CHIEF COMPLAINT: Transfer from [**Hospital3 **] for respiratory distress,
elevated troponins and pneumonia.

PRESENT ILLNESS: Ms. [**Known lastname 27671**] is a 60 year-old patient of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 11493**] with a
long history of CAD s/p 2-vessel CABG in [**2100**] (SVG to LAD and
SVG to OM), s/p PTCA to RCA and multiple PTCAs and brachytherapy
of the SVG to OM (last in [**2121-1-29**]), who was admitted to
[**Location (un) **] with cough and wheezing, as well as anginal symptoms on
[**2123-3-8**]. She describes a sore throat with "gland swelling" for
2-3 days PTA, anorexia, as well as a productive cough and
wheezing on the day prior to presentation. She also had several
anginal episodes in the day prior to admission, some at rest,
relieved with NTG SL.

MEDICAL HISTORY: 1. Coronary artery disease, s/p CABG in [**2100**] with SVG to the LAD
and an SVG to the OM. S/p RCA stenting in [**2114**], s/p stenting of
SVG to OM in [**2117**], s/p PTCA of focal instent restenosis at the
ostium of SVG to the OM, s/p PTCA and gammatherapy of SVG to OM
in 01/[**2121**]. Last cath in [**7-/2122**]: SVG to the LAD had mild
diffuse disease up to 30%, patent SVG to OM with 40-50% stenosis
in the mid distal graft section not hemodynamically significant
to the obtuse marginal and the previously placed stent was
widely patent. Concern over possible ostial RCA lesion, but
could not be engaged.
2. Peripheral vascular disease
3. CHF, EF unknown. Had echo in past month at OSH.
4. Status post bilateral carotid stenting [**10/2117**]
5. COPD/Asthma, no prior intubation, no home O2.
6. Depression
7. GERD
8. Irritable bowel syndrome
9. Osteoarthritis
10. Kidney stones
11. Obesity

MEDICATION ON ADMISSION: Nitro-Patch 0.8 mg/hour 24 hours a day
Adalat CC 90 mg PO QD
Aldactone 50 mg PO QD
Albuterol 2 inh q4 hours prn (not using it)
Serevent (not using it)
Hydralazine 25 mg PO TID
Atenolol 150 mg PO QD
Calcium 600 mg PO BID with vitamin D 400 IU daily
Celexa 20 mg PO QD
Demadex 40 mg PO BID
Depakote 250 mg PO BID
Detrol LA 4 mg PO QD
ECASA 325 mg PO QD
Folic acid ? dose
Imdur 120 mg PO BID
Klor-Con 20 mEq PO QD
[**First Name3 (LF) 27672**] 50 mcg PO QD
Lipitor 80 mg PO QD
MVI 1 tablet PO QD
NTG SL prn
Plavix 75 mg PO QD
Protonix 40 mg PO BID
Colace 100 mg PO BID
Welchol 625 mg PO QD
Zyprexa 2.5 mg PO QHS

ALLERGIES: Sulfur / Morphine / Imipramine / Oxybutynin / Oxycontin / Ace
Inhibitors

PHYSICAL EXAM: Physical examination on admission to CCU:
VITALS: T 99.0, HR 81, BP right arm (164/67, left arm 117/67)
previously documented, RR 16, Sat 100% on NRB
GEN: Morbidly obese caucasian woman. Mildly tachypneic.
HEENT: Anicteric. MMM.
NECK: Bilateral carotid bruits. Bilateral clavicular bruits (?
subclavian). JVP difficult to assess secondary to body habitus.
RESP: Distant breath sounds. Distant inspiratory crackles,
wheezing anteriorly.
CVS: Distant heart sounds. Normal S1, S2. No S3, S4. SEM at
LLSB, difficult to characterize.
GI: Obese abdomen. Soft, non-tender.
EXT: Good right femoral pulse, unable to palpate left femoral
pulse. Difficult to assess for bruit secondary to body habitus.
Palpable right DP pulse, unable to palpate other pulses. 1+
bilateral edema, slightly more on the right.
NEURO: Alert and oriented X 3.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: She lives alone. She has a housekeeper who comes in once a week
to help with her laundry. Ex-smoker, she quit 23 years ago. She
denies EtOH use.
Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Other vascular complications of medical care, not elsewhere classified,Acute kidney failure, unspecified,Anemia, unspecified,Unspecified acquired hypothyroidism,Phlebitis and thrombophlebitis of other sites,Other restorative surgery causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Coronary atherosclerosis of artery bypass graft
Subendo infarct, initial,Pneumonia, organism NOS,CHF NOS,Vasc comp med care NEC,Acute kidney failure NOS,Anemia NOS,Hypothyroidism NOS,Thrombophlebitis NEC,Abn react-plast surg NEC,Cor ath artry bypas grft
Admission Date:  [**2123-3-9**]              Discharge Date:   [**2123-3-20**]

Date of Birth:  [**2061-3-31**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfur / Morphine / Imipramine / Oxybutynin / Oxycontin / Ace
Inhibitors

Attending:[**First Name3 (LF) 1145**]
Chief Complaint:
Transfer from [**Hospital3 **] for respiratory distress,
elevated troponins and pneumonia.

Major Surgical or Invasive Procedure:
Cardiac cath s/p 2 bare metal stents to SVG-OM

History of Present Illness:
Ms. [**Known lastname 27671**] is a 60 year-old patient of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 11493**] with a
long history of CAD s/p 2-vessel CABG in [**2100**] (SVG to LAD and
SVG to OM), s/p PTCA to RCA and multiple PTCAs and brachytherapy
of the SVG to OM (last in [**2121-1-29**]), who was admitted to
[**Location (un) **] with cough and wheezing, as well as anginal symptoms on
[**2123-3-8**]. She describes a sore throat with "gland swelling" for
2-3 days PTA, anorexia, as well as a productive cough and
wheezing on the day prior to presentation. She also had several
anginal episodes in the day prior to admission, some at rest,
relieved with NTG SL.

She presented to the OSH on [**2123-3-8**], and was found to have a
temperature of 101.4 in the ED, WBC 13.1, 18% bands, and CXR
revealed a LLL infiltrate on CXR. Given her history of chest
pain, cardiac enzymes were also sent. She was started on
Ceftriaxone and Azithromycin for LLL pneumonia. While in
hospital, her cardiac enzymes rose with peak CK-MB 41.6,
Troponin I 13.02, and EKG revealed ST depressions in
anterolateral leads. On [**2123-3-9**], she also developed what seems
to be acute respiratory distress in the setting of elevated
blood pressure with SBP 150-200, and desaturation to 60s on 2L
via NC. ABG 7.25/69/103. She was placed on BiPAP 13/6-->15/6,
and was given Lasix 80 mg IV X 2 with 1 liter diuresis. She was
also started on Heparin gtt, Aggrestat gtt (D/C'd because of
nose bleeding)  and NTG gtt, and received Labetalol 5 mg IV X 4.
She was transferred to the [**Hospital1 18**] for consideration for further
management.

Of note, by the patient account, she recently had an echo and
had her Nitro patch increased to 0/8 mg/24 hours over 24 hours
because of accelerating anginal symptoms.

Past Medical History:
1. Coronary artery disease, s/p CABG in [**2100**] with SVG to the LAD
and an SVG to the OM. S/p RCA stenting in [**2114**], s/p stenting of
SVG to OM in [**2117**], s/p PTCA of focal instent restenosis at the
ostium of SVG to the OM, s/p PTCA and gammatherapy of SVG to OM
in 01/[**2121**]. Last cath in [**7-/2122**]: SVG to the LAD had mild
diffuse disease up to 30%, patent SVG to OM with 40-50% stenosis
in the mid distal graft section not hemodynamically significant
to the obtuse marginal and the previously placed stent was
widely patent. Concern over possible ostial RCA lesion, but
could not be engaged.
2. Peripheral vascular disease
3. CHF, EF unknown. Had echo in past month at OSH.
4. Status post bilateral carotid stenting [**10/2117**]
5. COPD/Asthma, no prior intubation, no home O2.
6. Depression
7. GERD
8. Irritable bowel syndrome
9. Osteoarthritis
10. Kidney stones
11. Obesity

NOTE: She has had a 70 point difference in blood pressure in
both arms in the past.

Past surgical history:
1. Status post cholecystectomy
2. Status post hysterectomy
3. Status post tonsillectomy
4. Status post umbilical hernia repair
5. Basal cell carcinoma removed from face

Social History:
She lives alone. She has a housekeeper who comes in once a week
to help with her laundry. Ex-smoker, she quit 23 years ago. She
denies EtOH use.

Family History:
Non-contributory

Physical Exam:
Physical examination on admission to CCU:
VITALS: T 99.0, HR 81, BP right arm (164/67, left arm 117/67)
previously documented, RR 16, Sat 100% on NRB
GEN: Morbidly obese caucasian woman. Mildly tachypneic.
HEENT: Anicteric. MMM.
NECK: Bilateral carotid bruits. Bilateral clavicular bruits (?
subclavian). JVP difficult to assess secondary to body habitus.
RESP: Distant breath sounds. Distant inspiratory crackles,
wheezing anteriorly.
CVS: Distant heart sounds. Normal S1, S2. No S3, S4. SEM at
LLSB, difficult to characterize.
GI: Obese abdomen. Soft, non-tender.
EXT: Good right femoral pulse, unable to palpate left femoral
pulse. Difficult to assess for bruit secondary to body habitus.
Palpable right DP pulse, unable to palpate other pulses. 1+
bilateral edema, slightly more on the right.
NEURO: Alert and oriented X 3.



Pertinent Results:
Laboratory data from the OSH on admission:
CBC: WBC 13.1 with 18% bands, 66% neutrophils. Hct 40.6, Plt
137.

Chemistry:
Na 144, K 4.6, Cl 102, HCO3 27, BUN 21.6, Creat 1.3 (was 1.1 in
[**3-/2122**]), Glucose 1.3. Normal LFTs.

Cardiac enzymes:
CK 404-->576
CKMB 29.9-->41.6
MB index 7.4-->7.2
Trop 0.06-->13.02-->7.42

Microbiology data:
[**2123-3-8**] Blood cultures pending

CXR: LLL infiltrate

EKG [**2123-3-9**]: NSR, rate 110, normal intervals, normal axis. ST
elevation in aVR (and V1, V2 on different EKGs), 1-[**Street Address(2) 1766**]
depressions in I, II, aVF, V3-6. No T wave inversion. Qs in III.


EKG on arrival to CCU [**Hospital1 18**]: NSR, rate 77 bpm. Less than 1mm ST
elevation in V1,V2. ST depression I, II, aVL, V5.

Cath:
1. Selective graft angiography revealed a SVG->OM with a 60%
lesion in
the distal segment followed by a 70% lesion in the distal
anastomosis
into the native OM.
2. Hemodynamic evaluation revealed normal right and left heart
filling
pressures. There was no evidence of significant pulmonary HTN.
3. Successful PTCA/stenting of the SVG->OM graft with a 3.0x18mm
Driver
stent in the anastomosis postdilated to 3.5 in the proximal
segment and
with a 3.5x18mm Driver stent in the distal segment overlapping
the
previously placed Cypher DES as well as the new Driver stent in
the
anastomosis. Final angiography revealed 10% residual stenosis in
the
distal SVG, no dissection and TIMI-3 flow (see PTCA comments).

FINAL DIAGNOSIS:
1. One vessel coronary artery disease.
2. Normal right and left heart filling pressures.
3. PCI of the SVG->OM.

Echo:
The left atrium is moderately dilated. There is left ventricular
hypertrophy.  The left ventricular cavity size is normal. Due to
suboptimal technical quality, a focal wall motion abnormality
cannot be fully excluded. Overall left ventricular systolic
function iis probably preserved but views are technically
suboptimal for assessment of global and regional wall motion.
Right ventricular chamber size is normal. Right ventricular
systolic function is probably normal. The aortic valve leaflets
are moderately thickened. There is mild aortic valve stenosis.
No aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. Mild (1+) mitral regurgitation is seen.  The
tricuspid valve leaflets are mildly thickened. There is no
pericardial effusion.

Pertinent Labs:
[**2123-3-20**] 02:56PM BLOOD Hct-34.3*
[**2123-3-20**] 06:25AM BLOOD Glucose-121* UreaN-50* Creat-1.7* Na-142
K-4.0 Cl-100 HCO3-35* AnGap-11
[**2123-3-19**] 05:55AM BLOOD calTIBC-239* VitB12-1621* Folate->20
Ferritn-174* TRF-184*, IRON-53
[**2123-3-9**] 09:47PM BLOOD %HbA1c-6.1*
[**2123-3-19**] 05:55AM BLOOD TSH-5.0*
[**2123-3-19**] 05:55AM BLOOD Ret Aut-3.8*

Brief Hospital Course:
Mrs. [**Known lastname 27671**] is a 61 year-old female with long-standing
history of CAD status post 2-vessel CABG in [**2100**], s/p multiple
stents and interventions to SVG to OM graft, admitted with LLL
pneumonia, CHF and NSTEMI.

1) NSTEMI: Ruled in at OSH with elevated CK-MB, troponin I. Cath
was attempted after pt diuresed, however cath was aborted d/t pt
discomfort and desaturation on table.  She likely became
anxious, which caused tachycardia, demand-mediated ischemia, and
then flash pulmonary edema.  She quickly recovered. Cath showed
30-40% SVG-LAD-D, and 80% OM distal to SVG. She was subsequently
re-cathed and two bare metal stents were placed to her SVG-OM.
Pt now on ASA, plavix, BB, lipitor, Imdur, hydralazine, CCB.  Of
note, pt gets ARF on ACE inhibitors.

2) Refractory HTN: Pt's outpt hydralazine was doubled with
better control of her blood pressure, around 130-150
systolically.  The suspicion of renal artery stenosis was
raised.

3) CHF: She had flash pulmonary edema at the OSH, likely due to
ischemia as described above.  ECHO was limited, but showed
probably normal EF, with 3-4+ MR. Pt was aggresively diuresed to
a dry weight of 133.8kg, which is the lowest she has weighed per
pt.  Pt will continue spironolactone and Demadex, which was
increased in dose.

4) LLL pneumonia: Treated with CTX and Azithromycin.

5) COPD: Pt not on standing inhalers at home. Started on Advair
100/50 1 inhalation [**Hospital1 **].  She received Atrovent and Albuterol
nebs for bronchodilator therapy during her hospitalization, and
was d/c'd on MDI's.  There was no need for steroids.

6) ARF: Due to Lisinopril, with resolution of the medication.
Would not give pt ACE inhibitors in the future given her
propensity to go into ARF on them.

6) Hyperglycemia: Patient denies history of DM type 2. However,
she has risk factors for it, and prior records document DM type
2.  Her HBA1C = 6.1%, consistent with borderline diabetes.

7) Anemia, maybe d/t hypothyroidism: Pt was guiaic negative with
normal iron, vitamin B12, and folate.  Her TSH was elevated, and
her [**Hospital1 27672**] dose was increased.  She was transfused a total of 2
units of PRBC during her hospitalization with her hematocrit on
discharge = 34.  She will follow up with her outpt PCP.

8) Hypothryoidism: Inadequately treated on [**Last Name (LF) 27672**], [**First Name3 (LF) **] her dose
was increased.

9) Left forearm thrombophlebitis: Due to an IV, with no evidence
of infection.

FULL CODE


Medications on Admission:
Nitro-Patch 0.8 mg/hour 24 hours a day
Adalat CC 90 mg PO QD
Aldactone 50 mg PO QD
Albuterol 2 inh q4 hours prn (not using it)
Serevent (not using it)
Hydralazine 25 mg PO TID
Atenolol 150 mg PO QD
Calcium 600 mg PO BID with vitamin D 400 IU daily
Celexa 20 mg PO QD
Demadex 40 mg PO BID
Depakote 250 mg PO BID
Detrol LA 4 mg PO QD
ECASA 325 mg PO QD
Folic acid ? dose
Imdur 120 mg PO BID
Klor-Con 20 mEq PO QD
[**First Name3 (LF) 27672**] 50 mcg PO QD
Lipitor 80 mg PO QD
MVI 1 tablet PO QD
NTG SL prn
Plavix 75 mg PO QD
Protonix 40 mg PO BID
Colace 100 mg PO BID
Welchol 625 mg PO QD
Zyprexa 2.5 mg PO QHS

Discharge Medications:
1. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
2. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO
DAILY (Daily).
3. Citalopram Hydrobromide 20 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
4. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*60 Disk with Device(s)* Refills:*0*
5. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
6. Calcium 600mg by mouth twice a day
7. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Divalproex Sodium 250 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO BID (2 times a day).
10. Multivitamin,Tx-Minerals     Tablet Sig: One (1) Tablet PO
DAILY (Daily).
11. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.)
Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12
hours).
12. Olanzapine 2.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
13. Atenolol 50 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
14. Spironolactone 25 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
15. Torsemide 20 mg Tablet Sig: Three (3) Tablet PO 3 pills
(60mg) every morning and 2 pills (40mg) every evening.
Disp:*150 Tablet(s)* Refills:*0*
16. Hydralazine HCl 50 mg Tablet Sig: One (1) Tablet PO Q8H
(every 8 hours).
Disp:*90 Tablet(s)* Refills:*0*
17. Levothyroxine Sodium 75 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
18. Nitroglycerin 0.4 mg/hr Patch 24HR Sig: One (1) Patch 24HR
Transdermal Q24H (every 24 hours): On for 12 hours, off for 12
hours.
19. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24HR
Sig: Two (2) Tablet Sustained Release 24HR PO BID (2 times a
day).
20. Detrol LA 4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO once a day.
21. Adalat CC 90 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO once a day.
22. Atrovent 0.03 % Aerosol, Spray Sig: One (1)  Nasal twice a
day.
23. WelChol 625 mg Tablet Sig: One (1) Tablet PO once a day.
24. Klor-Con 20 mEq Packet Sig: One (1)  PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] Nursing Services

Discharge Diagnosis:
1. NSTEMI s/p cardiac cath with 2 bare metal stents to SVG-OM
2. Decompensated CHF
3. LLL Pneumonia
4. Anemia NOS
5. Left forearm thrombophlebitis
6. Hyperglycemia
7. Hypothyroidism

Discharge Condition:
Pt had stable vital signs, a blood pressure around 140
systolically, with a Hct of 34, able to ambulate with walker,
saturating > 91% on room air, weighing 133.8 kgs, which is her
dry weight.

Discharge Instructions:
Please weight yourself each morning.  If you gain more than 3
pounds call your doctor.  Adhere to a 2mg Sodium per day diet.

Please continue taking all your medications as prescribed.  Call
your doctor or return to the hospital if you experience chest
pain, shortness of breath, weakness, pallor, inability to
urinate, fever.

Followup Instructions:
Call Dr. [**Last Name (STitle) **] for a follow up appointment this week.  He
will check your fluid status, blood counts, and kidney function.
{'Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Other vascular complications of medical care, not elsewhere classified,Acute kidney failure, unspecified,Anemia, unspecified,Unspecified acquired hypothyroidism,Phlebitis and thrombophlebitis of other sites,Other restorative surgery causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Coronary atherosclerosis of artery bypass graft'}


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: Transfer from [**Hospital3 **] for respiratory distress,
elevated troponins and pneumonia.

PRESENT ILLNESS: Ms. [**Known lastname 27671**] is a 60 year-old patient of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 11493**] with a
long history of CAD s/p 2-vessel CABG in [**2100**] (SVG to LAD and
SVG to OM), s/p PTCA to RCA and multiple PTCAs and brachytherapy
of the SVG to OM (last in [**2121-1-29**]), who was admitted to
[**Location (un) **] with cough and wheezing, as well as anginal symptoms on
[**2123-3-8**]. She describes a sore throat with "gland swelling" for
2-3 days PTA, anorexia, as well as a productive cough and
wheezing on the day prior to presentation. She also had several
anginal episodes in the day prior to admission, some at rest,
relieved with NTG SL.

MEDICAL HISTORY: 1. Coronary artery disease, s/p CABG in [**2100**] with SVG to the LAD
and an SVG to the OM. S/p RCA stenting in [**2114**], s/p stenting of
SVG to OM in [**2117**], s/p PTCA of focal instent restenosis at the
ostium of SVG to the OM, s/p PTCA and gammatherapy of SVG to OM
in 01/[**2121**]. Last cath in [**7-/2122**]: SVG to the LAD had mild
diffuse disease up to 30%, patent SVG to OM with 40-50% stenosis
in the mid distal graft section not hemodynamically significant
to the obtuse marginal and the previously placed stent was
widely patent. Concern over possible ostial RCA lesion, but
could not be engaged.
2. Peripheral vascular disease
3. CHF, EF unknown. Had echo in past month at OSH.
4. Status post bilateral carotid stenting [**10/2117**]
5. COPD/Asthma, no prior intubation, no home O2.
6. Depression
7. GERD
8. Irritable bowel syndrome
9. Osteoarthritis
10. Kidney stones
11. Obesity

MEDICATION ON ADMISSION: Nitro-Patch 0.8 mg/hour 24 hours a day
Adalat CC 90 mg PO QD
Aldactone 50 mg PO QD
Albuterol 2 inh q4 hours prn (not using it)
Serevent (not using it)
Hydralazine 25 mg PO TID
Atenolol 150 mg PO QD
Calcium 600 mg PO BID with vitamin D 400 IU daily
Celexa 20 mg PO QD
Demadex 40 mg PO BID
Depakote 250 mg PO BID
Detrol LA 4 mg PO QD
ECASA 325 mg PO QD
Folic acid ? dose
Imdur 120 mg PO BID
Klor-Con 20 mEq PO QD
[**First Name3 (LF) 27672**] 50 mcg PO QD
Lipitor 80 mg PO QD
MVI 1 tablet PO QD
NTG SL prn
Plavix 75 mg PO QD
Protonix 40 mg PO BID
Colace 100 mg PO BID
Welchol 625 mg PO QD
Zyprexa 2.5 mg PO QHS

ALLERGIES: Sulfur / Morphine / Imipramine / Oxybutynin / Oxycontin / Ace
Inhibitors

PHYSICAL EXAM: Physical examination on admission to CCU:
VITALS: T 99.0, HR 81, BP right arm (164/67, left arm 117/67)
previously documented, RR 16, Sat 100% on NRB
GEN: Morbidly obese caucasian woman. Mildly tachypneic.
HEENT: Anicteric. MMM.
NECK: Bilateral carotid bruits. Bilateral clavicular bruits (?
subclavian). JVP difficult to assess secondary to body habitus.
RESP: Distant breath sounds. Distant inspiratory crackles,
wheezing anteriorly.
CVS: Distant heart sounds. Normal S1, S2. No S3, S4. SEM at
LLSB, difficult to characterize.
GI: Obese abdomen. Soft, non-tender.
EXT: Good right femoral pulse, unable to palpate left femoral
pulse. Difficult to assess for bruit secondary to body habitus.
Palpable right DP pulse, unable to palpate other pulses. 1+
bilateral edema, slightly more on the right.
NEURO: Alert and oriented X 3.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: She lives alone. She has a housekeeper who comes in once a week
to help with her laundry. Ex-smoker, she quit 23 years ago. She
denies EtOH use. 

### Response:
{'Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Other vascular complications of medical care, not elsewhere classified,Acute kidney failure, unspecified,Anemia, unspecified,Unspecified acquired hypothyroidism,Phlebitis and thrombophlebitis of other sites,Other restorative surgery causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Coronary atherosclerosis of artery bypass graft'}
