CHIEF COMPLAINT: Palpitations/fatigue

PRESENT ILLNESS: Mrs. [**Known lastname 95052**] is a 73 year old woman with a history of ASD repair
in [**2065**], hypertension, hyperlipidemia, atrial flutter (on
coumadin) who was admitted for an atrial flutter ablation and
developed complications of an RP bleed with hypotension, now
improved. She had been diagnosed with atrial flutter since [**2095**]
and since then has had intermittent palpitations. Lately she
developed worsening fatigue secondary to the a flutter as well
as the medications for a flutter and therefore elected to
undergo an ablation.
.
In the EP lab, she underwent a successful ablation and seemed to
tolerate the procedure well. After the procedure, the patient
developed acute hypotension. EKG revealed inferior ST elevations
and so she went to the cath lab which revealed an incidental 80%
D1 lesion as well as a total obstruction of a very small distal
LCx - no intervention was done. Her ST elevations resolved on
their own, however, a HCT showed a drop to 24 from 37
preprocedure. CT abdomen/pelvis revealed a retroperitoneal
bleed, so she was urgently admitted to the CCU. The massive
transfusion protocol was activated and she received 4 units of
PRBCs, and 4 units of FFP. Her HCT corrected to 32.8 and INR to
1.8. She was also given lasix 20mg IV for mild CHF, which
responded well. Vascular was consulted who recommended
correcting the coagulopathy, and holding pressure until INR was
1.5 or less.
.
On the floor, she noted some recurrent wheezing, dry mouth, and
groin pain where we are holding pressure.
.
On review of systems, she 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. She denies recent fevers, chills or
rigors. She denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS:
- Hypertriglyceridemia
- Hypertension
2. CARDIAC HISTORY:
- Atrial flutter/fibrillation s/p DCCV ([**2-/2101**])
3. OTHER PAST MEDICAL HISTORY:
- Subclinical hypothyroidism
- Allergic rhinitis
- Osteopenia
- s/p ASD repair ([**2065**])

MEDICATION ON ADMISSION: METOPROLOL SUCCINATE -  (Prescribed by Other Provider) - 100 mg
Tablet Extended Release 24 hr - 2.5 (two and a half) Tablet(s)
by
mouth once a day
WARFARIN -  (Prescribed by Other Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 73**] - 2 mg
Tablet - 2 (Two) Tablet(s) by mouth once a day/afternoon

ALLERGIES: Ketek Pak / Augmentin / Lisinopril / Cozaar / Norpace

PHYSICAL EXAM: PHYSICAL EXAMINATION ON ADMISSION:
VS: 97   82/50   73   21   99%RA
GENERAL: Agitated elderly woman in moderate distress
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother and father both with some type of CA when elderly. No
significant cardiac history.

SOCIAL HISTORY: Born and raised in [**Location (un) 1468**]. Married with 2 kids. No
grandchildren. Retired secretary. Smoked 2 packs per day from
age 20-40. No EtOH. Goes to the gym and does yoga, spinning,
muscle conditioning, and aerobics.
Cardiac complications, not elsewhere classified,Acute myocardial infarction of inferolateral wall, initial episode of care,Acute edema of lung, unspecified,Atrial flutter,Hemorrhage complicating a procedure,Unspecified essential hypertension,Pure hypercholesterolemia,Long-term (current) use of anticoagulants,Hemorrhage, unspecified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places
Surg compl-heart,AMI inferolateral, init,Acute lung edema NOS,Atrial flutter,Hemorrhage complic proc,Hypertension NOS,Pure hypercholesterolem,Long-term use anticoagul,Hemorrhage NOS,Abn react-cardiac cath,Accident in place NEC
Admission Date:  [**2104-2-13**]              Discharge Date:   [**2104-2-18**]

Date of Birth:  [**2030-7-16**]             Sex:   F

Service: MEDICINE

Allergies:
Ketek Pak / Augmentin / Lisinopril / Cozaar / Norpace

Attending:[**First Name3 (LF) 4327**]
Chief Complaint:
Palpitations/fatigue

Major Surgical or Invasive Procedure:
Atrial Flutter Ablation [**2104-2-13**]

History of Present Illness:
Mrs. [**Known lastname 95052**] is a 73 year old woman with a history of ASD repair
in [**2065**], hypertension, hyperlipidemia, atrial flutter (on
coumadin) who was admitted for an atrial flutter ablation and
developed complications of an RP bleed with hypotension, now
improved. She had been diagnosed with atrial flutter since [**2095**]
and since then has had intermittent palpitations. Lately she
developed worsening fatigue secondary to the a flutter as well
as the medications for a flutter and therefore elected to
undergo an ablation.
.
In the EP lab, she underwent a successful ablation and seemed to
tolerate the procedure well. After the procedure, the patient
developed acute hypotension. EKG revealed inferior ST elevations
and so she went to the cath lab which revealed an incidental 80%
D1 lesion as well as a total obstruction of a very small distal
LCx - no intervention was done. Her ST elevations resolved on
their own, however, a HCT showed a drop to 24 from 37
preprocedure. CT abdomen/pelvis revealed a retroperitoneal
bleed, so she was urgently admitted to the CCU. The massive
transfusion protocol was activated and she received 4 units of
PRBCs, and 4 units of FFP. Her HCT corrected to 32.8 and INR to
1.8. She was also given lasix 20mg IV for mild CHF, which
responded well. Vascular was consulted who recommended
correcting the coagulopathy, and holding pressure until INR was
1.5 or less.
.
On the floor, she noted some recurrent wheezing, dry mouth, and
groin pain where we are holding pressure.
.
On review of systems, she 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. She denies recent fevers, chills or
rigors. She denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

Past Medical History:
1. CARDIAC RISK FACTORS:
- Hypertriglyceridemia
- Hypertension
2. CARDIAC HISTORY:
- Atrial flutter/fibrillation s/p DCCV ([**2-/2101**])
3. OTHER PAST MEDICAL HISTORY:
- Subclinical hypothyroidism
- Allergic rhinitis
- Osteopenia
- s/p ASD repair ([**2065**])

Social History:
Born and raised in [**Location (un) 1468**]. Married with 2 kids. No
grandchildren. Retired secretary. Smoked 2 packs per day from
age 20-40. No EtOH. Goes to the gym and does yoga, spinning,
muscle conditioning, and aerobics.

Family History:
Mother and father both with some type of CA when elderly. No
significant cardiac history.

Physical Exam:
PHYSICAL EXAMINATION ON ADMISSION:
VS: 97   82/50   73   21   99%RA
GENERAL: Agitated elderly woman in moderate distress
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with normal JVP
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: Cool extremities. No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: DP 1+
Left: DP 1+


Pertinent Results:
LABS ON ADMISSION:
[**2104-2-13**] 07:35AM BLOOD WBC-6.4 RBC-4.35 Hgb-13.9 Hct-40.9 MCV-94
MCH-32.0 MCHC-34.0 RDW-12.6 Plt Ct-178
[**2104-2-13**] 07:35AM BLOOD Neuts-69.5 Lymphs-22.2 Monos-5.8 Eos-1.7
Baso-0.7
[**2104-2-13**] 07:35AM BLOOD PT-28.0* INR(PT)-2.7*
[**2104-2-13**] 07:35AM BLOOD Plt Ct-178
[**2104-2-13**] 07:35AM BLOOD Glucose-102* UreaN-10 Creat-0.6 Na-141
K-4.5 Cl-105 HCO3-28 AnGap-13
[**2104-2-13**] 06:30PM BLOOD Calcium-7.4* Phos-5.3*# Mg-1.6

CARDIAC ENZYMES:
[**2104-2-13**] 02:45PM BLOOD CK-MB-3 cTropnT-0.51*
[**2104-2-13**] 06:30PM BLOOD CK-MB-6 cTropnT-0.86*
[**2104-2-14**] 02:24AM BLOOD CK-MB-30* MB Indx-9.6* cTropnT-1.17*
[**2104-2-14**] 10:54AM BLOOD CK-MB-47* MB Indx-8.8* cTropnT-1.69*
[**2104-2-14**] 03:59PM BLOOD CK-MB-37* MB Indx-7.0* cTropnT-1.60*

Micro:
[**2104-2-15**] 4:52 pm URINE      Source: CVS.

                            **FINAL REPORT [**2104-2-16**]**

   URINE CULTURE (Final [**2104-2-16**]):
      MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT
WITH SKIN
      AND/OR GENITAL CONTAMINATION.

Imaging:
[**2-13**] TTE:
No atrial septal defect is seen by 2D or color Doppler. Regional
left ventricular wall motion is normal. Overall left ventricular
systolic function is low normal (LVEF 50-55%). The right
ventricular cavity is moderately dilated with mild global free
wall hypokinesis. The mitral valve leaflets are mildly
thickened. Physiologic mitral regurgitation is seen (within
normal limits). The tricuspid valve leaflets are mildly
thickened. Moderate [2+] tricuspid regurgitation is seen.

IMPRESSION: Low-normal LV systolic function. The inferior wall
motion is probably normal. The right ventricle appears mildly
dilated/hypokinetic. No ASD/PFO seen but cannot exclude on basis
of this study.

[**2-13**] CT Abd/Pelvis:
MPRESSION:
1. Large hematoma extending along the left pelvic sidewall into
the
preperitoneal and subperitoneal space surrounding the bladder
2. Small amount of ascites
3. Cholelithiasis without cholecystitis.

[**2-14**] TTE:
The left atrium is elongated. The right atrium is moderately
dilated. Left ventricular wall thicknesses and cavity size are
normal. There is mild regional left ventricular systolic
dysfunction with focal hypokinesis of the apical inferior and
apical lateral segments. Right ventricular chamber size and free
wall motion are normal. The diameters of aorta at the sinus,
ascending and arch levels are normal. The aortic valve leaflets
are mildly thickened (?#). There is no aortic valve stenosis. No
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. Trivial mitral regurgitation is seen. The
tricuspid valve leaflets are mildly thickened. There is mild
pulmonary artery systolic hypertension. There is no pericardial
effusion. There is an anterior space which most likely
represents a prominent fat pad.

IMPRESSION: Mild focal LV systolic dysfunction (consistent with
known PDA occlusion). Normal size and function of right
ventricle. No significant valvular abnormality seen.

[**2-14**] CXR:
IMPRESSION:
1) Increase in vascular congestion with lower lung volumes and
new right
basilar atelectasis. No pleural effusion is seen.
2) No pulmonary edema.

[**2-14**] Renal US:
RENAL ULTRASOUND: The right kidney measures 10.4 cm and the left
kidney
measures 10.9 cm. There is no hydronephrosis, mass or stone. The
parenchymal echogenicity is symmetric bilaterally. In the upper
pole of the right kidney, there is a 9 x 8 x 7 mm anechoic
avascular cyst. This study was performed with a decompressed
urinary bladder. In the suprapubic region at the midline, there
is a 10 cm fluid collection with some solid components presumed
to be the retroperitoneal hemorrhage.
IMPRESSION: No evidence of hydronephrosis.


Brief Hospital Course:
73 year old woman with a history of ASD repair in [**2065**],
hypertension, hyperlipidemia, atrial flutter (on coumadin) who
was admitted for an atrial flutter ablation and developed
complications of an RP bleed with hypotension and STEMI
secondary to PDA ablation.
.
ACTIVE DIAGNOSES:
.
# ST elevation MI: Patient was found to have posterior STE on
EKG.  At cath, she was found to have tight distal PDA lesion
likely secondary to ablation.  Patient was asymptomatic despite
persistent ST elevations. TTE showed mild focal LV systolic
dysfunction (consistent with known PDA occlusion), normal size
and function of right ventricle, and no significant valvular
abnormality. Patient was eventually restarted metoprolol
succinate 50mg daily, Atorvastatin 80, ASA 81 mg PO daily,
Coumadin 2mg daily. She was not started on an ACEi or [**Last Name (un) **] as
patient is allergic.

# Atrial flutter: Now resolved s/p ablation. She was restarted
on metoprolol when her blood pressure could tolerate it, and was
started on Amiodarone 200mg PO BID x2 weeks, then 200mg PO daily
x1-2 months.

# RP bleed: The patient was found to be hypotensive after her
aflutter ablation, secondary to acute blood loss from
retroperitoneal bleed as confirmed by CT abdomen/pelvis. This
bleeding resolved with aggressive blood transfusions and FFP.
Hct stabilized 12 hours after bleed at a hct of 30, and there
was no evidence of persistent bleeding. Patient did experience
abd and back pain, likely secondary to irritation from bleeding.
Pain from irritation from bleeding was controlled with oxycodone
as needed and a lidocaine patch.  Her anticoagulation was
reversed at the time of RP bleed, but Coumadin was eventually
restarted, initially at half home dose (2mg) and then titrated
to meet INR goal [**2-1**].

# Dyspnea/wheezing: After the multiple transfusions, the patient
developed wheezing on exam and dyspnea that worsened on lying
flat. Most likely etiology of dyspnea is secondary to pulmonary
edema due to aggressive volume resuscitation during RP bleed.
Patient was diuresed a total of ~2L during length of hospital
stay.  Upon discharge, she was breathing comfortably and her
oxygen saturation was well-maintained on room air.

# Leukocytosis: Mild up to 12, has been up to 13 before, most
likely secondary to stress. Differential showed no bandemia.
Patient remained afebrile, with no cough, dysuria or other focal
symptoms. Urine and blood cultures showed no growth.
Leukocytosis eventually resolved.
.
CHRONIC DIAGNOSES:
.
# HLD: Patient was continued on Atorvastatin 80.

# Subclinical hypothyroidism: Last T4 was normal and pt without
sx of hypothyroidism.

Medications on Admission:
METOPROLOL SUCCINATE -  (Prescribed by Other Provider) - 100 mg
Tablet Extended Release 24 hr - 2.5 (two and a half) Tablet(s)
by
mouth once a day
WARFARIN -  (Prescribed by Other Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 73**] - 2 mg
Tablet - 2 (Two) Tablet(s) by mouth once a day/afternoon

Medications - OTC
CALCIUM CARBONATE [TUMS] -  (Prescribed by Other Provider; OTC)
-
Dosage uncertain
CHOLECALCIFEROL (VITAMIN D3) -  (Prescribed by Other Provider) -
1,000 unit Capsule - 1 (One) Capsule(s) by mouth once a day
MULTIVITAMIN -  (Prescribed by Other Provider; OTC) -   Tablet -
1 Tablet(s) by mouth daily


Discharge Medications:
1. metoprolol succinate 100 mg Tablet Extended Release 24 hr
Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily).
2. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable
Sig: Two (2) Tablet, Chewable PO once a day.
3. Vitamin D-3 1,000 unit Tablet, Chewable Sig: One (1) Tablet,
Chewable PO once a day.
4. warfarin 2 mg Tablet Sig: 1.5 Tablets PO Once Daily at 4 PM.

5. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*0*
8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
9. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
10. aspirin 81 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*
11. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily).
Disp:*30 Adhesive Patch, Medicated(s)* Refills:*0*
12. oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q4H (every 4 hours)
as needed for Pain.
Disp:*30 Tablet(s)* Refills:*0*
13. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day).
Disp:*180 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
PRIMARY:
1. atrial flutter ablation
2. retroperitoneal bleed
3. myocardial infarction secondary to RF catheter ablation


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:
Dear Ms. [**Known lastname 95052**],

You were admitted to the hospital for a procedure called atrial
flutter ablation. You developed a complication, and had bleeding
into the back (retroperitoneal bleed). During this event, you
had a small heart attack. This was managed with maximal medical
therapy. You received blood products for your bleeding, and
stabilized.

MEDICATION CHANGES:
- START amiodarone to control your heart rate
- Decrease warfarin to 3mg daily
- Decrease metoprolol succinate to 100 mg daily
- START lipitor (Atorvastatin) to help prevent heart attacks and
help the current heart attack heal
- START amiodarone to help prevent further episodes of unstable
rhythm
- START aspirin to help prevent heart attacks and help the
current heart attack heal
- START lidocaine patches for pain control
- START oxycodone as needed for pain control
- START senna as needed for constipation
- START colace for bowel control
- START tylenol as needed for pain

Please seek medical attention for worsening symptoms.

Followup Instructions:
Unfortunately we were unable to make a post-discharge
appointment for you with your primary care provider. [**Name10 (NameIs) 357**] call
Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 10813**] to follow up, we would ideally like
you seen within 1 week. If you encounter problems making a quick
appointment call [**Telephone/Fax (1) 72722**].

Department: CARDIAC SERVICES
When: THURSDAY [**2104-3-13**] at 1:40 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 11899**], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: CARDIAC SERVICES
When: MONDAY [**2104-4-7**] at 10:40 AM
With: [**Doctor First Name 900**] [**Name8 (MD) 901**], M.D. [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: CARDIAC SERVICES
When: THURSDAY [**2104-4-24**] at 2:20 PM
With: [**Doctor First Name 900**] [**Name8 (MD) 901**], M.D. [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Cardiac complications, not elsewhere classified,Acute myocardial infarction of inferolateral wall, initial episode of care,Acute edema of lung, unspecified,Atrial flutter,Hemorrhage complicating a procedure,Unspecified essential hypertension,Pure hypercholesterolemia,Long-term (current) use of anticoagulants,Hemorrhage, unspecified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places'}


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: Palpitations/fatigue

PRESENT ILLNESS: Mrs. [**Known lastname 95052**] is a 73 year old woman with a history of ASD repair
in [**2065**], hypertension, hyperlipidemia, atrial flutter (on
coumadin) who was admitted for an atrial flutter ablation and
developed complications of an RP bleed with hypotension, now
improved. She had been diagnosed with atrial flutter since [**2095**]
and since then has had intermittent palpitations. Lately she
developed worsening fatigue secondary to the a flutter as well
as the medications for a flutter and therefore elected to
undergo an ablation.
.
In the EP lab, she underwent a successful ablation and seemed to
tolerate the procedure well. After the procedure, the patient
developed acute hypotension. EKG revealed inferior ST elevations
and so she went to the cath lab which revealed an incidental 80%
D1 lesion as well as a total obstruction of a very small distal
LCx - no intervention was done. Her ST elevations resolved on
their own, however, a HCT showed a drop to 24 from 37
preprocedure. CT abdomen/pelvis revealed a retroperitoneal
bleed, so she was urgently admitted to the CCU. The massive
transfusion protocol was activated and she received 4 units of
PRBCs, and 4 units of FFP. Her HCT corrected to 32.8 and INR to
1.8. She was also given lasix 20mg IV for mild CHF, which
responded well. Vascular was consulted who recommended
correcting the coagulopathy, and holding pressure until INR was
1.5 or less.
.
On the floor, she noted some recurrent wheezing, dry mouth, and
groin pain where we are holding pressure.
.
On review of systems, she 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. She denies recent fevers, chills or
rigors. She denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS:
- Hypertriglyceridemia
- Hypertension
2. CARDIAC HISTORY:
- Atrial flutter/fibrillation s/p DCCV ([**2-/2101**])
3. OTHER PAST MEDICAL HISTORY:
- Subclinical hypothyroidism
- Allergic rhinitis
- Osteopenia
- s/p ASD repair ([**2065**])

MEDICATION ON ADMISSION: METOPROLOL SUCCINATE -  (Prescribed by Other Provider) - 100 mg
Tablet Extended Release 24 hr - 2.5 (two and a half) Tablet(s)
by
mouth once a day
WARFARIN -  (Prescribed by Other Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 73**] - 2 mg
Tablet - 2 (Two) Tablet(s) by mouth once a day/afternoon

ALLERGIES: Ketek Pak / Augmentin / Lisinopril / Cozaar / Norpace

PHYSICAL EXAM: PHYSICAL EXAMINATION ON ADMISSION:
VS: 97   82/50   73   21   99%RA
GENERAL: Agitated elderly woman in moderate distress
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother and father both with some type of CA when elderly. No
significant cardiac history.

SOCIAL HISTORY: Born and raised in [**Location (un) 1468**]. Married with 2 kids. No
grandchildren. Retired secretary. Smoked 2 packs per day from
age 20-40. No EtOH. Goes to the gym and does yoga, spinning,
muscle conditioning, and aerobics. 

### Response:
{'Cardiac complications, not elsewhere classified,Acute myocardial infarction of inferolateral wall, initial episode of care,Acute edema of lung, unspecified,Atrial flutter,Hemorrhage complicating a procedure,Unspecified essential hypertension,Pure hypercholesterolemia,Long-term (current) use of anticoagulants,Hemorrhage, unspecified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places'}
