CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 80 year old female with a history of prosthetic mitral valve 8
years ago, who now has worsening prosthetic valve stenosis that
is causing progressive shortness of breath and lower extremity
edema which has been treated medically. In [**2171-2-5**], she was
deemed inoperable. Stated by Dr. [**Last Name (STitle) 914**] at that
time, if after balloon valvuloplasty her PA pressures return to
normal and her RV recovers, she may be a candidate for surgery.
She underwent valvuloplasty on [**2171-2-19**].  She returns today for
repeat cath and echo to further evaluate efficacy of
valvuloplasty based on response of PA pressures.  Last dose of
coumadin was [**2171-5-9**] and she will be admitted post cath for
heparin and pre-op workup.

MEDICAL HISTORY: Mitral Regurgitation
Prosthetic Valve Mitral Stenosis
Dyslipidemia
Hypertension
Anxiety
COPD
Severe Pulm Hypertension
s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3843**] [**Doctor Last Name **] Bovine Pericardial MVR w/ preservation of
anterior/posterior chordal structure/ CABG  LIMA to LAD, SVG to
OMI, SVG to OM2 and SVG to PDA  ([**Hospital3 **] [**2163**])
s/p left atrial cyroablation, Left atrial appendage resection
s/p appendectomy
s/p removal of breast, sinus and abdominal tumor (benign)

MEDICATION ON ADMISSION: ALBUTEROL SULFATE 90 mcg HFA 2 puffs inhaled PRN up to three
times a day
ATENOLOL 12.5 mg twice a day
ETHACRYNIC ACID 25 mg tablet - [**12-9**] Tablet(s) by mouth once a day

ALLERGIES: Claritin / [**Doctor First Name **] / Sulfa (Sulfonamide Antibiotics) /
Furosemide / Lipitor / Zocor / Lescol

PHYSICAL EXAM: Pulse:  60SR  Resp: 20  O2 sat: 94%RA
B/P  150/73
Height:     Weight: 60.7 kgs

FAMILY HISTORY: Mom with cerebral hemorrhage at 48 yo. Dad had CVA at 72

SOCIAL HISTORY: Lives with: husband
Occupation: retired
Tobacco: Quit somking 35 years ago,history of [**12-9**] ppd for 20
years
ETOH:denies
Other complications due to heart valve prosthesis,Chronic airway obstruction, not elsewhere classified,Thrombocytopenia, unspecified,Other chronic pulmonary heart diseases,Ostium secundum type atrial septal defect,Aortocoronary bypass status,Atrial fibrillation,Other iatrogenic hypotension,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Anxiety state, unspecified,Atherosclerosis of native arteries of the extremities, unspecified,Physical restraints status,Personal history of tobacco use,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Dermatitis due to drugs and medicines taken internally,Other diuretics causing adverse effects in therapeutic use
Comp-heart valve prosth,Chr airway obstruct NEC,Thrombocytopenia NOS,Chr pulmon heart dis NEC,Secundum atrial sept def,Aortocoronary bypass,Atrial fibrillation,Iatrogenc hypotnsion NEC,Abn react-artif implant,Hyperlipidemia NEC/NOS,Hypertension NOS,Anxiety state NOS,Athscl extrm ntv art NOS,Physical restrain status,History of tobacco use,Hx-ven thrombosis/embols,Long-term use anticoagul,Drug dermatitis NOS,Adv eff diuretics NEC
Admission Date:  [**2171-5-14**]              Discharge Date:   [**2171-5-21**]

Date of Birth:  [**2090-11-13**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Claritin / [**Doctor First Name **] / Sulfa (Sulfonamide Antibiotics) /
Furosemide / Lipitor / Zocor / Lescol

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
[**2171-5-14**] Cardiac Catheterization
[**2171-5-16**] Redo mitral valve replacement ([**First Name8 (NamePattern2) 17009**] [**Male First Name (un) 923**]
Bioprosthetic) via right thoracotomy and atrial septal defect
closure

History of Present Illness:
80 year old female with a history of prosthetic mitral valve 8
years ago, who now has worsening prosthetic valve stenosis that
is causing progressive shortness of breath and lower extremity
edema which has been treated medically. In [**2171-2-5**], she was
deemed inoperable. Stated by Dr. [**Last Name (STitle) 914**] at that
time, if after balloon valvuloplasty her PA pressures return to
normal and her RV recovers, she may be a candidate for surgery.
She underwent valvuloplasty on [**2171-2-19**].  She returns today for
repeat cath and echo to further evaluate efficacy of
valvuloplasty based on response of PA pressures.  Last dose of
coumadin was [**2171-5-9**] and she will be admitted post cath for
heparin and pre-op workup.

Past Medical History:
Mitral Regurgitation
Prosthetic Valve Mitral Stenosis
Dyslipidemia
Hypertension
Anxiety
COPD
Severe Pulm Hypertension
s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3843**] [**Doctor Last Name **] Bovine Pericardial MVR w/ preservation of
anterior/posterior chordal structure/ CABG  LIMA to LAD, SVG to
OMI, SVG to OM2 and SVG to PDA  ([**Hospital3 **] [**2163**])
s/p left atrial cyroablation, Left atrial appendage resection
s/p appendectomy
s/p removal of breast, sinus and abdominal tumor (benign)

Social History:
Lives with: husband
Occupation: retired
Tobacco: Quit somking 35 years ago,history of [**12-9**] ppd for 20
years
ETOH:denies

Family History:
Mom with cerebral hemorrhage at 48 yo. Dad had CVA at 72

Physical Exam:
Pulse:  60SR  Resp: 20  O2 sat: 94%RA
B/P  150/73
Height:     Weight: 60.7 kgs

General: NAD, supine post cath
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Midline incision is well healed.
       Lungs clear bilaterally [x] but diminished at bases
Heart: RRR [x]  Irregular [x]  Murmur early [**1-13**] diastolic murmur

       with radiation to the right carotid area
Abdomen: Soft [x] non-distended [x] non-tender [x]
        bowel sounds + [x]
Extremities: Warm [x], well-perfused [x]
       2+ pitting Edema bilaterally; no  Varicosities or venous

       insufficiency changes. Vein harvested from the right leg

       endoscopically.
Neuro: Grossly intact
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 0   Left: 0
PT           [**Name (NI) 167**]: 0   Left: 0
Radial       Right: 2+  Left: 2+

Carotid Bruit        Right:    Left:
no bruits appreciated

Pertinent Results:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *4.9 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  *5.9 cm  <= 5.2 cm
Right Atrium - Four Chamber Length:  *5.6 cm  <= 5.0 cm
Left Ventricle - Ejection Fraction:  55% to 65%  >= 55%
Aorta - Annulus:  1.7 cm  <= 3.0 cm
Aorta - Sinus Level:  3.3 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.3 cm  <= 3.0 cm
Aorta - Ascending:  2.7 cm  <= 3.4 cm
Aortic Valve - LVOT diam:  2.0 cm
Mitral Valve - Peak Velocity:  2.0 m/sec
Mitral Valve - Pressure Half Time:  304 ms
Mitral Valve - MVA (P [**12-9**] T):  0.7 cm2

Findings
LEFT ATRIUM: Moderate LA enlargement. Probable thrombus in the
LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Mildly dilated RA. A catheter
or pacing wire is seen in the RA and extending into the RV. No
ASD by 2D or color Doppler.
LEFT VENTRICLE: Small LV cavity. Overall normal LVEF (>55%).
RIGHT VENTRICLE: Dilated RV cavity. RV function depressed.
Abnormal septal motion/position consistent with RV
pressure/volume overload.
AORTA: Normal ascending aorta diameter. Normal descending aorta
diameter. Simple atheroma in descending aorta. No thoracic
aortic dissection.
AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AS. No
AR.
MITRAL VALVE: Bioprosthetic mitral valve prosthesis (MVR).
Thickened MVR leaflets.. Increased MVR gradient. Severe valvular
MS (MVA <1.0cm2). Mild to moderate ([**12-9**]+) MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild to
moderate [[**12-9**]+] TR.
PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
Mild PR.
Conclusions
PRE-CPB:
The left atrium is moderately dilated. The LAA has been ligated.
A probable thrombus is seen in the left atrial appendage. No
atrial septal defect is seen by 2D or color Doppler.
The left ventricular cavity is unusually small. Overall left
ventricular systolic function is normal (LVEF>55%).
The right ventricular cavity is dilated with depressed free wall
contractility. There is abnormal septal motion/position
consistent with right ventricular volume overload.
There are simple atheroma in the descending thoracic aorta. No
thoracic aortic dissection is seen.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic stenosis. No aortic
regurgitation is seen.
A bioprosthetic mitral valve prosthesis is present. The
prosthetic mitral valve leaflets are thickened. The gradients
are higher than expected for this type of prosthesis. There is
severe valvular mitral stenosis (area <1.0cm2). Mild to moderate
([**12-9**]+) mitral regurgitation is seen.
POST-CPB:
There is a new bioprosthetic valve in the mitral position. The
valve is well-seated with normal leaflet motion. There is no MR.
A trivial paravalvular jet is seen at the 7-o-clock position.
The peak gradient across the mitral valve posthesis is 17mmHg,
the mean gradient is 8mmHg with CO of 4.7. The MVA by PHT is
1.7cm2.
The RV systolic function remains depressed, however appears
slightly improved from pre-op. (The pt is on milrinone and
norepi infusions as well as inhaled NO.) The LV systolic
function remains normal, estimated EF is 60%.
The aortic valve remains normal in structure and function. The
TR has decreased to trace.

Hematology
  COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2171-5-21**] 06:03    11.0 4.34 11.2* 35.8* 83 25.8* 31.3 16.5*
121*
  BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Ct INR(PT)
[**2171-5-21**] 06:03        121*
[**2171-5-21**] 06:03    22.2* 29.8   2.1
Chemistry
  RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2171-5-21**] 06:03    811 25* 0.8 138 4.9 102 31 10

[**Known lastname **],[**Known firstname **] [**Medical Record Number 89781**] F  80  [**2090-11-13**]
Radiology Report CHEST (PA & LAT) Study Date of [**2171-5-21**] 8:24 AM



[**Last Name (LF) **],[**First Name7 (NamePattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] FA6A [**2171-5-21**] 8:24 AM
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 89782**]
Reason: eval for effusion

Final Report
INDICATION: Evaluate for effusion after MVR.

COMPARISON: Multiple radiographs dating back to [**2171-5-14**], most
recently
[**2171-5-18**].

FINDINGS: The patient is status post mitral valve replacement
with intact
median sternotomy wires. The right internal jugular introducer
has been
removed. Small bilateral pleural effusions, left greater than
right, and
associated atelectasis are stable. The right mid lung pleural
density is
unchanged from [**2171-5-17**] but is new from [**2171-5-14**] and is likely a
loculated
pleural effusion. There is no pneumothorax. Aortic valve
calcifications are
re-demonstrated. Cardiac and mediastinal silhouettes and hilar
contours are
stable. Right axillary clips are again noted.

IMPRESSION:
1. Bilateral pleural effusions and atelectasis, left greater
than right, are
stable.
2. Small right loculated pleural effusion.






Brief Hospital Course:
Mrs. [**Known lastname 33590**] presented for cardiac catheterization on [**5-14**] and was
admitted post procedure for preoperative workup. On [**5-16**] she was
brought to the operating room and underwent redo mitral valve
replacement and atrial septal defect via right thoracotomy.
Please see operative report for further details. She received
cefazolin and vancomycin for perioperative antibiotics and was
transferred to the intensive care unit for post operative
management. She was paced coming out of the operating room with
an underlying rhythm of atrial fibrillation. Post-op she had
some hypotension that required Levophed and Milrinone. Due to
hemodynamics she remained intubated until post-op day two. On
this day she was weaned from sedation, awoke neurologically
intact and extubated. In addition to continuing pre-op
medications, she was started on beta-blockers and diuretics and
diuresed towards her pre-op medications. On post-op day three
she was difficult to arouse and a stat head CT and neuro consult
were performed. CT was negative and neurology thought her mental
status was from sedative medications. Chest tubes and epicardial
pacing wires were removed per protocol. Coumadin was restarted
and titrated for a goal INR of [**1-9**].5. The following day she was
transferred to the step-down unit for further recovery where she
worked with physical therapy for strength and mobility. On
post-op day five she appeared to be doing well and was
discharged to rehab with the appropriate medications and
follow-up appointments.

Medications on Admission:
ALBUTEROL SULFATE 90 mcg HFA 2 puffs inhaled PRN up to three
times a day
ATENOLOL 12.5 mg twice a day
ETHACRYNIC ACID 25 mg tablet - [**12-9**] Tablet(s) by mouth once a day

FLUTICASONE-SALMETEROL 250 mcg-50 mcg/Dose Disk 2 puffs daily
FOLIC ACID 1 mg DAILY
IPRATROPIUM-ALBUTEROL 18 mcg-103 mcg (90 mcg)/Actuation Aerosol
- 2 (Two)
puffs inhaled four times a day
LEVALBUTEROL HCL 0.63 mg/3 mL q6hrs prn () as needed for
wheezing/SOB
PREDNISONE 5 mg every other day
VALSARTAN 80 mg twice a day
WARFARIN 2.5 mg daily (Sunday, Tu/Thurs/Saturday, none on other
days. Last dose [**2171-5-9**] pre mitral valve surgery)
ASCORBIC ACID 500 mg  once a day
ASPIRIN 81 mg once a day
B COMPLEX VITAMINS 1 Capsule(s) by mouth once a day
B COMPLEX VITAMINS 1 Tablet(s) by mouth once a day
CALCIUM CARBONATE 200 mg calcium (500 mg) Tablet, Chewable - 1
Tablet(s) by mouth twice a day
CHOLECALCIFEROL 1,000 unit once a day
CYANOCOBALAMIN 1,000 mcg once a day
CYANOCOBALAMIN 50 mcg DAILY
DOCUSATE SODIUM 100 mg twice a day
FLAXSEED OIL 1,000 mg twice a day
MULTIVITAMIN twice a day
VITAMIN E 400 unit once a day

Discharge Medications:
1. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
2. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
5. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. ethacrynic acid 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 Puffs Inhalation Q4H (every 4 hours) as needed for dyspnea.

8. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q6H (every 6 hours) as needed for dyspnea.
9. prednisone 5 mg Tablet Sig: One (1) Tablet PO EVERY OTHER DAY
(Every Other Day).
10. ascorbic acid 500 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable
Sig: One (1) Tablet, Chewable PO BID (2 times a day).
12. B complex vitamins     Capsule Sig: One (1) Cap PO DAILY
(Daily).
13. multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. valsartan 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
15. vitamin E 400 unit Capsule Sig: One (1) Capsule PO DAILY
(Daily).
16. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
17. cyanocobalamin (vitamin B-12) 100 mcg Tablet Sig: 0.5 Tablet
PO DAILY (Daily).
18. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
19. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed for pain.
20. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
21. warfarin 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
Titrate for Goal INR 2-2.5.
(Pre-op doses were 0.5mg Sat, Sun, Tues, [**Last Name (un) **]. None on other
days).
22. amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day): 200mg [**Hospital1 **] x 5 days, then 200mg daily until stopped by
cardiologist.
23. bumetanide 2 mg Tablet Sig: One (1) Tablet PO twice a day
for 10 days.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] House Nursing Home - [**Location 9583**]

Discharge Diagnosis:
Prosthetic Mitral Valve Stenosis s/p Mitral Valve Replacement
Atrial septal defect s/p ASD closure
Past medical history:
Dyslipidemia
Hypertension
Anxiety
Chronic obstructive pulmonary disease
Severe Pulmonary Hypertension
Past Surgical History:
-s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3843**] [**Doctor Last Name **] Bovine Pericardial MVR w/ preservation
of
anterior/posterior chordal structure/ CABG LIMA to LAD, SVG to
OMI, SVG to OM2 and SVG to PDA ([**Hospital3 **] [**2163**])
-s/p left atrial cyroablation, Left atrial appendage resection
-s/p appendectomy
-s/p removal of breast, sinus and abdominal tumor (benign)

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Right thoracotomy - healing well, no erythema or drainage
Edema

Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Followup Instructions:
You are scheduled for the following appointments
Wound check on [**5-28**] at 10:45am in [**Last Name (un) 2577**] [**Hospital Unit Name **]
Surgeon: Dr.[**Last Name (STitle) 914**] on [**6-11**] at 1:15pm
Cardiologist: Dr [**Last Name (STitle) 74605**] on [**6-26**] at 11:15am in

Please call to schedule appointments with your
Primary Care Dr [**Last Name (STitle) **] in [**3-12**] weeks [**Telephone/Fax (1) 41901**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Labs: PT/INR for Coumadin ?????? indication: Atrial fibrillation
Goal INR 2-2.5
First draw - Wed [**5-22**]


Completed by:[**2171-5-21**]
{'Other complications due to heart valve prosthesis,Chronic airway obstruction, not elsewhere classified,Thrombocytopenia, unspecified,Other chronic pulmonary heart diseases,Ostium secundum type atrial septal defect,Aortocoronary bypass status,Atrial fibrillation,Other iatrogenic hypotension,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Anxiety state, unspecified,Atherosclerosis of native arteries of the extremities, unspecified,Physical restraints status,Personal history of tobacco use,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Dermatitis due to drugs and medicines taken internally,Other diuretics causing adverse effects in therapeutic 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: Shortness of breath

PRESENT ILLNESS: 80 year old female with a history of prosthetic mitral valve 8
years ago, who now has worsening prosthetic valve stenosis that
is causing progressive shortness of breath and lower extremity
edema which has been treated medically. In [**2171-2-5**], she was
deemed inoperable. Stated by Dr. [**Last Name (STitle) 914**] at that
time, if after balloon valvuloplasty her PA pressures return to
normal and her RV recovers, she may be a candidate for surgery.
She underwent valvuloplasty on [**2171-2-19**].  She returns today for
repeat cath and echo to further evaluate efficacy of
valvuloplasty based on response of PA pressures.  Last dose of
coumadin was [**2171-5-9**] and she will be admitted post cath for
heparin and pre-op workup.

MEDICAL HISTORY: Mitral Regurgitation
Prosthetic Valve Mitral Stenosis
Dyslipidemia
Hypertension
Anxiety
COPD
Severe Pulm Hypertension
s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3843**] [**Doctor Last Name **] Bovine Pericardial MVR w/ preservation of
anterior/posterior chordal structure/ CABG  LIMA to LAD, SVG to
OMI, SVG to OM2 and SVG to PDA  ([**Hospital3 **] [**2163**])
s/p left atrial cyroablation, Left atrial appendage resection
s/p appendectomy
s/p removal of breast, sinus and abdominal tumor (benign)

MEDICATION ON ADMISSION: ALBUTEROL SULFATE 90 mcg HFA 2 puffs inhaled PRN up to three
times a day
ATENOLOL 12.5 mg twice a day
ETHACRYNIC ACID 25 mg tablet - [**12-9**] Tablet(s) by mouth once a day

ALLERGIES: Claritin / [**Doctor First Name **] / Sulfa (Sulfonamide Antibiotics) /
Furosemide / Lipitor / Zocor / Lescol

PHYSICAL EXAM: Pulse:  60SR  Resp: 20  O2 sat: 94%RA
B/P  150/73
Height:     Weight: 60.7 kgs

FAMILY HISTORY: Mom with cerebral hemorrhage at 48 yo. Dad had CVA at 72

SOCIAL HISTORY: Lives with: husband
Occupation: retired
Tobacco: Quit somking 35 years ago,history of [**12-9**] ppd for 20
years
ETOH:denies 

### Response:
{'Other complications due to heart valve prosthesis,Chronic airway obstruction, not elsewhere classified,Thrombocytopenia, unspecified,Other chronic pulmonary heart diseases,Ostium secundum type atrial septal defect,Aortocoronary bypass status,Atrial fibrillation,Other iatrogenic hypotension,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Anxiety state, unspecified,Atherosclerosis of native arteries of the extremities, unspecified,Physical restraints status,Personal history of tobacco use,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Dermatitis due to drugs and medicines taken internally,Other diuretics causing adverse effects in therapeutic use'}
