CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: Ms. [**Known lastname **] is an 81 year old woman with multiple medical
problems, including DM, chronic renal insufficiency, recent
NSTEMI (3 weeks prior to admission)did not have cardiac
catheterization secondary to poor renal function, diastolic CHF,
requiring lasix gtt on last admission, discharged without lasix,
but recently started on Lasix 20mg po by Dr. [**Last Name (STitle) **] on an
outpatient visit, who presents with 3-4 days of progressive
shortness of breath with intermittent substernal chest pressure.
She has had increasing trouble walking around the house and even
completing full sentences. Her visiting nurse visited her
yesterday and instructed her to call her doctor; her doctor
referred her to the ED today. The chest pressure did not radiate
anywhere but was associated with some nausea and diaphoresis.
.
In the ED, EKG showed an old LBBB, and first set of cardiac
enzymes were negative. She was given 40mg IV Lasix. The chest
pressure resolved with the addition of oxygen. Given an elevated
D-dimer, a heparin drip was entertained; however, given the
presence of alternate explanations for shortness of breath in
conjunction with elevated INR (3.8), it was not.
.
Of note, she has had two nosebleeds in the past week which
resolved with pressure and application of ice. She had an
episode of nausea and vomiting last night after dinner, as well
as decrease in appetite. She denies fevers, chills, abdominal
pain, muscle cramps, lower extremity edema, constipation. She
has had looser stools since she was discharged from the hospital
several weeks ago, likely secondary to being discharged on senna
and colace.

MEDICAL HISTORY: 1) PVD s/p cath
2) HTN
3) DMII-HgAlc 6.1% on [**2187-8-20**] at OSH
4) hypercholesterolemia
5) Rheumatic Fever
6) hypothyroidism
7) peptic ulcer disease
8) Recent Urinary Tract Infection-On admission to OSH, patient
moderate leukocyte esterase and 30-40 WBC.  Treated with
bactrim.
9) s/p thyroidectomy
10) s/p hysterectomy
11) s/p R mastectomy [**3-16**] breast ca
[**92**]) Chronic renal insufficency-Baseline Cr of 2.0.  At OSH, Cr
trended upwards from 2.0 on admission to 2.6 at discharge.

MEDICATION ON ADMISSION: Aspirin 325mg daily
Levothyroxine 150mcg daily
Pantoprazole 40mg [**Hospital1 **]
Clopidogrel 75mg daily
Epoietin Alfa 10,000 units/mL QMoWeFr
Cyanocobalamin 500 mcg daily
Atorvastatin 40mg daily
Warfarin 5mg QHS
Metoprolol 75mg [**Hospital1 **]
Ferrous sulfate 325mg daily
Ipratropium Neb Q4H
Fexofenadine 60mg [**Hospital1 **]
Senna 8.6mg [**Hospital1 **]
Calcium Acetate 667 PO TID with meals
Metformin (unknown dose)
Lasix 20mg daily (recently started by cardiologist)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
Vitals: T 98.1, BP 154/61, HR 78, RR 16, Sat 94%RA
Gen: Appears in mild respiratory distress, unable to complete
full sentences
HEENT: EOMI, PERRL, OP clear
Neck: No carotid bruit, no JVD appreciated (but + hepatojugular
reflex)
Cardiac: RRR, normal S1/S2, no m/r/g appreciated
Lungs: Crackles [**2-13**] way up bilaterally. No wheezes.
Abd: Soft, obese, non-distended, non-tender, normal active bowel
sounds. No hepatosplenomegaly. + hepatojugular reflex.
Back: No CVA tenderness
Ext: No clubbing, cyanosis, peripheral edema. 1+ DP pulses
bilaterally
Skin: No rashes appreciated
Neuro: A&O x 3, moving all four extremities

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Ms. [**Known lastname **] is a widow who lives alone.  She denies current
tobacco, alcohol, or drug use.  In the past, she smoked and has
a thirty pack year history.
Coronary atherosclerosis of native coronary artery,Diastolic heart failure, unspecified,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Acute kidney failure, unspecified,Cellulitis and abscess of upper arm and forearm,Chronic kidney disease, unspecified,Subendocardial infarction, subsequent episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Unspecified acquired hypothyroidism,Anemia, unspecified
Crnry athrscl natve vssl,Diastolc hrt failure NOS,Intermed coronary synd,Surg compl-heart,Atrial fibrillation,Acute kidney failure NOS,Cellulitis of arm,Chronic kidney dis NOS,Subendo infarct, subseq,Hy kid NOS w cr kid I-IV,Hypothyroidism NOS,Anemia NOS
Admission Date:  [**2187-9-25**]              Discharge Date:   [**2187-10-18**]

Date of Birth:  [**2105-9-13**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
[**2187-10-9**] - Coronary bypass grafting x2 with left internal mammary
artery to left anterior descending coronary artery, reverse
saphenous vein single graft from the aorta to the first obtuse
marginal coronary artery.
[**2187-10-3**] - Cardiac Catheterization


History of Present Illness:
Ms. [**Known lastname **] is an 81 year old woman with multiple medical
problems, including DM, chronic renal insufficiency, recent
NSTEMI (3 weeks prior to admission)did not have cardiac
catheterization secondary to poor renal function, diastolic CHF,
requiring lasix gtt on last admission, discharged without lasix,
but recently started on Lasix 20mg po by Dr. [**Last Name (STitle) **] on an
outpatient visit, who presents with 3-4 days of progressive
shortness of breath with intermittent substernal chest pressure.
She has had increasing trouble walking around the house and even
completing full sentences. Her visiting nurse visited her
yesterday and instructed her to call her doctor; her doctor
referred her to the ED today. The chest pressure did not radiate
anywhere but was associated with some nausea and diaphoresis.
.
In the ED, EKG showed an old LBBB, and first set of cardiac
enzymes were negative. She was given 40mg IV Lasix. The chest
pressure resolved with the addition of oxygen. Given an elevated
D-dimer, a heparin drip was entertained; however, given the
presence of alternate explanations for shortness of breath in
conjunction with elevated INR (3.8), it was not.
.
Of note, she has had two nosebleeds in the past week which
resolved with pressure and application of ice. She had an
episode of nausea and vomiting last night after dinner, as well
as decrease in appetite. She denies fevers, chills, abdominal
pain, muscle cramps, lower extremity edema, constipation. She
has had looser stools since she was discharged from the hospital
several weeks ago, likely secondary to being discharged on senna
and colace.

Past Medical History:
1) PVD s/p cath
2) HTN
3) DMII-HgAlc 6.1% on [**2187-8-20**] at OSH
4) hypercholesterolemia
5) Rheumatic Fever
6) hypothyroidism
7) peptic ulcer disease
8) Recent Urinary Tract Infection-On admission to OSH, patient
moderate leukocyte esterase and 30-40 WBC.  Treated with
bactrim.
9) s/p thyroidectomy
10) s/p hysterectomy
11) s/p R mastectomy [**3-16**] breast ca
[**92**]) Chronic renal insufficency-Baseline Cr of 2.0.  At OSH, Cr
trended upwards from 2.0 on admission to 2.6 at discharge.

Social History:
Ms. [**Known lastname **] is a widow who lives alone.  She denies current
tobacco, alcohol, or drug use.  In the past, she smoked and has
a thirty pack year history.


Family History:
Non-contributory

Physical Exam:
Admission:
Vitals: T 98.1, BP 154/61, HR 78, RR 16, Sat 94%RA
Gen: Appears in mild respiratory distress, unable to complete
full sentences
HEENT: EOMI, PERRL, OP clear
Neck: No carotid bruit, no JVD appreciated (but + hepatojugular
reflex)
Cardiac: RRR, normal S1/S2, no m/r/g appreciated
Lungs: Crackles [**2-13**] way up bilaterally. No wheezes.
Abd: Soft, obese, non-distended, non-tender, normal active bowel
sounds. No hepatosplenomegaly. + hepatojugular reflex.
Back: No CVA tenderness
Ext: No clubbing, cyanosis, peripheral edema. 1+ DP pulses
bilaterally
Skin: No rashes appreciated
Neuro: A&O x 3, moving all four extremities

Discharge:
VS  T98.2  HR 62SR  BP 159/69  RR 18 O2sat 97%/2LNP
Gen: NAD
Neuro: A&Ox3, nonfocal exam
CV RRR, sternum stable incision CDI
Pulm CTA-bilat
Abdm: soft,NT/+BS
Ext: Warm 1+ pedal edema bilat. Bilat leg wounds CDI

Pertinent Results:
[**2187-9-25**] 11:33PM   CK(CPK)-48
[**2187-9-25**] 11:33PM   CK-MB-NotDone cTropnT-0.02*
[**2187-9-25**] 05:22PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.014
[**2187-9-25**] 05:22PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2187-9-25**] 05:22PM URINE  RBC-0-2 WBC-0-2 BACTERIA-NONE YEAST-NONE
EPI-0-2 RENAL EPI-0-2
[**2187-9-25**] 04:57PM   K+-4.0
[**2187-9-25**] 04:30PM   GLUCOSE-183* UREA N-36* CREAT-1.6* SODIUM-135
POTASSIUM-6.0* CHLORIDE-97 TOTAL CO2-22 ANION GAP-22*
[**2187-9-25**] 04:30PM   estGFR-Using this
[**2187-9-25**] 04:30PM   CK(CPK)-89
[**2187-9-25**] 04:30PM   CK-MB-NotDone cTropnT-<0.01 proBNP-[**Numeric Identifier 6338**]*
[**2187-9-25**] 04:30PM   CALCIUM-9.2 PHOSPHATE-3.4 MAGNESIUM-2.2
[**2187-9-25**] 04:30PM   WBC-11.6* RBC-3.88* HGB-10.6* HCT-32.1*
MCV-83 MCH-27.3 MCHC-33.0 RDW-15.5
[**2187-9-25**] 04:30PM   NEUTS-78.5* LYMPHS-15.2* MONOS-5.3 EOS-0.8
BASOS-0.2
[**2187-9-25**] 04:30PM   PLT COUNT-627*
[**2187-9-25**] 04:30PM   PT-34.8* PTT-41.3* INR(PT)-3.8*
[**2187-9-25**] 04:30PM   D-DIMER-2051*
COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2187-10-17**] 08:00AM    11.0 3.53* 10.2* 32.0* 91 28.7 31.7 16.5*
618*
RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2187-10-17**] 05:55AM    92 26* 1.8* 135 5.0 100 22 18
[**2187-10-17**] 05:55AM    15.2* 33.5   1.4*

[**2187-9-25**]-BILATERAL LOWER EXTREMITY VEIN DOPPLER ULTRASOUND:
Grayscale and Doppler
examination of the bilateral common femoral, superficial femoral
and popliteal
veins were performed.  Normal compressibility, augmentation,
waveforms and
Doppler flow is demonstrated.  There is no evidence of
intraluminal clot.

Renal US [**2187-9-29**]-
1) No hydronephrosis.
2) Hypoechoic nodule in upper pole of left kidney not
definitively
identified on recent priors. In absence of clinical signs to
suggest an acute pathology, recommend follow-up in [**4-17**] months to
reevaluate.

Cardiac Cath 8/22/07-1. Coronary angiography of this right
dominant system revealed a LMCA
with an eccentric 60% lesion extending into the ostial/proximal
portion
of the LCX. The LAD was without significant coronary disease.
The RCA
was without apparent angiographic significant disease.
2. Resting hemodynamics revealed severe systemic hypertension
with an
SBP of 176 mm Hg. Left sided pressures were severely elevated
with an
LVEDP of 32 mm Hg.
3. Left ventriculography was deferred.

FINAL DIAGNOSIS:
1. Two vessel coronary artery disease.
2. Markedly elevated LVEDP suggestive of severe diastolic
dysfunction.

[**2187-10-5**]- CT-chest w/o contrast-
1. Extensive calcifications of the ascending aorta, normal in
caliber.

2. Mediastinal lymphadenopathy of uncertain significance.

3. Upper normal limit size of pulmonary arteries.  Small left
pleural
effusion.

[**2187-10-5**]-Echo-Symmetric left ventricular hypertrophy with
preserved global and regional biventricular systolic function.
Diastolic LV dysfunction with
elevated filling pressures. Mild mitral regurgitation.

[**2187-10-6**]-Femoral U/S bilateral-
No pseudoaneurysm or hematoma.

[**2187-10-9**] ECHO
PRE-BYPASS:
1. Mild spontaneous echo contrast is present in the left atrial
appendage. The left atrial appendage emptying velocity is
depressed (<0.2m/s). A left atrial appendage thrombus cannot be
excluded.
2. No atrial septal defect is seen by 2D or color Doppler.
3. Overall left ventricular systolic function is severely
depressed (LVEF= 25%.
4. The right ventricular cavity is mildly dilated.
5. There are complex, mobile atheroma in the aortic arch. There
are complex
(>4mm) atheroma in the descending thoracic aorta.
6. There are three aortic valve leaflets. The aortic valve
leaflets are mildly thickened. Trace aortic regurgitation is
seen.
7. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened.


Post bypass
1. Initial attempt at coming off CPB was associated with severe
MR and high PA pressures . Back on CPB and started milrinone and
epinephrine.
2. Septal and anteroseptal walls of the LV shows improved
function. RV
function unchanged.
3. Trace mitral regurgitation present.
4. Aorta intact post decannulation.

   RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2187-10-16**] 1:32 PM

CHEST (PA & LAT)

Reason: r/o effusion

[**Hospital 93**] MEDICAL CONDITION:
82 year old woman with CAD to go for CABG
REASON FOR THIS EXAMINATION:
r/o effusion
TYPE OF EXAMINATION: Chest PA and lateral.

INDICATION: Coronary artery disease, scheduled for bypass
surgery. Evaluate for effusion.

FINDINGS: AP single view of the chest has been obtained with
patient in sitting semi-upright position. Comparison is made
with a similar preceding study of [**2187-10-11**]. There is mild
blunting of the lateral pleural sinuses confirmed by blunting of
the posterior pleural sinuses in the lateral view. The amount is
considered mild to moderate. There remain some linear densities
on the left base, but these densities have not progressed in
comparison with the previous study. On the right base, the
previously identified linear atelectasis has improved with only
one remaining. Also, the previously existing perivascular haze
has improved slightly. No new parenchymal infiltrates are
identified. Position of previously described right-sided
internal jugular vein approach central venous line is unchanged.
The previously existing post-operative mediastinal widening has
regressed.

IMPRESSION: Improvement of post-operative changes.
Mild-to-moderate amount of bilateral pleural effusions. No
pneumothorax or any other complication.

DR. [**First Name (STitle) **] [**Initials (NamePattern5) 3250**] [**Last Name (NamePattern5) 3251**]


Brief Hospital Course:
Ms. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2187-9-25**] for further
management of her shortness of breath and NSTEMI. Diuresis was
initiated and cardiac enzymes were negative. Her BNP was noted
to be quite elevated. A lower extremity ultrasound was negative
for a deep vein thrombosis. Her renal function stuides suggested
some mild renal failure. A renal ultrasound was performed which
showed no hydronephrosis and a hypoechoic nodule in upper pole
of left kidney not definitively identified on recent priors. A
[**4-17**] month follow-up was recommended. Slowly her renal function
improved. She was treated for a urinary tract infection. Ms.
[**Known lastname **] continued to have episodes of chest pain treated with
nitroglycerin with relief. Her coumadin was reversed with the
plan for a cardiac catheterization. A cardiac catheterization
was performed which showed left main and circumflex artery
disease. Heparin was continued. Given the anatomy and severity
of her disease, the cardiac surgical service was consulted for
surgical management. She was worked-up in the usual preoperative
manner including a carotid duplex ultrasound which showed
moderate plaque with bilateral 40-59% carotid stenosis. She was
tranfused to maintain a hematocrit of greater then or equal to
30%. Plavix was allowed to clear while her INR normalized in
anticipation of surgery. A superficiall phlebitis was treated.
On [**2187-10-9**], Ms. [**Known lastname **] was taken to the operating room where she
underwent coronary artery bypass grafting to two vessels.
Postoperatively she was taken to the intensive care unit for
monitoring. On postoperative day one, Ms. [**Known lastname **] [**Last Name (Titles) 5058**]
neurologically intact and was extubated. A hematology consult
was obtained for thrombocytosis however her platelets quickly
normalized and it was assummed she had a reactive
thrombocytosis. Amiodarone was started for atrial fibrillation.
On postoperative day two, Ms. [**Known lastname **] was transferred to the step
down unit for further recovery. She was gently diuresed towards
her preoperative weight. The physical therapy service was
consulted for assistance with her postoperative strength and
mobility. Coumadin was resumed for anticoagulation. Over the
next several days the patient worked with PT to increase
endurance without much gain, it was decided she would benefit
from a short rehabilitation stay and on  POD 9 she was
transferred to rehab.

Medications on Admission:
Aspirin 325mg daily
Levothyroxine 150mcg daily
Pantoprazole 40mg [**Hospital1 **]
Clopidogrel 75mg daily
Epoietin Alfa 10,000 units/mL QMoWeFr
Cyanocobalamin 500 mcg daily
Atorvastatin 40mg daily
Warfarin 5mg QHS
Metoprolol 75mg [**Hospital1 **]
Ferrous sulfate 325mg daily
Ipratropium Neb Q4H
Fexofenadine 60mg [**Hospital1 **]
Senna 8.6mg [**Hospital1 **]
Calcium Acetate 667 PO TID with meals
Metformin (unknown dose)
Lasix 20mg daily (recently started by cardiologist)

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule 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. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
4. Levothyroxine 75 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Acetaminophen-Codeine 300-30 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
7. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day).
8. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Warfarin 1 mg Tablet Sig: Two (2) Tablet PO once a day:
Adjust dose to target INR 1.5-2.
10. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
11. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): 40mg QD x 10 days then decrease to 20mg QD.
12. Captopril 12.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
13. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. Epoetin Alfa 10,000 unit/mL Solution Sig: [**Numeric Identifier 961**] ([**Numeric Identifier 961**])
units Injection Q Mo-We-Fri.
15. Ferrous Sulfate 325 (65) mg Tablet, Delayed Release (E.C.)
Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 245**] [**Hospital6 **] Hospital

Discharge Diagnosis:
CAD s/p CABG
Congestive heart failure exacerbation, supratherapeutic INR
Diastolic heart failure
Coronary artery disease, status post myocardial infarction
Atrial fibrillation
peripheral vascular disease
hypertension
hypercholesterolemia
chronic renal insufficiency
diabetes
hypothyroidism
peptic ulcer disease


Discharge Condition:
stable


Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain. Contact surgeon at ([**Telephone/Fax (1) 1504**]
with any wound issues.
2) Report any weight gain of greater the 2 pounds in 24 hours or
5 pounds in 1 week.
3) No lifting greater the 10 pounds for 10 weeks.
4) No driving for 1 month.
5) You may wash incision and gently pat it dry. No swimming or
bathing until wound has healed. Please shower daily. No lotions,
creams or powders to incision until it has healed.

Followup Instructions:
Dr. [**Last Name (STitle) 914**] in 1 month. ([**Telephone/Fax (1) 1504**]
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1557**]  [**Telephone/Fax (1) 8506**]
Dr. [**Last Name (STitle) **]  [**2190-10-29**]:20am [**Telephone/Fax (1) 2386**]
Please call all providers for appointments.



Completed by:[**2187-10-18**]
{'Coronary atherosclerosis of native coronary artery,Diastolic heart failure, unspecified,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Acute kidney failure, unspecified,Cellulitis and abscess of upper arm and forearm,Chronic kidney disease, unspecified,Subendocardial infarction, subsequent episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Unspecified acquired hypothyroidism,Anemia, unspecified'}


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: Ms. [**Known lastname **] is an 81 year old woman with multiple medical
problems, including DM, chronic renal insufficiency, recent
NSTEMI (3 weeks prior to admission)did not have cardiac
catheterization secondary to poor renal function, diastolic CHF,
requiring lasix gtt on last admission, discharged without lasix,
but recently started on Lasix 20mg po by Dr. [**Last Name (STitle) **] on an
outpatient visit, who presents with 3-4 days of progressive
shortness of breath with intermittent substernal chest pressure.
She has had increasing trouble walking around the house and even
completing full sentences. Her visiting nurse visited her
yesterday and instructed her to call her doctor; her doctor
referred her to the ED today. The chest pressure did not radiate
anywhere but was associated with some nausea and diaphoresis.
.
In the ED, EKG showed an old LBBB, and first set of cardiac
enzymes were negative. She was given 40mg IV Lasix. The chest
pressure resolved with the addition of oxygen. Given an elevated
D-dimer, a heparin drip was entertained; however, given the
presence of alternate explanations for shortness of breath in
conjunction with elevated INR (3.8), it was not.
.
Of note, she has had two nosebleeds in the past week which
resolved with pressure and application of ice. She had an
episode of nausea and vomiting last night after dinner, as well
as decrease in appetite. She denies fevers, chills, abdominal
pain, muscle cramps, lower extremity edema, constipation. She
has had looser stools since she was discharged from the hospital
several weeks ago, likely secondary to being discharged on senna
and colace.

MEDICAL HISTORY: 1) PVD s/p cath
2) HTN
3) DMII-HgAlc 6.1% on [**2187-8-20**] at OSH
4) hypercholesterolemia
5) Rheumatic Fever
6) hypothyroidism
7) peptic ulcer disease
8) Recent Urinary Tract Infection-On admission to OSH, patient
moderate leukocyte esterase and 30-40 WBC.  Treated with
bactrim.
9) s/p thyroidectomy
10) s/p hysterectomy
11) s/p R mastectomy [**3-16**] breast ca
[**92**]) Chronic renal insufficency-Baseline Cr of 2.0.  At OSH, Cr
trended upwards from 2.0 on admission to 2.6 at discharge.

MEDICATION ON ADMISSION: Aspirin 325mg daily
Levothyroxine 150mcg daily
Pantoprazole 40mg [**Hospital1 **]
Clopidogrel 75mg daily
Epoietin Alfa 10,000 units/mL QMoWeFr
Cyanocobalamin 500 mcg daily
Atorvastatin 40mg daily
Warfarin 5mg QHS
Metoprolol 75mg [**Hospital1 **]
Ferrous sulfate 325mg daily
Ipratropium Neb Q4H
Fexofenadine 60mg [**Hospital1 **]
Senna 8.6mg [**Hospital1 **]
Calcium Acetate 667 PO TID with meals
Metformin (unknown dose)
Lasix 20mg daily (recently started by cardiologist)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
Vitals: T 98.1, BP 154/61, HR 78, RR 16, Sat 94%RA
Gen: Appears in mild respiratory distress, unable to complete
full sentences
HEENT: EOMI, PERRL, OP clear
Neck: No carotid bruit, no JVD appreciated (but + hepatojugular
reflex)
Cardiac: RRR, normal S1/S2, no m/r/g appreciated
Lungs: Crackles [**2-13**] way up bilaterally. No wheezes.
Abd: Soft, obese, non-distended, non-tender, normal active bowel
sounds. No hepatosplenomegaly. + hepatojugular reflex.
Back: No CVA tenderness
Ext: No clubbing, cyanosis, peripheral edema. 1+ DP pulses
bilaterally
Skin: No rashes appreciated
Neuro: A&O x 3, moving all four extremities

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Ms. [**Known lastname **] is a widow who lives alone.  She denies current
tobacco, alcohol, or drug use.  In the past, she smoked and has
a thirty pack year history. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Diastolic heart failure, unspecified,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Acute kidney failure, unspecified,Cellulitis and abscess of upper arm and forearm,Chronic kidney disease, unspecified,Subendocardial infarction, subsequent episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Unspecified acquired hypothyroidism,Anemia, unspecified'}
