CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This is a 65 yoM w/h/o CAD s/p BMS to LAD and LCS on [**2110-2-17**]
discharged on [**2110-2-19**] home and represents w/SOB and CP this AM.
Pt notes that he had had fatigue but was otherwise feeling well
since his discharge w/o any SOB or CP. However, this AM, after
his shower this AM, he had SOB, nausea, emesis x 2 w/gradual
onset of CP that persisted >1hour. He describes CP as substernal
w/o radiation same as the pain he had on [**2-17**] when he received
his first BMS; this is his first episode since prior
presentation. He took two [**Month/Year (2) **] w/o improvement, his daughter
called EMS and he was brought in to the ED. EMS strips showed ST
elevations in V2-V5.
.
Upon arrival, he was noted to have [**3-6**] cp and V2-V5 ST
elevations no EKG; code stemi was initiated and pt went to cath
lab where he had LAD clot lysis and a stent placed distal to his
original stent.
.
Of note, he and his daughter report that they did not pick up
his new discharge cardiac medications and the only meds he has
been taking is a baby [**Month/Year (2) **], and his psych meds.
.
On review of symptoms, 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. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. He denies sx of
recent depression/anxiety; no thoughts of harming himself or SI.
All of the other review of systems were negative.
.
Cardiac review of systems is notable for absence of prior chest
pain, dyspnea on exertion, paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: anxiety
depression w/prior suicide attempts including on prior admission
[**2110-2-17**]
Hx ETOH abuse-sober x 15 years
NIDDM

MEDICATION ON ADMISSION: *** unclear if patient taking these medications. These were his
discharge medications from last admission

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98, BP 142/69, HR 56, RR 18, O2 100% on 4L
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple unable to assess JVP lying flat.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: sheath in place, No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the positive for recent
tobacco use 1pack/day, reports that he quit on [**Month/Day/Year 2974**]. There is
a positive history of alcohol abuse.
Other complications due to other cardiac device, implant, and graft,Subendocardial infarction, initial episode of care,Acute on chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Comp-oth cardiac device,Subendo infarct, initial,Ac on chr syst hrt fail,Crnry athrscl natve vssl,Atrial fibrillation,Iatrogenc hypotnsion NEC,DMII wo cmp nt st uncntr
Admission Date:  [**2110-2-26**]              Discharge Date:   [**2110-3-6**]

Date of Birth:  [**2044-10-30**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
Cardiac catherization and stent placement

History of Present Illness:
This is a 65 yoM w/h/o CAD s/p BMS to LAD and LCS on [**2110-2-17**]
discharged on [**2110-2-19**] home and represents w/SOB and CP this AM.
Pt notes that he had had fatigue but was otherwise feeling well
since his discharge w/o any SOB or CP. However, this AM, after
his shower this AM, he had SOB, nausea, emesis x 2 w/gradual
onset of CP that persisted >1hour. He describes CP as substernal
w/o radiation same as the pain he had on [**2-17**] when he received
his first BMS; this is his first episode since prior
presentation. He took two [**Month/Year (2) **] w/o improvement, his daughter
called EMS and he was brought in to the ED. EMS strips showed ST
elevations in V2-V5.
.
Upon arrival, he was noted to have [**3-6**] cp and V2-V5 ST
elevations no EKG; code stemi was initiated and pt went to cath
lab where he had LAD clot lysis and a stent placed distal to his
original stent.
.
Of note, he and his daughter report that they did not pick up
his new discharge cardiac medications and the only meds he has
been taking is a baby [**Month/Year (2) **], and his psych meds.
.
On review of symptoms, 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. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. He denies sx of
recent depression/anxiety; no thoughts of harming himself or SI.
All of the other review of systems were negative.
.
Cardiac review of systems is notable for absence of prior chest
pain, dyspnea on exertion, paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, palpitations, syncope or presyncope.


Past Medical History:
anxiety
depression w/prior suicide attempts including on prior admission
[**2110-2-17**]
Hx ETOH abuse-sober x 15 years
NIDDM

Cardiac Risk Factors: + Diabetes, - Dyslipidemia, - Hypertension


Social History:
Social history is significant for the positive for recent
tobacco use 1pack/day, reports that he quit on [**Month/Day/Year 2974**]. There is
a positive history of alcohol abuse.


Family History:
There is no family history of premature coronary artery disease
or sudden death.

Physical Exam:
VS: T 98, BP 142/69, HR 56, RR 18, O2 100% on 4L
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple unable to assess JVP lying flat.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: sheath in place, No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP



Pertinent Results:
Cardiac cath [**2110-2-26**]
COMMENTS:
1. Selective coronary angiography of the LMCA, LAD and LCX
revealed
totally occluded LAD at mid segment with abundant thrombus
burden
therafter.  The LCX had slow flow but otehrwise was patent. The
RCA was
not engaged.
2. Limited resting hemodynamic assessment revealed systemic
arterial
hypertension (143/104 mmHg).
3. Left ventriculography was deferred.
4. Successful PCI/stent to stent thrombosis of mid LAD with a
3.0x12mm
Vision stent deployed to 15atms. The stents were postdilated to
3.25mm
at 14 atms. Excellent result with normal flow down vessel and no

residual stenosis.

TTE [**2110-2-27**]
The left atrium is moderately dilated. There is moderate
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. There is severe regional left ventricular
systolic dysfunction with akinesis of the mid-distal septum,
anterior wall and the entire distal one-third of the left
ventricle, as well as mild hypokinesis of the basal inferior
wall (EF 25-30%), c/w multivessel CAD. No masses or thrombi are
seen in the left ventricle. Tissue Doppler imaging suggests a
normal left ventricular filling pressure (PCWP<12mmHg). Right
ventricular chamber size and free wall motion are normal. The
number of aortic valve leaflets cannot be determined. There is
no aortic valve stenosis. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen. There is a trivial/physiologic
pericardial effusion.

IMPRESSION: Severe gional left ventricular systolic dysfunction,
c/w CAD.

Compared with the prior study (images reviewed) of [**2110-2-18**],
regional LV wall motion abnormalities in the distribution of the
LAD are new.

FEMORAL VASCULAR US RIGHT  [**2110-3-2**] 9:27 PM
RIGHT GROIN ULTRASOUND: There is a 2.7 x 2.6 x 1.6 cm ovoid
hypoechoic structure adjacent and superficial to the right
common femoral artery, which appears to be connected to the
artery with a short neck. No definite flow is demonstrable
within the structure, although there does appear to be some
arterial flow within the neck. The common femoral arterial
waveform is normal. The common femoral venous waveform is
normal.

IMPRESSION: Findings are most suggestive of a thrombosed
pseudoaneurysm arising from the right common femoral artery.
Flow detectable only within the neck of the pseudoaneurysm.

LABS
[**2110-2-27**] 06:47AM BLOOD WBC-10.9 RBC-4.65 Hgb-14.8 Hct-42.8
MCV-91 MCH-31.8 MCHC-34.9 RDW-13.2 Plt Ct-261
[**2110-2-27**] 06:47AM BLOOD Plt Ct-261
[**2110-2-27**] 03:51PM BLOOD PT-14.4* PTT-67.0* INR(PT)-1.3*
[**2110-2-27**] 06:47AM BLOOD Glucose-197* UreaN-19 Creat-0.6 Na-142
K-4.4 Cl-104 HCO3-22 AnGap-20
[**2110-2-27**] 06:47AM BLOOD ALT-69* AST-216* LD(LDH)-902*
CK(CPK)-2179* AlkPhos-91 TotBili-1.2
[**2110-2-27**] 06:47AM BLOOD Albumin-3.7 Calcium-9.6 Phos-3.1 Mg-1.9
[**2110-2-27**] 06:47AM BLOOD TSH-1.1

LFTS
[**2110-2-27**] 06:47AM BLOOD ALT-69* AST-216* LD(LDH)-902*
CK(CPK)-2179* AlkPhos-91 TotBili-1.2
[**2110-3-1**] 05:58AM BLOOD ALT-35 AST-41* AlkPhos-74 TotBili-0.9

CARDIAC ENZYMES
[**2110-2-26**] 08:39PM BLOOD CK-MB-321* MB Indx-8.3*
[**2110-2-27**] 06:47AM BLOOD CK-MB-118* MB Indx-5.4
[**2110-2-28**] 03:41AM BLOOD CK-MB-17* MB Indx-3.6 cTropnT-3.5*
[**2110-2-26**] 08:39PM   POTASSIUM-5.2*
[**2110-2-26**] 08:39PM   CK(CPK)-3881*
[**2110-2-26**] 08:39PM   CK-MB-321* MB INDX-8.3*
[**2110-2-26**] 08:39PM   PLT COUNT-272
[**2110-3-6**] 09:30AM BLOOD WBC-7.2 RBC-4.07* Hgb-12.7* Hct-36.6*
MCV-90 MCH-31.2 MCHC-34.6 RDW-14.0 Plt Ct-222
[**2110-3-6**] 09:30AM BLOOD PT-22.0* PTT-39.1* INR(PT)-2.1*
[**2110-3-6**] 08:00AM BLOOD PT-21.1* PTT-40.7* INR(PT)-2.0*
[**2110-3-6**] 09:30AM BLOOD Glucose-214* UreaN-13 Creat-0.7 Na-140
K-4.1 Cl-105 HCO3-24 AnGap-15
[**2110-3-1**] 05:58AM BLOOD ALT-35 AST-41* AlkPhos-74 TotBili-0.9
[**2110-3-6**] 09:30AM BLOOD Calcium-8.9 Phos-3.3 Mg-1.9
[**2110-3-4**] 07:25AM BLOOD Osmolal-292
[**2110-2-27**] 06:47AM BLOOD TSH-1.1
[**2110-3-4**] 05:56PM URINE Hours-RANDOM Creat-121 Na-25
[**2110-3-4**] 05:56PM URINE Osmolal-447

Brief Hospital Course:
This is a 65 yoM w/h/o CAD s/p BMS to LAD and LCS discharged on
[**2110-2-19**] represents after 1 week off of cardiac medications
w/STEMI now s/p stent distal to initial LAD stent for in-stent
thrombosis off [**Date Range 4532**].

# CAD/Ischemia: Patient had recent admission for placement of
BMS to LAD, LCS who represented w/STEMI after 1 week of not
taking any cardiac medications (including [**Date Range 4532**]) prior to
readmission. He had ST elevations in V2-V5 which resolved after
being taken emergently to cath lab and receiving distal stent to
LAD for in-stent thrombosis off [**Date Range 4532**]. He received integrillin
after the procedure and was optimized on regimen of [**Last Name (LF) 4532**], [**First Name3 (LF) **],
statin, ACEi, and beta blocker. Patient was CP free after the
procedure. The importance of taking [**First Name3 (LF) **] and other cardiac
medications has been reemphasized to the pt multiple times. They
deny financial or social reasons for not picking up the
medications. He has follow-up next week with Dr. [**Last Name (STitle) **].  His
BBlocker was decreased upon discharge for SBP ranging from 90s
to 120s.  It should be titrated appropriately.  Cath was
complicated by a pseudocyst, which thrombosed spontaneously.
Distal pulses were intact.

# Pump: EF on prior TTE 45% w/inferoapical and lateral akinesis,
he also has diastolic dysfunction noted on prior TTE. Repeat
ECHO on [**2-27**] showed worsened EF of 25-30% and global LV systolic
dysfunction. He was euvolemic and started on ACE inhibitor for
afterload reduction.

# Rhythm: Rhythm: Patient was NSR until AM of [**2-27**] when he had
acute episode of afib with RVR and hypotension to SBP 70s. He
was given IV boluses of metoprolol and started on amiodarone
bolus and gtt. EP was consulted, but intermittent afib thought
to be [**12-28**] recent ischemia and no need for amiodarone unless
recurrent episodes. Patient had question of transaminitis with
amiodarone so PO amiodarone was never started. He was titrated
up on his metoprolol and he had no additional episodes of afib
and maintained NSR with beta blocker. He was started on coumadin
5mg PO daily given high risk of thromboembolic event (both [**12-28**]
afib and severe LV dysfunction).  His dose was titrated as high
as 10mg/day to get therapeutic, though his dose was decreased
upon discharge as there would be 4 days until he could get his
INR drawn. He was discharged on coumadin with followup with PCP
and lab draws for INR to follow coumadin dosing with goal INR
[**12-29**].  He has a prescription for lab draws and an appointment to
follow-up with his PCP, [**First Name4 (NamePattern1) 794**] [**Last Name (NamePattern1) 77374**], NP.  Phone: [**Telephone/Fax (1) 25350**].
 Fax: [**Telephone/Fax (1) 77375**].

# Orthostatic Hypotension: Pt was symptomatic on [**2110-3-4**] with
lightheadedness upon standing.  His vitals showed orthostatic
hypotension.  He was given a fluid bolus with improvement in
symptoms.  Urine lytes FeNA consistent with prerenal.  He
continued to be orthostatic by vitals through the rest of his
stay, though he was asymptomatic.  He was encouraged to take PO
fluids.  His BBlocker was decreased to 100mg Toprol qday upon
discharge and may need to be further titrated down.

# DM: Had been off of diabetes meds prior to admission. covered
w/SSI while in house and he was started on metformin 500mg [**Hospital1 **]
with improved control.  His regimen should continue to be
titrated for blood glucose.

# Depression/anxiety: S/P recent suicide attempt.  Patient was
continued on venlafaxine and clonazepam. No SI/HI and was seen
by outpatient psychiatrist in hospital.

# Prophylaxis: heparin, PPI, bowel regimen

# Code: Full

Medications on Admission:
*** unclear if patient taking these medications. These were his
discharge medications from last admission

1. Aspirin 325 mg PO daily
2. Clopidogrel 75 mg Tablet PO daily
3. Atorvastatin 80 mg Tablet PO daily
4. Venlafaxine SR 150 mg Capsule, PO daily
5. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) as needed for anxiety.
6. Pantoprazole 40 mg PO daily
7. Lisinopril 5 mg Tablet PO daily

Discharge Medications:
1. Outpatient Lab Work
INR check on [**2110-3-10**].  Please fax to [**First Name5 (NamePattern1) 794**] [**Last Name (NamePattern1) 77376**] at
[**Telephone/Fax (1) 77375**].  Phone: [**Telephone/Fax (1) 25350**].
2. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*80 Tablet(s)* Refills:*2*
5. Venlafaxine 150 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO once a day.
6. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) as needed for anxiety.
7. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*15 Tablet(s)* Refills:*2*
8. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
9. Warfarin 5 mg Tablet Sig: One (1) Tablet PO DAILY16 (Once
Daily at 16).
Disp:*30 Tablet(s)* Refills:*2*
10. Toprol XL 100 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:*2*
11. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary:
stemi from instent thrombosis
acute on chronic systolic heart failure
.
Secondary:
anxiety
depression w/prior suicide attempts including on prior admission
[**2110-2-17**]
Hx ETOH abuse-sober x 15 years
NIDDM


Discharge Condition:
good


Discharge Instructions:
You were seen at [**Hospital1 18**] for thrombosis in your coronary stents.
It is imperative that you take all of your medications,
especially your aspirin and [**Hospital1 4532**], to avoid future
complications.  All of your medications are important.
.
You have been started on a medication called coumadin.  The
level of this medication is important to maintain.  You will
need close follow-up for this.  Please go to [**First Name5 (NamePattern1) 794**] [**Last Name (NamePattern1) 77377**]
office on Monday [**2110-3-10**] (in addition to the appointments below)
to get your blood drawn.  You have a prescription for this.
.
You were also lightheaded during your stay, which improved with
fluid.  You should stay hydrated by drinking plenty of fluid
daily.  You should discuss this lightheadedness with your PCP as
well as further monitoring of your blood pressure, which was
occasionally low especially when standing (orthostasis).
.
Please take your medications as prescribed.
.
Please follow-up as below.  You should discuss your blood
pressure, orthostatic symptoms, coumadin, and blood sugar
(titration of metformin or other diabetic medications) with
[**First Name5 (NamePattern1) 794**] [**Last Name (NamePattern1) 77376**].
.
You should call your primary care provider or return to the
emergency department if you experience chest pain, shortness of
breath, lightheadedness, loss of consciousness, lower extremity
swelling, or any other symptoms that concern you.

Followup Instructions:
Provider: [**First Name4 (NamePattern1) 794**] [**Last Name (NamePattern1) 77376**], NP.  [**Hospital 86**] Health Center.  Wednesday,
[**2110-3-12**] at 1:15pm.  Phone: [**Telephone/Fax (1) 25350**]
.
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D. Phone:[**Telephone/Fax (1) 4023**]
Date/Time:[**2110-3-14**] 1:40
{'Other complications due to other cardiac device, implant, and graft,Subendocardial infarction, initial episode of care,Acute on chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: Chest pain

PRESENT ILLNESS: This is a 65 yoM w/h/o CAD s/p BMS to LAD and LCS on [**2110-2-17**]
discharged on [**2110-2-19**] home and represents w/SOB and CP this AM.
Pt notes that he had had fatigue but was otherwise feeling well
since his discharge w/o any SOB or CP. However, this AM, after
his shower this AM, he had SOB, nausea, emesis x 2 w/gradual
onset of CP that persisted >1hour. He describes CP as substernal
w/o radiation same as the pain he had on [**2-17**] when he received
his first BMS; this is his first episode since prior
presentation. He took two [**Month/Year (2) **] w/o improvement, his daughter
called EMS and he was brought in to the ED. EMS strips showed ST
elevations in V2-V5.
.
Upon arrival, he was noted to have [**3-6**] cp and V2-V5 ST
elevations no EKG; code stemi was initiated and pt went to cath
lab where he had LAD clot lysis and a stent placed distal to his
original stent.
.
Of note, he and his daughter report that they did not pick up
his new discharge cardiac medications and the only meds he has
been taking is a baby [**Month/Year (2) **], and his psych meds.
.
On review of symptoms, 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. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. He denies sx of
recent depression/anxiety; no thoughts of harming himself or SI.
All of the other review of systems were negative.
.
Cardiac review of systems is notable for absence of prior chest
pain, dyspnea on exertion, paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: anxiety
depression w/prior suicide attempts including on prior admission
[**2110-2-17**]
Hx ETOH abuse-sober x 15 years
NIDDM

MEDICATION ON ADMISSION: *** unclear if patient taking these medications. These were his
discharge medications from last admission

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98, BP 142/69, HR 56, RR 18, O2 100% on 4L
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple unable to assess JVP lying flat.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: sheath in place, No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the positive for recent
tobacco use 1pack/day, reports that he quit on [**Month/Day/Year 2974**]. There is
a positive history of alcohol abuse. 

### Response:
{'Other complications due to other cardiac device, implant, and graft,Subendocardial infarction, initial episode of care,Acute on chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
