CHIEF COMPLAINT: pulmonary edema, anemia,chest pain

PRESENT ILLNESS: 75 yo F w/ severe 3vd s/p multiple stents on recent admission
p/w chest pain, s/p NSTEMI from OSH. SHe was woken from sleep
with 8/10 chest pressure similar to prior angina and presented
to [**Hospital1 1774**] w/ SOB, nausea and chest pressure. She was initially in
heart failure and hypoxic to 80% and was given lasix 40mg IV en
route to hospital. On arrival she was placed on Bipap, got
another 50mg IV lasix and put out 1200mL urine within 3 hours
and her respiratory status significantly improved. Her chest
pain resolved after several nitros but returned this morning
prior to transport and then again resolved with nitro. Heparin
drip was started. Trop I was elevated at 0.96 then peaked at
2.95 with but CK 133. BNP was elevated at 959. There were no new
ST -T wave changes. She was continued on ASA, plavix,
metoprolol, statin.
.
She was admitted last month with cath x 3 and several stents
placed. It was thought that she may have had an LMCA dissection
but on review of imaging it appears that this is not true. Her
plan had been a staged procedure consisting of CABG (LIMA-LAD)
and stenting but unclear what the [**Name (NI) **] plan would be now if she
is a candidate. She was a high risk surgical candidate for poor
sternal wound healing She went to [**Hospital1 **] then Home and then
right back into local hospital with Pulmonary Edema. She was not
intubated, diuresed, no unstable EKG changes, no evolving
changes. Got blood transfusion 1 Unit for for HCT 26.5 and SOB
again occurred but resolved prior to transfer. FAMILY requested
the transfer to [**Hospital1 **].
HCT 25.4 without source of bleeding, receiving blood today
.
She is on tele, IV Hep, O2 via NC, IV Bumex, groin site fine
Was on Bipap in ER and responded??????.
.
Dr. [**Last Name (STitle) 24471**] can be reached directly at [**Telephone/Fax (1) 24472**], which is a
direct line at the ICU.
.
On review of systems, s/he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. S/he denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-CABG: None
-PERCUTANEOUS CORONARY INTERVENTIONS:
-PACING/ICD:
3. OTHER PAST MEDICAL HISTORY:
- [**Location (un) **] disease s/p ablation of pituitary adenoma at [**Hospital1 2025**].
- Hip replacement for osteoarthritis.
- Obesity.
- Lower back pain.
- Status post right knee patella removal after motor vehicle
accident.
- History of left lower leg hematoma after a fall 3 years ago.
- Depression.
- Hypothyroidism.
- Deep vein thrombosis in left calf 3 years ago.
- Cataract in both eyes status post extraction.

MEDICATION ON ADMISSION: Home:
1. clopidogrel 75 mg PO DAILY
2. nitroglycerin 0.3 mg Sublingual PRN
3. aspirin 325 mg PO DAILY
4. escitalopram 10 mg PO DAILY
5. simvastatin 80 mg PO DAILY
6. ezetimibe 10 mg PO DAILY
7. bumetanide 6 mg PO DAILY
8. ergocalciferol (vitamin D2) 50,000 unit PO once a week.
9. gabapentin 300 mg PO Q 24H
10. hydrocodone-acetaminophen 7.5-650 mg PO three times a day
11. Cortef 25 mg PO qAM
12. Cortef 5 mg PO qPM
13. miconazole nitrate 2 % Powder Topical TID prn
14. senna 8.6 mg PO BID prn
15. docusate sodium 100 mg PO BID
16. Synthroid 150 mcg PO daily
17. lisinopril 5 mg PO DAILY
18. pantoprazole 40 mg PO DAILY
19. metoprolol succinate 25 mg PO DAILY
20. quetiapine 25 mg PO Q4PM
21. quetiapine 25 mg PO Q10PM
22. insulin glargine 26 units Subcutaneous qAM
23. Humalog TID SSI
24. pioglitazone 30 mg PO DAILY

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / nitrofurantoin (macrocryst25%)
/ Cortisone / Levoxyl

PHYSICAL EXAM: On admission:
VS: T= 98.3 BP= 112/47 HR=79 RR= 18 O2 sat= 98% RA
GENERAL: NAD. Oriented x3. Mood, affect appropriate, pleasant
conversant, unable to [**First Name8 (NamePattern2) **] [**Doctor Last Name 1841**] in reverse but able to do forward.

FAMILY HISTORY: Brother died from an MI at 50. Daughter had a stent at age 36.

SOCIAL HISTORY: She lives with her husband and daughter in a
house. She has 4 children. She does not use any services
currently. She is independent in her ADL's but is known to have
a gait disorder and a history of falls in the past.
-Tobacco history: Never
-ETOH: None
-Illicit drugs: None
Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Subendocardial infarction, initial episode of care,Cushing's syndrome,Cellulitis and abscess of leg, except foot,Body Mass Index 40.0-44.9, adult,Delirium due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Percutaneous transluminal coronary angioplasty status,Unspecified acquired hypothyroidism,Hip joint replacement,Morbid obesity,Long-term (current) use of steroids,Depressive disorder, not elsewhere classified
Ac on chr diast hrt fail,Pneumonia, organism NOS,Subendo infarct, initial,Cushing's syndrome,Cellulitis of leg,BMI 40.0-44.9, adult,Delirium d/t other cond,DMII wo cmp nt st uncntr,Status-post ptca,Hypothyroidism NOS,Joint replaced hip,Morbid obesity,Long-term use steroids,Depressive disorder NEC
Admission Date:  [**2133-1-7**]              Discharge Date:   [**2133-1-11**]

Date of Birth:  [**2057-11-26**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfa (Sulfonamide Antibiotics) / nitrofurantoin (macrocryst25%)
/ Cortisone / Levoxyl

Attending:[**First Name3 (LF) 2698**]
Chief Complaint:
pulmonary edema, anemia,chest pain

Major Surgical or Invasive Procedure:
none


History of Present Illness:
75 yo F w/ severe 3vd s/p multiple stents on recent admission
p/w chest pain, s/p NSTEMI from OSH. SHe was woken from sleep
with 8/10 chest pressure similar to prior angina and presented
to [**Hospital1 1774**] w/ SOB, nausea and chest pressure. She was initially in
heart failure and hypoxic to 80% and was given lasix 40mg IV en
route to hospital. On arrival she was placed on Bipap, got
another 50mg IV lasix and put out 1200mL urine within 3 hours
and her respiratory status significantly improved. Her chest
pain resolved after several nitros but returned this morning
prior to transport and then again resolved with nitro. Heparin
drip was started. Trop I was elevated at 0.96 then peaked at
2.95 with but CK 133. BNP was elevated at 959. There were no new
ST -T wave changes. She was continued on ASA, plavix,
metoprolol, statin.
.
She was admitted last month with cath x 3 and several stents
placed. It was thought that she may have had an LMCA dissection
but on review of imaging it appears that this is not true. Her
plan had been a staged procedure consisting of CABG (LIMA-LAD)
and stenting but unclear what the [**Name (NI) **] plan would be now if she
is a candidate. She was a high risk surgical candidate for poor
sternal wound healing She went to [**Hospital1 **] then Home and then
right back into local hospital with Pulmonary Edema. She was not
intubated, diuresed, no unstable EKG changes, no evolving
changes. Got blood transfusion 1 Unit for for HCT 26.5 and SOB
again occurred but resolved prior to transfer. FAMILY requested
the transfer to [**Hospital1 **].
HCT 25.4 without source of bleeding, receiving blood today
.
She is on tele, IV Hep, O2 via NC, IV Bumex, groin site fine
Was on Bipap in ER and responded??????.
.
Dr. [**Last Name (STitle) 24471**] can be reached directly at [**Telephone/Fax (1) 24472**], which is a
direct line at the ICU.
.
On review of systems, s/he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. S/he denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.


Past Medical History:
1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-CABG: None
-PERCUTANEOUS CORONARY INTERVENTIONS:
-PACING/ICD:
3. OTHER PAST MEDICAL HISTORY:
- [**Location (un) **] disease s/p ablation of pituitary adenoma at [**Hospital1 2025**].
- Hip replacement for osteoarthritis.
- Obesity.
- Lower back pain.
- Status post right knee patella removal after motor vehicle
accident.
- History of left lower leg hematoma after a fall 3 years ago.
- Depression.
- Hypothyroidism.
- Deep vein thrombosis in left calf 3 years ago.
- Cataract in both eyes status post extraction.


Social History:
She lives with her husband and daughter in a
house. She has 4 children. She does not use any services
currently. She is independent in her ADL's but is known to have
a gait disorder and a history of falls in the past.
-Tobacco history: Never
-ETOH: None
-Illicit drugs: None


Family History:
Brother died from an MI at 50. Daughter had a stent at age 36.

Physical Exam:
On admission:
VS: T= 98.3 BP= 112/47 HR=79 RR= 18 O2 sat= 98% RA
GENERAL: NAD. Oriented x3. Mood, affect appropriate, pleasant
conversant, unable to [**First Name8 (NamePattern2) **] [**Doctor Last Name 1841**] in reverse but able to do forward.

HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP to level of Jaw w/ HJR.
CARDIAC: RRR, distant heart sounds, no MRG
LUNGS: Crackles in the bases bilaterally w/ diffuse end
expiratory wheeze
ABDOMEN: Soft, obese, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: Trace LE edema, no sacral edema, chronic venous
stasis changes to L leg.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ DP 1+ PT not palpable
Left: Carotid 2+ DP 1+ PT not palpable

Pertinent Results:
[**2133-1-7**] 11:50PM   WBC-12.0* RBC-3.42* HGB-9.0* HCT-28.2* MCV-82
MCH-26.4* MCHC-32.1 RDW-17.4*
[**2133-1-7**] 11:50PM   PLT COUNT-271#
[**2133-1-7**] 11:50PM   PTT-108.5*
[**2133-1-8**] 05:45AM BLOOD Glucose-74 UreaN-17 Creat-1.1 Na-146*
K-3.4 Cl-104 HCO3-34* AnGap-11
[**2133-1-8**] 05:45AM BLOOD CK-MB-4 cTropnT-0.59* proBNP-[**Numeric Identifier 24473**]*

Brief Hospital Course:
75 yo F with severe 3VD s/p multiple stents, [**Location (un) 3484**] disease
s/p laser removal of pituitary adenoma now on chronic steroids,
HTN, HLD p/w chest pressure and new O2 requirement likely in the
setting of demand with acute on chronic diastolic heart failure.
.
# Chest pain/PUMP: Chest pain was most likely due to demand
ischemia in the setting of acute on chronic diastolic heart
failure.  Presented with STE initially, which resolved and pain
resolved with nitro. Elevated trop, which was elevated prior,
but no elevation of CK/MB. Dr. [**Last Name (STitle) 911**], who did her prior caths,
was consulted and recommended not doing a cath again unless
intractable chest pain as it may not have improved her sx and
she has known cardiac disease with multiple stents.  On initial
exam, appeared overloaded with lower extermity edema and had
crackles on exam.  Diuresis with IV bumex was initiated.  She
was transferred to the CCU on day of admission, where diuresis
was continued with IV bumex and lasix volume status improved and
recurrent chest pain resolved. She was also put on stress dose
steroids for her h/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3484**] disease, s/p laser ablation of
pituitary, as described below.  She was transitioned back to her
home dose of PO bumex
.
# CORONARIES: Has known 3vd as described above, and chest pain
thought to be [**2-26**] demand ischemia from CHF exacerbation rather
than from ACS.  Initially was started on heparin gtt, but was
dc'ed.  No cath was done, likely not a candidate for surgery so
she was medically managed with her regimen of aspirin, plavix,
simvastatin 80, metoprolol, lisinopril, and imdur was started.
.
# CCU Course: On HD2, patient developed fever to 101.7 with new
infiltrate on CXR. She was started on vancomycin/cefepime for
empiric HCAP. Over the course of the day, her mental status
declined and she became difficult to arouse and she was
transferred to the CCU. She was observed in the unit overnight
where her respiratory status remained stable and her mental
status improved. After a one day stay, she was returned to the
general medical floor.
.
#RHYTHM: NSR, was monitored on tele with no events.
.
#RLE cellulitis: had painful, erythematous, well defined skin
lesion on RLE and fever at OSH so was started on vancomycin, for
MRSA considering history, and cefepime, considering h/o DM. Was
transitioned to PO abx of levofloxacin and keflex for total 10
day course.
.
# Cushings: Is on chronic steroids for panhypopituitarism s/p
laser ablation of pituitary in the setting of [**Location (un) 3484**] Disease.
 Dose was doubled in thes etting of illness and infection.  On
discharge, was transitioned back to home dose.
.
# DM:  home regimen of glargine 48U qAM and 15U qPM  continued,
home pioglitizone was discontinued, with well controlled FS on
insulin.
.
# Hypothyroid: continued synthroid
.
# Depression: continued escitalopram

Medications on Admission:
Home:
1. clopidogrel 75 mg PO DAILY
2. nitroglycerin 0.3 mg Sublingual PRN
3. aspirin 325 mg PO DAILY
4. escitalopram 10 mg PO DAILY
5. simvastatin 80 mg PO DAILY
6. ezetimibe 10 mg PO DAILY
7. bumetanide 6 mg PO DAILY
8. ergocalciferol (vitamin D2) 50,000 unit PO once a week.
9. gabapentin 300 mg PO Q 24H
10. hydrocodone-acetaminophen 7.5-650 mg PO three times a day
11. Cortef 25 mg PO qAM
12. Cortef 5 mg PO qPM
13. miconazole nitrate 2 % Powder Topical TID prn
14. senna 8.6 mg PO BID prn
15. docusate sodium 100 mg PO BID
16. Synthroid 150 mcg PO daily
17. lisinopril 5 mg PO DAILY
18. pantoprazole 40 mg PO DAILY
19. metoprolol succinate 25 mg PO DAILY
20. quetiapine 25 mg PO Q4PM
21. quetiapine 25 mg PO Q10PM
22. insulin glargine 26 units Subcutaneous qAM
23. Humalog TID SSI
24. pioglitazone 30 mg PO DAILY

On transfer:
1. Lantus 15U qpm, 48U qam
Metoprolol XL 12.5mg Q24
Nystatin topical
ASA 325mg Q24
Atorvastatin 80mg Qhs
Bumetanide 2mg Q12
Clopidogrel 75mg Q24
Escitalopram 10mg Q24
Gabapentin 300mg Q24
Insulin SS
Acetaminophen 325mg Q6 PRN
Heparin IV
vicodin 5/500mg Q8 PRN
Normal [**Last Name (un) **] 100mL/hr
citalopram 10mg Q24
Hydrocortisone 50mg qam
hydrocortisone 5mg qpm
Levothyroxine 150mcg daily
Lisinopril 5mg Q24
Pantoprazole 40mg PO BID

Discharge Medications:
1. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. gabapentin 300 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
4. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day).
5. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
6. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
7. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for chest
pressure.
8. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. metoprolol succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0*
10. escitalopram 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. isosorbide mononitrate 60 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0*
13. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for pain.
14. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
15. Cortef 10 mg Tablet Sig: 2.5 Tablets PO QAM (once a day (in
the morning)).
16. Cortef 5 mg Tablet Sig: One (1) Tablet PO QPM (once a day
(in the evening)).
17. bumetanide 2 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
18. insulin glargine 100 unit/mL Cartridge Sig: Twenty Six (26)
units Subcutaneous once a day.
19. Humalog 100 unit/mL Cartridge Sig: as directed  Subcutaneous
three times a day: sliding scale, take as directed.
20. pioglitazone 30 mg Tablet Sig: One (1) Tablet PO once a day.

21. quetiapine 25 mg Tablet Sig: One (1) Tablet PO Q4PM.
22. quetiapine 25 mg Tablet Sig: One (1) Tablet PO Q10PM.
23. levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
24. cephalexin 500 mg Capsule Sig: One (1) Capsule PO every
eight (8) hours for 7 days.
Disp:*21 Capsule(s)* Refills:*0*
25. ergocalciferol (vitamin D2) 50,000 unit Capsule Sig: One (1)
Capsule PO once a week.
26. Outpatient Lab Work
On [**1-14**], please have the follows labs checked as faxed to your
primary care physician Dr [**Last Name (STitle) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1022**] at [**Telephone/Fax (1) 716**]:
Na, K, Cl, HCO3, BUN, Cr, Mg
27. simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.



Discharge Disposition:
Home With Service

Facility:
caregroup vna

Discharge Diagnosis:
PRIMARY
Acute on chronic diastolic heart failure
Cellulitis

SECONDARY
[**Location (un) 3484**] Disease


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Ms. [**Known lastname 12101**],

It was a pleasure taking care of you at [**Hospital1 827**].  You were admitted for chest pain and found to
have worsening of your heart failure.  You were diuresed with
improvement in your symptoms, and then restarted on your home
bumex.

You also had a skin infection in your right leg for which we
treated you with antibiotics.  Please continue to take your
antibiotics (bactrim and keflex) for the next 7 days.

Changes to your medications:
-STOP pioglitazone
-INCREASE metoprolol succinate (toprol XL) to 50mg daily
-START Imdur 60 mg daily
-START Cephalexin 500mg every 8 hours (for 7 days)
-START Levofloxacin 250mg daily (for 7 days)

Please see below for your scheduled follow-up appointments

Followup Instructions:
**Please call your primary care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1022**]
[**Telephone/Fax (1) 719**] to arrange for a follow-up visit within 1 week**

**On Wednesday [**2133-1-14**] please have your labs checked as
instructed on your attached prescription**

Cardiology
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2908**], MD
WEDNESDAY [**2133-2-4**] at 1:20 PM
SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
[**Telephone/Fax (1) 62**]



Completed by:[**2133-1-12**]
{"Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Subendocardial infarction, initial episode of care,Cushing's syndrome,Cellulitis and abscess of leg, except foot,Body Mass Index 40.0-44.9, adult,Delirium due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Percutaneous transluminal coronary angioplasty status,Unspecified acquired hypothyroidism,Hip joint replacement,Morbid obesity,Long-term (current) use of steroids,Depressive disorder, not elsewhere classified"}


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: pulmonary edema, anemia,chest pain

PRESENT ILLNESS: 75 yo F w/ severe 3vd s/p multiple stents on recent admission
p/w chest pain, s/p NSTEMI from OSH. SHe was woken from sleep
with 8/10 chest pressure similar to prior angina and presented
to [**Hospital1 1774**] w/ SOB, nausea and chest pressure. She was initially in
heart failure and hypoxic to 80% and was given lasix 40mg IV en
route to hospital. On arrival she was placed on Bipap, got
another 50mg IV lasix and put out 1200mL urine within 3 hours
and her respiratory status significantly improved. Her chest
pain resolved after several nitros but returned this morning
prior to transport and then again resolved with nitro. Heparin
drip was started. Trop I was elevated at 0.96 then peaked at
2.95 with but CK 133. BNP was elevated at 959. There were no new
ST -T wave changes. She was continued on ASA, plavix,
metoprolol, statin.
.
She was admitted last month with cath x 3 and several stents
placed. It was thought that she may have had an LMCA dissection
but on review of imaging it appears that this is not true. Her
plan had been a staged procedure consisting of CABG (LIMA-LAD)
and stenting but unclear what the [**Name (NI) **] plan would be now if she
is a candidate. She was a high risk surgical candidate for poor
sternal wound healing She went to [**Hospital1 **] then Home and then
right back into local hospital with Pulmonary Edema. She was not
intubated, diuresed, no unstable EKG changes, no evolving
changes. Got blood transfusion 1 Unit for for HCT 26.5 and SOB
again occurred but resolved prior to transfer. FAMILY requested
the transfer to [**Hospital1 **].
HCT 25.4 without source of bleeding, receiving blood today
.
She is on tele, IV Hep, O2 via NC, IV Bumex, groin site fine
Was on Bipap in ER and responded??????.
.
Dr. [**Last Name (STitle) 24471**] can be reached directly at [**Telephone/Fax (1) 24472**], which is a
direct line at the ICU.
.
On review of systems, s/he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. S/he denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-CABG: None
-PERCUTANEOUS CORONARY INTERVENTIONS:
-PACING/ICD:
3. OTHER PAST MEDICAL HISTORY:
- [**Location (un) **] disease s/p ablation of pituitary adenoma at [**Hospital1 2025**].
- Hip replacement for osteoarthritis.
- Obesity.
- Lower back pain.
- Status post right knee patella removal after motor vehicle
accident.
- History of left lower leg hematoma after a fall 3 years ago.
- Depression.
- Hypothyroidism.
- Deep vein thrombosis in left calf 3 years ago.
- Cataract in both eyes status post extraction.

MEDICATION ON ADMISSION: Home:
1. clopidogrel 75 mg PO DAILY
2. nitroglycerin 0.3 mg Sublingual PRN
3. aspirin 325 mg PO DAILY
4. escitalopram 10 mg PO DAILY
5. simvastatin 80 mg PO DAILY
6. ezetimibe 10 mg PO DAILY
7. bumetanide 6 mg PO DAILY
8. ergocalciferol (vitamin D2) 50,000 unit PO once a week.
9. gabapentin 300 mg PO Q 24H
10. hydrocodone-acetaminophen 7.5-650 mg PO three times a day
11. Cortef 25 mg PO qAM
12. Cortef 5 mg PO qPM
13. miconazole nitrate 2 % Powder Topical TID prn
14. senna 8.6 mg PO BID prn
15. docusate sodium 100 mg PO BID
16. Synthroid 150 mcg PO daily
17. lisinopril 5 mg PO DAILY
18. pantoprazole 40 mg PO DAILY
19. metoprolol succinate 25 mg PO DAILY
20. quetiapine 25 mg PO Q4PM
21. quetiapine 25 mg PO Q10PM
22. insulin glargine 26 units Subcutaneous qAM
23. Humalog TID SSI
24. pioglitazone 30 mg PO DAILY

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / nitrofurantoin (macrocryst25%)
/ Cortisone / Levoxyl

PHYSICAL EXAM: On admission:
VS: T= 98.3 BP= 112/47 HR=79 RR= 18 O2 sat= 98% RA
GENERAL: NAD. Oriented x3. Mood, affect appropriate, pleasant
conversant, unable to [**First Name8 (NamePattern2) **] [**Doctor Last Name 1841**] in reverse but able to do forward.

FAMILY HISTORY: Brother died from an MI at 50. Daughter had a stent at age 36.

SOCIAL HISTORY: She lives with her husband and daughter in a
house. She has 4 children. She does not use any services
currently. She is independent in her ADL's but is known to have
a gait disorder and a history of falls in the past.
-Tobacco history: Never
-ETOH: None
-Illicit drugs: None 

### Response:
{"Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Subendocardial infarction, initial episode of care,Cushing's syndrome,Cellulitis and abscess of leg, except foot,Body Mass Index 40.0-44.9, adult,Delirium due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Percutaneous transluminal coronary angioplasty status,Unspecified acquired hypothyroidism,Hip joint replacement,Morbid obesity,Long-term (current) use of steroids,Depressive disorder, not elsewhere classified"}
