CHIEF COMPLAINT: Chest pain, elevated INR, transfer for concern for tamponade
.

PRESENT ILLNESS: 89 yo female with history of diastolic CHF, a fib on coumadin,
hypertension, TIA and CVA in [**2192**], chronic kidney disease with
baseline creatinine of 1.3 who is transferred here from [**Hospital1 **]
[**Location (un) 620**] with concern for tamponade.
.
Pt presented initially [**7-28**] to [**Hospital 197**] clinic and was found to
have an INR of 7.1. She reported increasing weakness,
intermittent substernal chest pressure in certain positions and
intermittent shortness of breath so was referred to the
hospital. She denied any associated diaphoresis, no radiation,
no palpitations and stated that only exacerbating factors were
moving in certain positions. She denies any recent fevers,
cough, N/V, no diarrhea or constipation, though she does state
that she has some blood in her stool yesterday. No dysuria or
recent hematuria, no recent falls.
.
At [**Name (NI) 620**], pt was noted to have elevated creatinine to 3.4 from
baseline 1.3. She also had trop increase to 0.048. She had an
elevated BNP to 4752 (though may be her baseline) and there was
concern that she symptoms of DOE were secondary to volume
overload so she was diuresed with lasix 40 mg IV, at least once,
despite BP 87/70. She also received her home dose of clonidine.
Her CXR showed possible worse cardiomegaly. Her creatinine
continued to rise with diuresis to 3.6. Renal and cardiology
were consulted who both felt that her continued increase in
creatinine was likely secondary to over diuresis.

MEDICAL HISTORY: Cardiac Risk Factors: Hypertension with Renal artery stenosis
.
Percutaneous coronary intervention, in [**4-12**] anatomy as follows:
prox LAD 50%, D1 60% on cath
.
Other Past History:
1. CAD (prox LAD 50%, D1 60% on cath [**4-12**])
2. Hypercholesterolemia
3. TIA/CVA [**1-18**] (neg carotid US)
4. GERD
5. esophageal stricture (solid dysphagia) s/p dilation ([**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
at [**Hospital1 18**] [**Location (un) 620**])
6. hypothyroidism
7. post-herpetic neuraligia
8. C4-5 spinal stenosis
9. s/p bilateral RA stenting [**4-12**]
10. s/p TAH-BSO @ 52yo
11. s/p appy @ 16yo

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Family/CaregiverPharmacy.
1. Atorvastatin 10 mg PO DAILY
2. CloniDINE 0.2 mg PO BID
3. Furosemide 40 mg PO BID
4. Klor-Con M20 *NF* (potassium chloride) 20 mEq Oral daily
5. Verapamil SR 240 mg PO Q24H
6. Warfarin 2.5 mg PO DAILY16
alternating with 5mg daily
7. Levothyroxine Sodium 125 mcg PO DAILY
8. Aspirin 81 mg PO DAILY
9. Valsartan 160 mg PO BID
10. Vitamin D 1000 UNIT PO BID
11. Divalproex (DELayed Release) 500 mg PO HS
12. OLANZapine 5 mg PO HS

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: VS: T= 98 BP=121/71 HR= 85 RR= 18 O2 sat=  96%
GENERAL: pale appearing woman in NAD. Oriented x2-3. Mood,
affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
dry mucous membranes
NECK: Supple with JVP of 10 cm.
CARDIAC: irregularly irregular, normal S1, S2. No m/r/g. No
thrills, lifts. No S3 or S4.
LUNGS: Resp were unlabored, no accessory muscle use. decreased
breath sounds over L>R base
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No c/c/trace edema. 2+ DP pulses

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. Her mother died of an MI at 67 and her father
died of an MI at an unknown age.

SOCIAL HISTORY: Social history is significant for the absence of current or past
tobacco use, though her deceased husband was a heavy smoker.
There is no history of alcohol abuse. She lives with her son who
works for the [**Name (NI) 2318**]. She used to work in quality control. Her
husband passed away 15 years ago.
Unspecified disease of pericardium,Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Esophageal reflux,Unspecified acquired hypothyroidism,Other iatrogenic hypotension,Hematuria, unspecified
Pericardial disease NOS,Ac on chr diast hrt fail,Acute kidney failure NOS,Abnrml coagultion prfile,Adv eff anticoagulants,Atrial fibrillation,Long-term use anticoagul,Hx TIA/stroke w/o resid,Chronic kidney dis NOS,Hy kid NOS w cr kid I-IV,Pure hypercholesterolem,Esophageal reflux,Hypothyroidism NOS,Iatrogenc hypotnsion NEC,Hematuria NOS
Admission Date:  [**2197-7-29**]              Discharge Date:   [**2197-8-7**]


Service: MEDICINE

Allergies:
Ace Inhibitors

Attending:[**Last Name (NamePattern1) 1167**]
Chief Complaint:
Chest pain, elevated INR, transfer for concern for tamponade
.

Major Surgical or Invasive Procedure:
None

History of Present Illness:
89 yo female with history of diastolic CHF, a fib on coumadin,
hypertension, TIA and CVA in [**2192**], chronic kidney disease with
baseline creatinine of 1.3 who is transferred here from [**Hospital1 **]
[**Location (un) 620**] with concern for tamponade.
.
Pt presented initially [**7-28**] to [**Hospital 197**] clinic and was found to
have an INR of 7.1. She reported increasing weakness,
intermittent substernal chest pressure in certain positions and
intermittent shortness of breath so was referred to the
hospital. She denied any associated diaphoresis, no radiation,
no palpitations and stated that only exacerbating factors were
moving in certain positions. She denies any recent fevers,
cough, N/V, no diarrhea or constipation, though she does state
that she has some blood in her stool yesterday. No dysuria or
recent hematuria, no recent falls.
.
At [**Name (NI) 620**], pt was noted to have elevated creatinine to 3.4 from
baseline 1.3. She also had trop increase to 0.048. She had an
elevated BNP to 4752 (though may be her baseline) and there was
concern that she symptoms of DOE were secondary to volume
overload so she was diuresed with lasix 40 mg IV, at least once,
despite BP 87/70. She also received her home dose of clonidine.
Her CXR showed possible worse cardiomegaly. Her creatinine
continued to rise with diuresis to 3.6. Renal and cardiology
were consulted who both felt that her continued increase in
creatinine was likely secondary to over diuresis.

Yesterday evening, pt developed worsening hypotension with SBP
80s for which she received 500 cc NS bolus x 2 with increase in
SBP to 100s transiently, then decreased. With fluid boluses also
came hypoxia requiring 3L oxgyen. She was started on norepi and
a pulsus checked then was reportedly 20 mmHg.  She was started
on vanc, ceftriaxone and zosyn as well. At that time, echo was
performed by the ED staff and showed a moderate pericardial
effusion. The patient was then transferred to the [**Hospital1 18**] CCU for
further management. She received vitamin K and FFP prior to
transfer.
.
In the CCU, pt reports chest pain when turning, asymptomatic at
rest, breathing comfortably. She is very tired. Initially she
was confused and thought she was in a parking garage. She
eventually cleared and was able to identify [**Hospital1 **] [**Location (un) 86**].

Past Medical History:
Cardiac Risk Factors: Hypertension with Renal artery stenosis
.
Percutaneous coronary intervention, in [**4-12**] anatomy as follows:
prox LAD 50%, D1 60% on cath
.
Other Past History:
1. CAD (prox LAD 50%, D1 60% on cath [**4-12**])
2. Hypercholesterolemia
3. TIA/CVA [**1-18**] (neg carotid US)
4. GERD
5. esophageal stricture (solid dysphagia) s/p dilation ([**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
at [**Hospital1 18**] [**Location (un) 620**])
6. hypothyroidism
7. post-herpetic neuraligia
8. C4-5 spinal stenosis
9. s/p bilateral RA stenting [**4-12**]
10. s/p TAH-BSO @ 52yo
11. s/p appy @ 16yo


Social History:
Social history is significant for the absence of current or past
tobacco use, though her deceased husband was a heavy smoker.
There is no history of alcohol abuse. She lives with her son who
works for the [**Name (NI) 2318**]. She used to work in quality control. Her
husband passed away 15 years ago.



Family History:
There is no family history of premature coronary artery disease
or sudden death. Her mother died of an MI at 67 and her father
died of an MI at an unknown age.

Physical Exam:
VS: T= 98 BP=121/71 HR= 85 RR= 18 O2 sat=  96%
GENERAL: pale appearing woman in NAD. Oriented x2-3. Mood,
affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
dry mucous membranes
NECK: Supple with JVP of 10 cm.
CARDIAC: irregularly irregular, normal S1, S2. No m/r/g. No
thrills, lifts. No S3 or S4.
LUNGS: Resp were unlabored, no accessory muscle use. decreased
breath sounds over L>R base
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No c/c/trace edema. 2+ DP pulses

Discharge PE:
Vitals - Tm/Tc:99/98.7 HR:85-91 BP:143-151/82-92 RR:18-20 02
sat: 95% 4L
In/Out:
Last 24H:1200/2155
Last 8H:100/400
Weight: 65.5(66.3)

GENERAL: pale appearing woman in NAD. Oriented x2-3. Mood,
affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
dry mucous membranes
NECK: Supple with JVP of 10 cm.
CARDIAC: irregularly irregular, normal S1, S2. No m/r/g. No
thrills, lifts. No S3 or S4.
LUNGS: Resp were unlabored, no accessory muscle use. Fine b/l
crackles.
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No c/c/trace edema. 2+ DP pulses


Pertinent Results:
Admission:
[**2197-7-29**] 03:25PM   GLUCOSE-83 UREA N-76* CREAT-2.9* SODIUM-136
POTASSIUM-4.7 CHLORIDE-104 TOTAL CO2-21* ANION GAP-16
[**2197-7-29**] 03:25PM   CALCIUM-8.2* PHOSPHATE-5.4* MAGNESIUM-2.3
[**2197-7-29**] 03:25PM   [**Doctor First Name **]-POSITIVE * TITER-1:40
[**2197-7-29**] 05:23AM URINE  RBC->182* WBC-96* BACTERIA-MOD
YEAST-NONE EPI-0
[**2197-7-29**] 04:32AM   CK-MB-3 cTropnT-0.03*
.
Discharged Labs:
[**2197-8-7**] 09:00AM BLOOD WBC-9.0 RBC-4.31 Hgb-12.0 Hct-37.7 MCV-87
MCH-27.8 MCHC-31.8 RDW-14.9 Plt Ct-266
[**2197-8-7**] 09:00AM BLOOD PT-21.0* INR(PT)-2.0*
[**2197-8-7**] 09:00AM BLOOD Glucose-90 UreaN-32* Creat-1.5* Na-139
K-4.2 Cl-100 HCO3-30 AnGap-13
[**2197-8-7**] 09:00AM BLOOD Calcium-8.4 Phos-3.1 Mg-2.3
[**2197-7-29**] 03:25PM BLOOD [**Doctor First Name **]-POSITIVE * Titer-1:40
.
Head CT:FINDINGS:  There is no evidence of hemorrhage, edema,
mass effect, or infarction.  Prominent ventricles and sulci
suggest age-related atrophy.  Periventricular white matter
hypodensities are consistent with chronic small vessel ischemic
disease.  There is a small hypodensity in the left occipital
lobe consistent with encephalomalacia from an old infarct.  It
is stable from previous exam.  The basal cisterns appear patent
and there is preservation of [**Doctor Last Name 352**]-white differentiation.
No fracture is identified.  There is fluid in the left sphenoid
sinus.  The remaining visualized paranasal sinuses, mastoid air
cells and middle ear cavities are clear.  The globes are
unremarkable.
CONCLUSION:
No evidence of acute intracranial process.
.
C-Spine:
FINDINGS:  There is anterolisthesis of C3 on C4 and
retrolisthesis of C4 on C5 with extensive degenerative changes
at both levels.  There is fusion of the left facet joint at
C3-4. These findings suggest that the subluxations are due to
degenerative disk disease. There is mild canal narrowing at C5.
There is no evidence of a fracture.  CT is not able to provide
intrathecal detail comparable to MRI, but visualized outline of
the thecal sac appears unremarkable.  No lymphadenopathy is
present by CT size criteria.  Vascular calcifications are noted
at the aortic arch and in the carotid bifurcations bilaterally.
There are bilateral pleural effusions, larger on the left than
right.

IMPRESSION:
1.  No evidence of fracture. Subluxation involving C4 appears
chronic. No
other alignment abnormalities detected.
2.  Multilevel degenerative changes of the cervical spine.
3.  Bilateral pleural effusions.

TTE: [**2197-8-7**]:
Left ventricular wall thicknesses and cavity size are normal.
There is moderate global left ventricular hypokinesis. The
estimated pulmonary artery systolic pressure is normal. There is
a small to moderate sized circumferential pericardial effusion
which is echo dense, consistent with blood, inflammation or
other cellular elements [**Last Name (un) **] stranding c/w organization. There
are no echocardiographic signs of tamponade or constriction.
.
IMPRESSION: Small to moderate circumferential pericardial
effusion c/w organiziation/blood-inflammation as described
above.
.
Compared with the prior study (images reviewed) of [**2197-7-31**],
the pericardial effusion is smaller and more intense
organization is suggested. Left ventricular systolic function is
more depressed (global).


Brief Hospital Course:
89 yo female with hx of diastolic CHF, CKD with baseline cr 1.3
admitted with supratherapeutic INR, [**Last Name (un) **] and pericardial
effusion.

# Pericardial effusion: Pt was orginally admitted to [**Hospital1 **] [**Location (un) 620**]
and transferred to [**Hospital1 18**] with concern for tamponade physiology.
Bedside TTE on admission showed moderate to large loculated
pericardial effusion with no signs of tamponade. On admission
she was hypotensive (though in the setting of diuresis), was
tachycardia (with atrial fibrillation) with mildl pulsus
paradoxus of 14-16. Loculated nature of effusions suggested
subacute nature. Differential Dx included inflammation from
recent pneumonia, viral pericarditis, drug induced lupus
secondary to hydralazine, but also considered possible uremic
pericarditis in setting of [**Last Name (un) **], though less likely given timing.
Supratherapeutic INR may have exacerbated pericardial effusion.
[**First Name8 (NamePattern2) 6**] [**Doctor First Name **] was (+) but at low titers. Pt continued to remain
hemodynamically stable and pressures improved with IV fluids.
Her home antihypertensives were held and reintroduced bp
returned to baseline (SBP 130-140. Given the loculated nature of
effusion and her hemodynamic stability, pericaridal effusion was
not drained.  She had repeat TTE on the day of discharge which
showed the pericardial effusion to be decreasing.  She will
follow up with her cardiologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4135**] who will get a
repeat TTE in two weeks to reassess the pericardial effusion.
.
# Atrial fibrillation: Patient has a hx of afib and presented
with a supratheraputic INR to 7.1 and received Vit K and FFP.
Patient was rate controlled with both metoprolol and verapamil
with HR. Patient was considered to ba a poor candidate for
coumdain therefore she was transtioned to rivaroxiban 15mg
daily.
.
# Hypotension: Initially patient presented with hypotension
likely secondary to over diuresis. Had been treated with vanc,
zosyn, ceftriaxone at OSH though no clear indication that she
was infected. Her abx were stopped at [**Hospital1 18**] and she contined to
be afebrile. Her antihypertensives were held on admission and
decision was made to hold [**Last Name (un) **] and hydralazine on discharge as it
is believed hypotension is a greater risk to the patient at this
time.  Her blood pressure during rest of admission continued to
be in the 130s systoilics.
.
#Hypoxemia: Patient continued to have sat int he 90s during the
day however at night patient would have drop her sat which would
recover after wakening the patient likely clinically
insignificant.
.
# [**Last Name (un) **]: Creatinine elevated to 3.6 from baseline 1.3 on
admission. Most likely secondary to poor flow secondary over
diuresis.  Cr normalized with IVF.
.
# Diastolic CHF: On admission,  patient did not have signs of
fluid overload and appeared dry on exam. Diuresis was held for
several days and was restarted when patient had decreased 02
sats and cxr consistent with pulmonary edema. Pt needs daily
weights.  She will continue lasix 40mg daily lasix.
.
#  HTN: Pt was hypotensive on admission secondary to pericardial
effusion and over diuresis. Metoprolol and verapamil restarted
during admission.  [**Last Name (un) **] and hydralazine held on discharge.
.
# Hematuria: Unclear if secondary to elevated INR vs other
underlying process. Resolved on admission. Follow up with outpt
PCP for further evaluation.

Transitions of Care:
1. Pt'[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] and Hydralzine are being held on discharge over
concern for hypotension
2. Pt's anticoagulation transitioned to rivaroxiban on discharge
3. Pt instructed to report further hematuria to PCP and consider
additional work up if further episodes.
4.Full Code
5. Pt will follow up with cardiologist Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4135**] who will
get a repeat TTE to assess for pericardial effusion in two
weeks.

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from Family/CaregiverPharmacy.
1. Atorvastatin 10 mg PO DAILY
2. CloniDINE 0.2 mg PO BID
3. Furosemide 40 mg PO BID
4. Klor-Con M20 *NF* (potassium chloride) 20 mEq Oral daily
5. Verapamil SR 240 mg PO Q24H
6. Warfarin 2.5 mg PO DAILY16
alternating with 5mg daily
7. Levothyroxine Sodium 125 mcg PO DAILY
8. Aspirin 81 mg PO DAILY
9. Valsartan 160 mg PO BID
10. Vitamin D 1000 UNIT PO BID
11. Divalproex (DELayed Release) 500 mg PO HS
12. OLANZapine 5 mg PO HS


Discharge Medications:
1. Atorvastatin 10 mg PO DAILY
2. Levothyroxine Sodium 125 mcg PO DAILY
3. OLANZapine 5 mg PO HS
4. Verapamil SR 240 mg PO Q24H
5. Vitamin D 1000 UNIT PO BID
6. Divalproex (DELayed Release) 500 mg PO HS
7. Metoprolol Succinate XL 200 mg PO DAILY
Hold SBP < 100, Hr < 55
RX *metoprolol succinate 200 mg 1 tablet(s) by mouth Daily Disp
#*30 Tablet Refills:*0
8. Multivitamins 1 TAB PO DAILY
9. Aspirin 81 mg PO DAILY
10. Rivaroxaban 15 mg PO DAILY
RX *rivaroxaban [Xarelto] 15 mg 1 tablet(s) by mouth Daily Disp
#*30 Tablet Refills:*0
11. Furosemide 40 mg PO DAILY
Hold for SBP < 95
RX *furosemide 40 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet
Refills:*0


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 582**] at [**Location (un) 620**]

Discharge Diagnosis:
Chronic Diastolic CHF
Atrial fibrillation with rapid ventricular response
Hypertension
Acute on Chronic Kidney Injury
Hypercoagulopathy


Discharge Condition:
Mental Status: Confused - always.
Level of Consciousness: Lethargic but arousable.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Dear Mrs. [**Known lastname **],
It was a pleasure taking care of you during your [**Hospital1 18**]
admission. You were transferred from [**Hospital1 **] [**Location (un) 620**] because you had
a collection of fluid around your heart and low blood pressure.
An ultrasound of your heart showed that the fluid likely had
been there for some time and it was not drained. Your heart
function was initially poor because of the fluid but has
improved considerably. Your kidney function had worsened because
your lasix dose was too high for you.  Your lasix dose was
decreased and you kidney function is now back to baseline. Your
INR or warfarin level was very high therefore we have switched
you to a different medication called rivaroxiban.  On the day of
discharge you were feeling better wihout any chest pain or SOB.
A repeat ultrasound of your heart showed the fluid around your
heart to be decreeasing.  You should follow up with your
cardiologist Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4135**] for further managment.

Followup Instructions:
Name: [**Last Name (LF) 4135**], [**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Location: BIDH-[**Location (un) **] CARDIOLOGY
Address: [**Street Address(2) **], [**Location (un) **],[**Numeric Identifier 3002**]
Phone: [**Telephone/Fax (1) 4105**]
Appointment: Tuesday [**2197-8-22**] 11:40am



Completed by:[**2197-8-7**]
{'Unspecified disease of pericardium,Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Esophageal reflux,Unspecified acquired hypothyroidism,Other iatrogenic hypotension,Hematuria, 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: Chest pain, elevated INR, transfer for concern for tamponade
.

PRESENT ILLNESS: 89 yo female with history of diastolic CHF, a fib on coumadin,
hypertension, TIA and CVA in [**2192**], chronic kidney disease with
baseline creatinine of 1.3 who is transferred here from [**Hospital1 **]
[**Location (un) 620**] with concern for tamponade.
.
Pt presented initially [**7-28**] to [**Hospital 197**] clinic and was found to
have an INR of 7.1. She reported increasing weakness,
intermittent substernal chest pressure in certain positions and
intermittent shortness of breath so was referred to the
hospital. She denied any associated diaphoresis, no radiation,
no palpitations and stated that only exacerbating factors were
moving in certain positions. She denies any recent fevers,
cough, N/V, no diarrhea or constipation, though she does state
that she has some blood in her stool yesterday. No dysuria or
recent hematuria, no recent falls.
.
At [**Name (NI) 620**], pt was noted to have elevated creatinine to 3.4 from
baseline 1.3. She also had trop increase to 0.048. She had an
elevated BNP to 4752 (though may be her baseline) and there was
concern that she symptoms of DOE were secondary to volume
overload so she was diuresed with lasix 40 mg IV, at least once,
despite BP 87/70. She also received her home dose of clonidine.
Her CXR showed possible worse cardiomegaly. Her creatinine
continued to rise with diuresis to 3.6. Renal and cardiology
were consulted who both felt that her continued increase in
creatinine was likely secondary to over diuresis.

MEDICAL HISTORY: Cardiac Risk Factors: Hypertension with Renal artery stenosis
.
Percutaneous coronary intervention, in [**4-12**] anatomy as follows:
prox LAD 50%, D1 60% on cath
.
Other Past History:
1. CAD (prox LAD 50%, D1 60% on cath [**4-12**])
2. Hypercholesterolemia
3. TIA/CVA [**1-18**] (neg carotid US)
4. GERD
5. esophageal stricture (solid dysphagia) s/p dilation ([**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
at [**Hospital1 18**] [**Location (un) 620**])
6. hypothyroidism
7. post-herpetic neuraligia
8. C4-5 spinal stenosis
9. s/p bilateral RA stenting [**4-12**]
10. s/p TAH-BSO @ 52yo
11. s/p appy @ 16yo

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Family/CaregiverPharmacy.
1. Atorvastatin 10 mg PO DAILY
2. CloniDINE 0.2 mg PO BID
3. Furosemide 40 mg PO BID
4. Klor-Con M20 *NF* (potassium chloride) 20 mEq Oral daily
5. Verapamil SR 240 mg PO Q24H
6. Warfarin 2.5 mg PO DAILY16
alternating with 5mg daily
7. Levothyroxine Sodium 125 mcg PO DAILY
8. Aspirin 81 mg PO DAILY
9. Valsartan 160 mg PO BID
10. Vitamin D 1000 UNIT PO BID
11. Divalproex (DELayed Release) 500 mg PO HS
12. OLANZapine 5 mg PO HS

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: VS: T= 98 BP=121/71 HR= 85 RR= 18 O2 sat=  96%
GENERAL: pale appearing woman in NAD. Oriented x2-3. Mood,
affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
dry mucous membranes
NECK: Supple with JVP of 10 cm.
CARDIAC: irregularly irregular, normal S1, S2. No m/r/g. No
thrills, lifts. No S3 or S4.
LUNGS: Resp were unlabored, no accessory muscle use. decreased
breath sounds over L>R base
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No c/c/trace edema. 2+ DP pulses

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. Her mother died of an MI at 67 and her father
died of an MI at an unknown age.

SOCIAL HISTORY: Social history is significant for the absence of current or past
tobacco use, though her deceased husband was a heavy smoker.
There is no history of alcohol abuse. She lives with her son who
works for the [**Name (NI) 2318**]. She used to work in quality control. Her
husband passed away 15 years ago. 

### Response:
{'Unspecified disease of pericardium,Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Esophageal reflux,Unspecified acquired hypothyroidism,Other iatrogenic hypotension,Hematuria, unspecified'}
