CHIEF COMPLAINT: Syncope.

PRESENT ILLNESS: 86 year old woman with critical AS (valve area < 0.8cm2, mean
gradient 59, peak gradient of 85), parkinson's disease,
orthostatic hypotension previously on droxidopa), who presents
with one episode of syncope last night.  Patient was recently
admitted to [**Hospital1 18**] from [**Date range (1) 29273**] for dyspnea attributed to
pulmonary edema secondary to critical AS, diastolic CHF, and
mod/severe mitral regurg and/or early pneumonia (lives at senior
housing).  She was started on levofloxacin for a 5 day course,
diuresed with lasix, and her droxidopa was held (due to ?
increased afterload [**2-7**] norepi effects exacerbating CHF).  She
is on no home lasix.  Unfortunately patient is a poor historian.
 On the day of admission, patient went for a ten minute walk and
felt lightheaded and fatigued.  She felt "crummy" but denies
frank lightheadedness or vertigo.  She went to sit on her cough
and lost consciousness per report for 2-3 minutes.  Her eyes
were reported to remain open and she did have urinary
incontinence.  There was no seizure activity or tongue biting.
When she regained consciousness her speech was garbled but is
without any focal deficits.  Denies chest discomfort,
palpitations, cough, fevers, chills, recent travel.
.
In the ED, initial VS: 97.4 75 150/72 18 100%. Labs notable for
HCT 25 (baseline 25-27), WBC 7, UA without evidence of
infection.  CXR shows improved airation of right lung with small
right pleural effusion, retrocardiac consolidation with left
sided pleural effusion, consistent with infection though final
read is pending.
.
Patient is now breathing comfortably on the floor without acute
complaints.

MEDICAL HISTORY: - aortic stenosis: gradient 37, valve area of 1.1 in 10/[**2178**].
- hyperlipidemia
- hypertension
- right bundle-branch block
- orthostatic hypotension
- Parkinson's disease, autonomic dysfunction
- Chronic anemia
- B12 deficiency
- osteoporosis
- gastroesophageal reflux disease
- sensory motor peripheral polyneuropathy
- periodic sleep movements with restless legs syndrome.
- hx of CBD stone in [**10-13**] requiring ERCP ([**Hospital1 112**])
- s/p trans urethral resection bladder lesion [**10/2178**] ([**Hospital1 112**])
- s/p L mastectomy ~[**2173**] for breast cancer

MEDICATION ON ADMISSION: 1. cholecalciferol (vitamin D3) 1,000 unit daily
2. Calcium 600 + D(3) 600 mg(1,500mg) -400 unit daily
3. multivitamin daily
4. mirtazapine 30 mg PO qHS
6. folic acid 400 mcg daily
7. Stalevo 100 25-100-200 mg q3H between hours of 6AM and 9PM
8. pregabalin 50 mg [**Hospital1 **] and 100mg qHS
9. polyethylene glycol 3350 17 gram/dose PO PRN constipation

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS - 98.6 150/80 75 20 97% RA
GENERAL - NAD, comfortable, appropriate
HEENT - NC/AT, PERRLA, EOMI, MMM, OP clear
NECK - supple, no cervical LAD
LUNGS - Clear to auscultation, no rhonchi/wheezes, no accessory
muscle use
HEART - RRR, 3/6 SEM harsh late peaking at RUSB with radiation
throughout precordium and to carotids, no rub/gallop, nl S1-S2
ABDOMEN - NABS, soft NTND, no masses or HSM, no rebound/guarding

FAMILY HISTORY: Brother and father with heart disease/CAD.
Noncontributory to admission

SOCIAL HISTORY: She is a writer who continues to be active editing a local
newspaper.  She has one son.  She does have a trainer and help
with some of her activities of daily living and is currently
considering [**Hospital3 **].
-Tobacco history: None, Quit tobacco 30yrs ago
-ETOH: None
-Illicit drugs: None
Aortic valve disorders,Atrioventricular block, complete,Diastolic heart failure, unspecified,Other chronic pulmonary heart diseases,Other degenerative diseases of the basal ganglia,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of breast,Esophageal reflux,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Hereditary sensory neuropathy,Other B-complex deficiencies,Benign essential hypertension,Do not resuscitate status,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Iron deficiency anemia, unspecified,Syncope and collapse,Constipation, unspecified
Aortic valve disorder,Atriovent block complete,Diastolc hrt failure NOS,Chr pulmon heart dis NEC,Degen basal ganglia NEC,Hematoma complic proc,Crnry athrscl natve vssl,Hx of breast malignancy,Esophageal reflux,Hyperlipidemia NEC/NOS,Osteoporosis NOS,Hered sensory neuropathy,B-complex defic NEC,Benign hypertension,Do not resusctate status,Abn react-cardiac cath,Iron defic anemia NOS,Syncope and collapse,Constipation NOS
Admission Date:  [**2181-12-28**]              Discharge Date:   [**2182-1-5**]

Date of Birth:  [**2095-11-17**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Doctor First Name 6807**]
Chief Complaint:
Syncope.

Major Surgical or Invasive Procedure:
Cardiac catheterization for balloon valvuloplasty
Temporary pacing wire placement after procedure
Holter monitor placement


History of Present Illness:
86 year old woman with critical AS (valve area < 0.8cm2, mean
gradient 59, peak gradient of 85), parkinson's disease,
orthostatic hypotension previously on droxidopa), who presents
with one episode of syncope last night.  Patient was recently
admitted to [**Hospital1 18**] from [**Date range (1) 29273**] for dyspnea attributed to
pulmonary edema secondary to critical AS, diastolic CHF, and
mod/severe mitral regurg and/or early pneumonia (lives at senior
housing).  She was started on levofloxacin for a 5 day course,
diuresed with lasix, and her droxidopa was held (due to ?
increased afterload [**2-7**] norepi effects exacerbating CHF).  She
is on no home lasix.  Unfortunately patient is a poor historian.
 On the day of admission, patient went for a ten minute walk and
felt lightheaded and fatigued.  She felt "crummy" but denies
frank lightheadedness or vertigo.  She went to sit on her cough
and lost consciousness per report for 2-3 minutes.  Her eyes
were reported to remain open and she did have urinary
incontinence.  There was no seizure activity or tongue biting.
When she regained consciousness her speech was garbled but is
without any focal deficits.  Denies chest discomfort,
palpitations, cough, fevers, chills, recent travel.
.
In the ED, initial VS: 97.4 75 150/72 18 100%. Labs notable for
HCT 25 (baseline 25-27), WBC 7, UA without evidence of
infection.  CXR shows improved airation of right lung with small
right pleural effusion, retrocardiac consolidation with left
sided pleural effusion, consistent with infection though final
read is pending.
.
Patient is now breathing comfortably on the floor without acute
complaints.

Past Medical History:
- aortic stenosis: gradient 37, valve area of 1.1 in 10/[**2178**].
- hyperlipidemia
- hypertension
- right bundle-branch block
- orthostatic hypotension
- Parkinson's disease, autonomic dysfunction
- Chronic anemia
- B12 deficiency
- osteoporosis
- gastroesophageal reflux disease
- sensory motor peripheral polyneuropathy
- periodic sleep movements with restless legs syndrome.
- hx of CBD stone in [**10-13**] requiring ERCP ([**Hospital1 112**])
- s/p trans urethral resection bladder lesion [**10/2178**] ([**Hospital1 112**])
- s/p L mastectomy ~[**2173**] for breast cancer

Social History:
She is a writer who continues to be active editing a local
newspaper.  She has one son.  She does have a trainer and help
with some of her activities of daily living and is currently
considering [**Hospital3 **].
-Tobacco history: None, Quit tobacco 30yrs ago
-ETOH: None
-Illicit drugs: None


Family History:
Brother and father with heart disease/CAD.
Noncontributory to admission


Physical Exam:
VS - 98.6 150/80 75 20 97% RA
GENERAL - NAD, comfortable, appropriate
HEENT - NC/AT, PERRLA, EOMI, MMM, OP clear
NECK - supple, no cervical LAD
LUNGS - Clear to auscultation, no rhonchi/wheezes, no accessory
muscle use
HEART - RRR, 3/6 SEM harsh late peaking at RUSB with radiation
throughout precordium and to carotids, no rub/gallop, nl S1-S2
ABDOMEN - NABS, soft NTND, no masses or HSM, no rebound/guarding

EXTREMITIES - WWP, no edema, 2+ peripheral pulses (radials, DPs)

NEURO - awake, A&Ox3,

Pertinent Results:
Complete Blood Count:
[**2181-12-28**] 06:11PM BLOOD WBC-7.5# RBC-2.77* Hgb-8.3* Hct-25.3*
MCV-91 MCH-30.0 MCHC-32.8 RDW-12.8 Plt Ct-191
[**2181-12-29**] 06:50AM BLOOD WBC-6.7 RBC-2.73* Hgb-8.2* Hct-25.2*
MCV-92 MCH-30.1 MCHC-32.6 RDW-13.1 Plt Ct-176
[**2181-12-30**] 04:50AM BLOOD WBC-7.1 RBC-2.64* Hgb-8.2* Hct-24.1*
MCV-91 MCH-30.9 MCHC-34.0 RDW-12.8 Plt Ct-178
[**2181-12-31**] 05:10AM BLOOD WBC-7.4 RBC-3.18* Hgb-9.8* Hct-29.0*
MCV-91 MCH-30.9 MCHC-33.8 RDW-13.2 Plt Ct-188
[**2182-1-1**] 07:15AM BLOOD WBC-7.0 RBC-3.15* Hgb-9.7* Hct-29.0*
MCV-92 MCH-30.8 MCHC-33.6 RDW-12.9 Plt Ct-193

Basic Metabolic Profile:
[**2181-12-28**] 06:11PM BLOOD Glucose-141* UreaN-22* Creat-0.9 Na-141
K-3.8 Cl-105 HCO3-26 AnGap-14
[**2181-12-29**] 06:50AM BLOOD Glucose-95 UreaN-18 Creat-0.9 Na-140
K-4.0 Cl-105 HCO3-29 AnGap-10
[**2181-12-30**] 04:50AM BLOOD Glucose-96 UreaN-18 Creat-0.8 Na-142
K-4.5 Cl-107 HCO3-30 AnGap-10
[**2181-12-31**] 05:10AM BLOOD Glucose-94 UreaN-22* Creat-0.8 Na-141
K-4.3 Cl-104 HCO3-30 AnGap-11
[**2182-1-1**] 07:15AM BLOOD Glucose-94 UreaN-20 Creat-0.9 Na-141
K-4.4 Cl-104 HCO3-31 AnGap-10
[**2181-12-29**] 06:50AM BLOOD ALT-4 AST-49* LD(LDH)-221 CK(CPK)-55
AlkPhos-64 TotBili-0.2
[**2181-12-29**] 06:50AM BLOOD Albumin-3.4* Calcium-9.1 Phos-4.6* Mg-2.0
[**2181-12-30**] 04:50AM BLOOD Calcium-8.8 Phos-3.5 Mg-2.0
[**2181-12-31**] 05:10AM BLOOD Calcium-8.8 Phos-3.7 Mg-2.1
[**2182-1-1**] 07:15AM BLOOD Calcium-8.5 Phos-3.9 Mg-2.2

[**2181-12-29**] 02:45PM BLOOD CK(CPK)-49
[**2181-12-31**] 05:10AM BLOOD CK(CPK)-30
[**2181-12-31**] 12:55PM BLOOD CK(CPK)-30
[**2181-12-29**] 06:50AM BLOOD CK-MB-2 cTropnT-<0.01
[**2181-12-29**] 02:45PM BLOOD CK-MB-2 cTropnT-<0.01
[**2181-12-31**] 05:10AM BLOOD CK-MB-1 cTropnT-<0.01
[**2181-12-31**] 12:55PM BLOOD CK-MB-1 cTropnT-<0.01

[**2181-12-28**] 06:11PM BLOOD Iron-20*
[**2181-12-31**] 05:10AM BLOOD PT-11.1 PTT-31.3 INR(PT)-1.0
[**2181-12-29**] 06:50AM BLOOD Ret Aut-1.7
[**2181-12-28**] 06:11PM BLOOD calTIBC-250* VitB12-1721* Folate-GREATER
TH Ferritn-153* TRF-192*
[**2181-12-29**] 06:50AM BLOOD Hapto-198

[**2181-12-29**] 05:45PM BLOOD %HbA1c-5.4 eAG-108

Urine:
[**2181-12-28**] 07:30PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.010
[**2181-12-28**] 07:30PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG

ECG [**2181-12-28**]: Sinus rhythm. Left atrial abnormality. Complete
right bundle-branch block.  Left ventricular hypertrophy.
Non-diagnostic repolarization abnormalities.  Compared to the
previous tracing of [**2181-12-23**] multiple abnormalities as noted
persist without major change.

ECG [**2181-12-31**]: Sinus rhythm. Right bundle-branch block. Compared
to the previous tracing there is no significant change.

ECG [**2182-1-3**]: Sinus rhythm.  RBBB with first degree AV block (PR
252).

ECG [**2182-1-3**] (6 hours after previous): Sinus, RBBB, resolution
of first degree AV block (PR 135).

Chest Radiograph (PA and Lat) [**2181-12-28**]: IMPRESSION: Left lung
base consolidation with associated pleural effusion. Small right
pleural effusion is present with improved aeration of the right
lung.

Chest Radiograph (PA and Lat) [**2181-12-31**]: FINDINGS: As compared to
the previous radiograph, there is moderate improvement, with
larger lung volumes and improved ventilation of the basal lung
areas.

On the right, a plate-like atelectasis along the minor fissure
persists, but the pre-existing medial basal opacity has
substantially decreased in extent and severity.  On the left,
the pre-existing retrocardiac atelectasis is also improved.

The bilateral pleural effusions, better visualized on the
lateral than on the frontal radiograph, are not substantially
changed.  The size of the cardiac silhouette is constant.  No
newly appeared parenchymal opacities.

Echo [**1-3**]:
Mild (1+) aortic regurgitation is seen. An eccentric,
posteriorly directed jet of moderate to severe (3+) mitral
regurgitation is seen.

IMPRESSION: Limited study/Focused views. Mild aortic
regurgitation. Mean transaortic valvular gradient 30 mmHg.
Moderate to severe posteriorly directed mitral regurgitation.

Compared with the prior study (images reviewed) of [**2181-12-25**],
the mean transaortic valvular gradient has decreased from 59
mmHg to 30 mmHg status-post aortic valvuloplasty. Given the
limited nature of the current study a comprehensive comparison
of all parameters could not be made.

Cardiac Cath [**1-3**]:
1. Selective coronary angiography of this right-dominant system
demonstrated single-vessel CAD. The LMCA was normal. The LAD had
30%
stenosis in the proximal vessel segment. The LCX was normal, but
had a
large OM branch with 80% proximal stenosis. The dominant RCA had
30%
stenoses in the proximal and mid-vessel segments.
2. Resting hemodynamics revealed mildly elevated right-sided
filling
pressures and moderately elevated left-sided filling pressures.
The
measured RVEDP was 10mmHg and LVEDP was 20mmHg. There was mild
pulmonary
artery hypertension with a mean PAP of 28mmHg. There was severe
systemic
arterial hypertension with a measured central aortic pressure of

163/74/110. Cardiac output/index were preserved and calculated
at
5.1L/min and 3.3 L/min/m2, respectively. There was critical AS
with a
measured mean gradient of 63mmHg. [**Location (un) 109**] calculated by Gorlin
equation was
0.6cm2.
3. Left ventriculography was deferred.


Brief Hospital Course:
86 year old woman with critical AS (valve area <0.8cm2),
Parkinson's disease, autonomic dysfunction, orthostatic
hypotension, generalized neuropathy, recent hospitalization for
pneumonia vs. pulmonary edema who presents with syncope.
.
# Syncope: Thought to be multifactorial as each of the following
were likely contributing factors: known critical aortic
stenosis, parkinson's disease with associated autonomic
dysfunction, and orthostatic hypotension with the recent
discontinuation of pressure supporting droxidopa several days
prior.  Cardiac enzymes and telemetry unremarkable.  Neurology
consulted and did not see evidence of acute stroke/TIA.
Orthostatics were floridly positive and patient was started on
midodrine with gentle diuresis as needed in lieu of afterload
effects.  The most likely culprit was thought to be known
critical aortic stenosis, and cardiothoracic surgery,
interventional cardiology, and atrius cardiology were all
consulted to discuss potential interventions - i.e., surgical
aortic valve replacement, balloon valvuloplasty, and
percutaneous aortic valve replacement.  Patient was not deemed
to be a surgical candidate.  Patient was medically optimized
with midodrine 2.5mg PO TID and diuresed as needed.  She was
also transfused one unit of prbcs for likely symptomatic anemia.
 Patient underwent balloon valvuloplasty with a decrease in her
mean gradient from 60 to 30.  After valvuloplasty while in the
lab, she had an episode of complete heart block in the setting
of RBBB which resolved by the end of the case and was
transferred to the CCU.  Temporary pacing wires were placed but
were not needed as she had no further episodes after the case
was completed and were pulled.  She did have some residual PR
prolongation to ~250ms, however this resolved over a matter of
hours and she remained in her native sinus rhythm with right
bundle branch block for greater than 24 hours after the
procedure.  She had a holter monitor placed to evaluate for
possible arrhythmogenic cause for her syncope.  This will be
interrogated at a later date.
.
# Critical AS/severe MR: Euvolemic on exam, asymptomatic with
stable oxygenation.  Patient was gently diuresed in lieu of her
dependence on preload and the initiation of midodrine, an
afterload increasing [**Doctor Last Name 360**].  After her valvuloplasty, she
required no further diuresis or change in her fluid management.
She will follow-up with Dr. [**Last Name (STitle) **] in 1 month for consideration
and further evaluation for percutaneous aortic valve replacement
and possible PCI for her 80% large OM lesion.
.
# Parkinsons: Stable, was continued on home stalevo and
pregabalin.  Midodrine initiated as above.
.
# Anemia: Uncertain etiology, but suspect anemia of chronic
disease.  B12, folate, iron studies, haptoglobin, and
reticulocyte count unremarkable.  Will need outpatient f/u.

Medications on Admission:
1. cholecalciferol (vitamin D3) 1,000 unit daily
2. Calcium 600 + D(3) 600 mg(1,500mg) -400 unit daily
3. multivitamin daily
4. mirtazapine 30 mg PO qHS
6. folic acid 400 mcg daily
7. Stalevo 100 25-100-200 mg q3H between hours of 6AM and 9PM
8. pregabalin 50 mg [**Hospital1 **] and 100mg qHS
9. polyethylene glycol 3350 17 gram/dose PO PRN constipation

Discharge Medications:
1. cholecalciferol (vitamin D3) 1,000 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
2. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable
Sig: One (1) Tablet, Chewable PO BID (2 times a day).
3. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. mirtazapine 15 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
5. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Stalevo 100 25-100-200 mg Tablet Sig: One (1) Tablet PO q3H
during the hours of 6AM and 9PM ().
7. pregabalin 25 mg Capsule Sig: Two (2) Capsule PO BID (2 times
a day).
8. pregabalin 100 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
9. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)  PO
DAILY (Daily) as needed for constipation.
10. midodrine 5 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day).
Disp:*45 Tablet(s)* Refills:*2*
11. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
Newbridge on the [**Doctor Last Name **] - [**Location (un) 1411**]

Discharge Diagnosis:
Critical aortic stenosis
Autonomic dysfunction
Orthostatic hypotension
Parkinson's disease
Mitral regurgitation

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


Discharge Instructions:
It was a pleasure taking care of you at [**Hospital1 827**].  You were admitted to the hospital after losing
consciousness at home.  We believe that this is likely secondary
to worsening function of your heart valve (critical aortic
stenosis) in combination with your body's difficulty with
regulation of your blood pressure regulation (autonomic
dysfunction).  During your last hospitalization, your
experimental drug droxidopa was discontinued, and this also
likely contributed to your episode of loss of consciousness.

In the hospital, you were evaluated by our cardiothoracic
surgeons, interventional cardiologists, and general cardiology
team.  After a discussion between the multiple groups, you
underwent balloon angioplasty of your aortic valve to open it.
This resulted in good improvement in the blood flow through the
valve.

 You were also transfused one unit of blood during your
hospitalization.

We have made the following changes to your medications:
- STOP droxidopa
- START midodrine 2.5mg by mouth three times a day
- START aspirin 81mg (baby aspirin) by mouth once per day

Please keep your appointments as listed below.

You also have a Holter monitor which you will wear to monitor
your heart rate for an extended period of time.

Followup Instructions:
Department: CARDIAC SERVICES
When: FRIDAY [**2182-2-1**] at 10:00 AM
With: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Aortic valve disorders,Atrioventricular block, complete,Diastolic heart failure, unspecified,Other chronic pulmonary heart diseases,Other degenerative diseases of the basal ganglia,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of breast,Esophageal reflux,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Hereditary sensory neuropathy,Other B-complex deficiencies,Benign essential hypertension,Do not resuscitate status,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Iron deficiency anemia, unspecified,Syncope and collapse,Constipation, 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: Syncope.

PRESENT ILLNESS: 86 year old woman with critical AS (valve area < 0.8cm2, mean
gradient 59, peak gradient of 85), parkinson's disease,
orthostatic hypotension previously on droxidopa), who presents
with one episode of syncope last night.  Patient was recently
admitted to [**Hospital1 18**] from [**Date range (1) 29273**] for dyspnea attributed to
pulmonary edema secondary to critical AS, diastolic CHF, and
mod/severe mitral regurg and/or early pneumonia (lives at senior
housing).  She was started on levofloxacin for a 5 day course,
diuresed with lasix, and her droxidopa was held (due to ?
increased afterload [**2-7**] norepi effects exacerbating CHF).  She
is on no home lasix.  Unfortunately patient is a poor historian.
 On the day of admission, patient went for a ten minute walk and
felt lightheaded and fatigued.  She felt "crummy" but denies
frank lightheadedness or vertigo.  She went to sit on her cough
and lost consciousness per report for 2-3 minutes.  Her eyes
were reported to remain open and she did have urinary
incontinence.  There was no seizure activity or tongue biting.
When she regained consciousness her speech was garbled but is
without any focal deficits.  Denies chest discomfort,
palpitations, cough, fevers, chills, recent travel.
.
In the ED, initial VS: 97.4 75 150/72 18 100%. Labs notable for
HCT 25 (baseline 25-27), WBC 7, UA without evidence of
infection.  CXR shows improved airation of right lung with small
right pleural effusion, retrocardiac consolidation with left
sided pleural effusion, consistent with infection though final
read is pending.
.
Patient is now breathing comfortably on the floor without acute
complaints.

MEDICAL HISTORY: - aortic stenosis: gradient 37, valve area of 1.1 in 10/[**2178**].
- hyperlipidemia
- hypertension
- right bundle-branch block
- orthostatic hypotension
- Parkinson's disease, autonomic dysfunction
- Chronic anemia
- B12 deficiency
- osteoporosis
- gastroesophageal reflux disease
- sensory motor peripheral polyneuropathy
- periodic sleep movements with restless legs syndrome.
- hx of CBD stone in [**10-13**] requiring ERCP ([**Hospital1 112**])
- s/p trans urethral resection bladder lesion [**10/2178**] ([**Hospital1 112**])
- s/p L mastectomy ~[**2173**] for breast cancer

MEDICATION ON ADMISSION: 1. cholecalciferol (vitamin D3) 1,000 unit daily
2. Calcium 600 + D(3) 600 mg(1,500mg) -400 unit daily
3. multivitamin daily
4. mirtazapine 30 mg PO qHS
6. folic acid 400 mcg daily
7. Stalevo 100 25-100-200 mg q3H between hours of 6AM and 9PM
8. pregabalin 50 mg [**Hospital1 **] and 100mg qHS
9. polyethylene glycol 3350 17 gram/dose PO PRN constipation

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS - 98.6 150/80 75 20 97% RA
GENERAL - NAD, comfortable, appropriate
HEENT - NC/AT, PERRLA, EOMI, MMM, OP clear
NECK - supple, no cervical LAD
LUNGS - Clear to auscultation, no rhonchi/wheezes, no accessory
muscle use
HEART - RRR, 3/6 SEM harsh late peaking at RUSB with radiation
throughout precordium and to carotids, no rub/gallop, nl S1-S2
ABDOMEN - NABS, soft NTND, no masses or HSM, no rebound/guarding

FAMILY HISTORY: Brother and father with heart disease/CAD.
Noncontributory to admission

SOCIAL HISTORY: She is a writer who continues to be active editing a local
newspaper.  She has one son.  She does have a trainer and help
with some of her activities of daily living and is currently
considering [**Hospital3 **].
-Tobacco history: None, Quit tobacco 30yrs ago
-ETOH: None
-Illicit drugs: None 

### Response:
{'Aortic valve disorders,Atrioventricular block, complete,Diastolic heart failure, unspecified,Other chronic pulmonary heart diseases,Other degenerative diseases of the basal ganglia,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of breast,Esophageal reflux,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Hereditary sensory neuropathy,Other B-complex deficiencies,Benign essential hypertension,Do not resuscitate status,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Iron deficiency anemia, unspecified,Syncope and collapse,Constipation, unspecified'}
