Hospital1 **]
* Advair 50/250 [**Hospital1 **]
* Spiriva 18mcg qd
* Levoxyl 25mcg qd
* Protonix 40mg qd
* Plavix 75mg qd
* ASA 325mg qd
* Isordil 10mg [**Hospital1 **]
* Zocor 80mg qd
.
HOME MEDS:
* HCTZ 25mg qd
* Lipitor 40mg qd
* Isordil 10mg [**Hospital1 **]
* Lasix 80mg qd
* Trental 40mg qd
* Flovent 220mcg [**Hospital1 **]
* Singulari 10mg qd
* Plavix 75mg qd
* ASA 325mg qd
* Coreg 25mg [**Hospital1 **]
* Amiodarone 200mg [**Hospital1 **]
* Advair 50/250mcg [**Hospital1 **]
* Spiriva 18mcg qd
* Levoxyl 25mcg qd


Discharge Medications:
1. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Furosemide 40 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*2*
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO QOD ().
4. Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Fluconazole 100 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours) for 4 days.
Disp:*8 Tablet(s)* Refills:*0*
6. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Flovent HFA 220 mcg/Actuation Aerosol Sig: One (1) puff
Inhalation twice a day.
8. Spiriva with HandiHaler 18 mcg Capsule, w/Inhalation Device
Sig: One (1) puff Inhalation once a day.
9. Lipitor 40 mg Tablet Sig: One (1) Tablet PO once a day.
10. Aspirin EC 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
11. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO twice a
day.
Disp:*60 Tablet(s)* Refills:*2*
12. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
13. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
14. Zaroxolyn 5 mg Tablet Sig: One (1) Tablet PO once a day:
please take this medication a half hour prior to your morning
dose of lasix.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
Congestive heart failure
Acute renal failure
Enterococcal bacteremia
Coronary artery disease
Renal artery stenosis s/p b/l renal artery stents (patent on US)
Elevated LFTs
Thrombocytopenia
COPD


Discharge Condition:
Hemodynamically stable. Tolerating POs. Afebrile.


Discharge Instructions:
Please continue to take your medications as directed.
.
Please weight yourself every day.  If your weight increases by 2
lbs call your health care provider as your lasix dose may need
to be adjusted.  Please continue to adhere to a low salt diet of
no more than 2gm/day.  To do this you should avoid processed
foods and canned foods as these contain a lot of sodium.  You
should also restrict your fluid intake to no more than 1.5
liters/day.
.
take your medications as prescribed.
.
attend your appointments as listed.
.
If you experience shortness of breath, chest pain or other
worrisome symptoms please seek medical attention.

Followup Instructions:
Please follow up with your nephrologist Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 805**] at the
renal unit of the [**Hospital **] Clinic (Phone: [**Telephone/Fax (1) 3637**]) on [**4-26**]
at 12PM. In addition, you have been put on a waiting list. His
secretary will call you if she can schedule you an earlier
appointment.
.
Please follow up with your primary care physician [**Name Initial (PRE) 176**] 1 week.
PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **] [**Telephone/Fax (1) 34574**]
.
Please follow up with your cardiologist within 2 weeks.
[**Last Name (LF) **],[**First Name3 (LF) **] J. [**Telephone/Fax (1) 2394**]



Completed by:[**2103-3-30**]
{'Acute kidney failure, unspecified,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Acidosis,Bacteremia,Mitral valve disorders,Diseases of tricuspid valve,Thrombocytopenia, unspecified,Automatic implantable cardiac defibrillator in situ,Atherosclerosis of renal artery,Chronic kidney disease, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other specified forms of chronic ischemic heart disease,Aortocoronary bypass status,Nonspecific abnormal results of function study of liver,Candidiasis of other urogenital sites'}


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: CHF exacerbation

PRESENT ILLNESS: 66M with hx of CHF
(EF10%), CRF (baseline 2.6), CAD s/p CABG, AAA, bilateral renal

MEDICAL HISTORY: * ischemic cardiomyopathy (EF 10-15%)
* CAD s/p CABG in [**2086**] (SVG to PLA, LIMA to LAD)
* s/p BiV AICD at [**Hospital1 18**] in [**2100**]
* s/p PEA arrest in [**11/2102**]
* hx of VT during [**11/2102**] admission now s/p amio load
* 100% Right ICA stenosis
* Left ICA stenosis s/p CEA
* AAA
* bilateral renal artery stenosis s/p stenting by [**Year (4 digits) **] in [**2097**]
and again to the left in [**1-/2103**]
* Chronic renal failure, baseline 2.6-2.9
* COPD
* OA in ankle
* bilateral inguinal hernias
* s/p appy
* hx of remote gastric ulcer

MEDICATION ON ADMISSION: CURRENT MEDICATIONS (on transfer):
* Ampicillin 1gm q8hr (on abx since [**3-16**])
* Lasix gtt 40mg/hr
* Coreg 25mg [**Hospital1 **]
* Amiodarone 200mg [**Hospital1 **]
* Advair 50/250 [**Hospital1 **]
* Spiriva 18mcg qd
* Levoxyl 25mcg qd
* Protonix 40mg qd
* Plavix 75mg qd
* ASA 325mg qd
* Isordil 10mg [**Hospital1 **]
* Zocor 80mg qd
.
HOME MEDS:
* HCTZ 25mg qd
* Lipitor 40mg qd
* Isordil 10mg [**Hospital1 **]
* Lasix 80mg qd
* Trental 40mg qd
* Flovent 220mcg [**Hospital1 **]
* Singulari 10mg qd
* Plavix 75mg qd
* ASA 325mg qd
* Coreg 25mg [**Hospital1 **]
* Amiodarone 200mg [**Hospital1 **]
* Advair 50/250mcg [**Hospital1 **]
* Spiriva 18mcg qd
* Levoxyl 25mcg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pt was afebrile at 96.1. Blood pressure was 113/51 mm Hg while
seated. Pulse was 70 beats/min and regular, respiratory rate was
18 breaths/min and 100% on room air. Weight 65kg on the
bedscale.  Generally the patient was well developed, well
nourished and well groomed. The patient was oriented to person,
place and time. The patient's mood and affect were not
inappropriate.
.
There was no xanthalesma and conjunctiva were pink with no
pallor or cyanosis of the oral mucosa. The neck was supple with
JVP of 14cm. The carotid waveform was normal. There was no
thyromegaly. The were no chest wall deformities, scoliosis or
kyphosis. The respirations were slightly labored and there were

FAMILY HISTORY: NC

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. 2PPD previously, quit 20 years ago. There is previous
history of alcohol abuse. 

### Response:
{'Acute kidney failure, unspecified,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Acidosis,Bacteremia,Mitral valve disorders,Diseases of tricuspid valve,Thrombocytopenia, unspecified,Automatic implantable cardiac defibrillator in situ,Atherosclerosis of renal artery,Chronic kidney disease, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other specified forms of chronic ischemic heart disease,Aortocoronary bypass status,Nonspecific abnormal results of function study of liver,Candidiasis of other urogenital sites'}
