CHIEF COMPLAINT: SOB

PRESENT ILLNESS: 53yoM with h/o metastatic esophageal cancer s/p esophageal stent
(most recently stented [**1-/2104**]) and PE diagnosed in [**10/2103**] for
which he is on lovenox presents with 2 days worsening SOB,
cough, chills/sweats, vomiting at home.  Pt reports that he
started coughing, wretching and vomiting early 2days PTA. Since
then, he has been tolerating minimal PO.  Slept the night in the
chair for fear that lying down would worsen his sx.  Vomiting
and wretching continued intermittently and he became
increasingly SOB and thus, presented to [**Hospital1 18**] for further
evaluation and management.  He denies hematemesis.  He endorses
chest pain [**7-4**] intermittently which is unchanged compared to
baseline pain for which he is on fentanyl patch and dilaudid.
He has had ongoing intermittent dry cough over the past several
weeks which has has remained stable and has not become markedly
worse over the past 2-3days; he denies sputum production.  His
SOB has progressed such that he was feeling winded with any
exertion and was noting increasing SOB even at rest. Denies
orthopnea currently, however.  No abdominal pain nor diarrhea.
No dysuria/hematuria.
.
In the ED, initial vitals revealed T 101.9, HR 139, BP 88/palp,
RR 23, O2 sat 89% RA.  He received 3L IVFs to which his SBP
improved to 90s.  He was complaining of chest pain (although
appears c/w his baseline pain thought [**12-28**] to his esophag. ca)
and EKG revealed minimal ST depressions in lateral leads; CK
negative and troponin 0.02.  His hct was noted to be 24 in the
ED and out of concern for possible ischemia, he was ordered for
2U prbcs.  A CTA chest was performed which showed no e/o PE, but
did reveal what appears to be esophageal microperforation.  It
also demonstrated worsening right sided pleural effusion.
Thoracic surgery was consulted and recommended broad spectrum
antibiotics and chest tube for drainage of right pleural
effusion.  He received levofloxacin and flagyl in the ED prior
to his transfer to the ICU.
.
ROS: +SOB although he reports it is much improved from initial
presentation and is approaching his baseline, Denies subjective
fever, chills, +nausea, vomiting (non bloody, +bile), +dry
cough.  No abd pain. Last BM [**7-3**]. Reports BMs darker than in the
past, but without gross blood.  Decreased urination over the
past 24 hours. No HA/lightheadedness/changes in vision. No LE
edema.

MEDICAL HISTORY: PMH:
1. Metastatic adenocarcinoma of esophagus. Five cycles of
cisplatin and 5-FU completed [**9-/2102**], some with concurrent
radiation therapy, followed by consolidation chemotherapy alone
and also CyberKnife radiation therapy to left pelvic metastasis
in [**10-29**]. Course c/b RUE DVT related to his line. In [**7-/2103**],
Mr. [**Known lastname 13144**] began to experience difficulty swallowing,
evaluation revealed local recurrence. He was referred to Dr.
[**Last Name (STitle) **] who removed as much of the mass as possible. Started
irinotecan 65 mg/m2 day one and day eight and cisplatin 30 mg/m2
days one and day eight of three-week cycle [**2103-10-23**]. Developed
PE [**2103-11-18**], since then is on Lovenox.
Changed to Taxotere [**1-2**] due to insufficient palliative response
in esophagus despite apparent systemic control; currently s/p
Cycle 1 Week 3 of Taxotere.
2. Hyperlipidemia
3. PE as above
h/o afib w/ rvr in setting of pericard effusion and window

MEDICATION ON ADMISSION: Lovenox 100 mg b.i.d.
Lipitor 10 mg daily
Protonix 40 mg b.i.d.
Toprol-XL 50 mg daily
Colace 100 mg b.i.d.
Remeron 15 mg daily
Ativan 1 mg q.h.s. p.r.n.
Reglan 10 mg q.6h. p.r.n.
Dilaudid 2-6 mg q.4h. p.r.n. pain
fentanyl patch 100 mcg q.72h

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:  T 97.3  BP 111/64  HR 103 ST  RR 21 O2sat 100% 3L NC
Gen:  Pale, chronically ill appearing man in NAD
HEENT:  Dry MM, pale conjunctivae
Neck:  No cervical LAD appreciated
CV:  Sinus tachy, no mrg appreciated
Resp:  No increased WOB noted.  Decreased BS right lung [**12-29**] way
up, fine rales left lung base, no wheezes nor rhonchi
appreciated
Abd:  +BS, soft, NT, ND
Ext:  2+ DP/PT pulses b/l, no c/c/e
Neuro:  CN 2-12, strength, sensation grossly intact

FAMILY HISTORY: Mother had ovarian cancer at age 54, father MI age 48. Multiple
family members on mother's side with 'cancers' 3
brothers/sisters in good health.

SOCIAL HISTORY: married and lives w/ wife, 17 and 13-yo sons, works in IT, never
smoked. Nonsmoker, occasional EtOH.  Last worked [**1-2**].  Has
recently started driving again.  Independent w/ ADLs at home.
Unspecified pleural effusion,Pneumonitis due to inhalation of food or vomitus,Malignant neoplasm of other specified part of esophagus,Hyposmolality and/or hyponatremia,Other specified cardiac dysrhythmias,Anemia, unspecified,Mixed hyperlipidemia,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism
Pleural effusion NOS,Food/vomit pneumonitis,Mal neo esophagus NEC,Hyposmolality,Cardiac dysrhythmias NEC,Anemia NOS,Mixed hyperlipidemia,Long-term use anticoagul,Hx-ven thrombosis/embols
Admission Date:  [**2104-7-5**]              Discharge Date:   [**2104-7-15**]

Date of Birth:  [**2051-4-1**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3276**]
Chief Complaint:
SOB

Major Surgical or Invasive Procedure:
[**2104-7-5**] chest tube placement

History of Present Illness:
53yoM with h/o metastatic esophageal cancer s/p esophageal stent
(most recently stented [**1-/2104**]) and PE diagnosed in [**10/2103**] for
which he is on lovenox presents with 2 days worsening SOB,
cough, chills/sweats, vomiting at home.  Pt reports that he
started coughing, wretching and vomiting early 2days PTA. Since
then, he has been tolerating minimal PO.  Slept the night in the
chair for fear that lying down would worsen his sx.  Vomiting
and wretching continued intermittently and he became
increasingly SOB and thus, presented to [**Hospital1 18**] for further
evaluation and management.  He denies hematemesis.  He endorses
chest pain [**7-4**] intermittently which is unchanged compared to
baseline pain for which he is on fentanyl patch and dilaudid.
He has had ongoing intermittent dry cough over the past several
weeks which has has remained stable and has not become markedly
worse over the past 2-3days; he denies sputum production.  His
SOB has progressed such that he was feeling winded with any
exertion and was noting increasing SOB even at rest. Denies
orthopnea currently, however.  No abdominal pain nor diarrhea.
No dysuria/hematuria.
.
In the ED, initial vitals revealed T 101.9, HR 139, BP 88/palp,
RR 23, O2 sat 89% RA.  He received 3L IVFs to which his SBP
improved to 90s.  He was complaining of chest pain (although
appears c/w his baseline pain thought [**12-28**] to his esophag. ca)
and EKG revealed minimal ST depressions in lateral leads; CK
negative and troponin 0.02.  His hct was noted to be 24 in the
ED and out of concern for possible ischemia, he was ordered for
2U prbcs.  A CTA chest was performed which showed no e/o PE, but
did reveal what appears to be esophageal microperforation.  It
also demonstrated worsening right sided pleural effusion.
Thoracic surgery was consulted and recommended broad spectrum
antibiotics and chest tube for drainage of right pleural
effusion.  He received levofloxacin and flagyl in the ED prior
to his transfer to the ICU.
.
ROS: +SOB although he reports it is much improved from initial
presentation and is approaching his baseline, Denies subjective
fever, chills, +nausea, vomiting (non bloody, +bile), +dry
cough.  No abd pain. Last BM [**7-3**]. Reports BMs darker than in the
past, but without gross blood.  Decreased urination over the
past 24 hours. No HA/lightheadedness/changes in vision. No LE
edema.


Past Medical History:
PMH:
1. Metastatic adenocarcinoma of esophagus. Five cycles of
cisplatin and 5-FU completed [**9-/2102**], some with concurrent
radiation therapy, followed by consolidation chemotherapy alone
and also CyberKnife radiation therapy to left pelvic metastasis
in [**10-29**]. Course c/b RUE DVT related to his line. In [**7-/2103**],
Mr. [**Known lastname 13144**] began to experience difficulty swallowing,
evaluation revealed local recurrence. He was referred to Dr.
[**Last Name (STitle) **] who removed as much of the mass as possible. Started
irinotecan 65 mg/m2 day one and day eight and cisplatin 30 mg/m2
days one and day eight of three-week cycle [**2103-10-23**]. Developed
PE [**2103-11-18**], since then is on Lovenox.
Changed to Taxotere [**1-2**] due to insufficient palliative response
in esophagus despite apparent systemic control; currently s/p
Cycle 1 Week 3 of Taxotere.
2. Hyperlipidemia
3. PE as above
h/o afib w/ rvr in setting of pericard effusion and window


Social History:
married and lives w/ wife, 17 and 13-yo sons, works in IT, never
smoked. Nonsmoker, occasional EtOH.  Last worked [**1-2**].  Has
recently started driving again.  Independent w/ ADLs at home.


Family History:
Mother had ovarian cancer at age 54, father MI age 48. Multiple
family members on mother's side with 'cancers' 3
brothers/sisters in good health.


Physical Exam:
PE:  T 97.3  BP 111/64  HR 103 ST  RR 21 O2sat 100% 3L NC
Gen:  Pale, chronically ill appearing man in NAD
HEENT:  Dry MM, pale conjunctivae
Neck:  No cervical LAD appreciated
CV:  Sinus tachy, no mrg appreciated
Resp:  No increased WOB noted.  Decreased BS right lung [**12-29**] way
up, fine rales left lung base, no wheezes nor rhonchi
appreciated
Abd:  +BS, soft, NT, ND
Ext:  2+ DP/PT pulses b/l, no c/c/e
Neuro:  CN 2-12, strength, sensation grossly intact


Pertinent Results:
[**2104-7-4**] 09:50PM   GLUCOSE-123* UREA N-14 CREAT-1.0 SODIUM-132*
POTASSIUM-4.1 CHLORIDE-96 TOTAL CO2-26 ANION GAP-14
[**2104-7-4**] 10:17PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-SM UROBILNGN-4* PH-6.0 LEUK-NEG
[**2104-7-4**] 09:50PM   LD(LDH)-184 CK(CPK)-36* TOT BILI-0.4 DIR
BILI-0.1 INDIR BIL-0.3
[**2104-7-4**] 09:50PM   CK-MB-NotDone cTropnT-0.02*
[**2104-7-5**] 09:34AM   CK(CPK)-29* CK-MB-2 cTropnT-<0.01
[**2104-7-5**] 09:34AM   CK(CPK)-29* CK-MB-2 cTropnT-<0.01

CTA chest:
1.  No evidence for acute pulmonary embolus or aortic
dissection.  Residual chronic pulmonary emboli.
2.  Status post placement of an esophageal stent with interval
increase in foci of gas adjacent to the right mid stent.  While
these foci may be retained within the mass given the lack of gas
in the superior mediastinum, possibility of a small
microperforation is not excluded, especially given the increase
in size of adjacent moderate pleural effusion.  If clinically
indicated, further characterization with chest CT using
Esophotrast oral contrast could be performed.
3.  Stable mediastinal lymphadenopathy.
.
EKG:  Sinus tachy to rate 107, nml axis, TWI III and aVF
(unchanged from old), TW flattening in II (old shows TWI in II),
<1mm ST depression V4-V5.
.
[**2104-7-5**] pleural fluid analysis: 3+PMNs, no microorg, cytology
negative for malignant cells
.
[**2104-7-5**] Barium swallow shows widely patent esoph in proper place
with no evidence on barium swallow of communication between
esophoagus and air.

Brief Hospital Course:
A/P:  53yoM with h/o esophageal ca s/p esophageal stents p/w
2-3days of N/V, fever, and worsening SOB found to have
?esophageal microperforation on CT chest and increasing size of
right pleural effusion admitted to ICU for further management.
.
# Pleural effusion: Pt was admitted with shortness of breath.
He was found to have a large R sided pleural effusion. A chest
tube was placed on [**7-5**] by cardiothoracic surgery. Analysis was
negative for microorganisms, with cytology negative for
malignant cells.  Once cultures were finalized as negative, he
underwent talc pleurodesis, which he tolerated well.
.
# Tachycardia: The patient was tachycardic in to the 170s in the
intensive care unit, then in the 100-115 range throughout
hospitalization.  He has a history of afib in the setting of
pericardial effusion and pericardial window. Pt had good
response to IV and 25mg po lopressor. He was started on standing
lopressor po tid, which was uptitrated to 37.5mg tid per
continued tachycardia.  He was maintained on this dose
.
# Fever:  Questionable etiology of initial fever, perhaps
aspiration PNA given history of vomiting and potential RLL
infiltrate on CXR. Pt was pancultured with all cultures negative
to date. He was continued on broad spectrum antibiotic coverage,
including levofloxacin, flagyl, vancomycin.  Both vancomycin and
flagyl were discontinued and he was kept on levofloxacin upon
transfer to the floor.
.
# Esophageal cancer: CT scan performed on [**2104-6-26**] that showed
interval
increase in the right-sided pleural effusion, stable pericardial
effusion and no significant change in the esophageal wall
thickening and mass nor in the intraabdominal and mediastinal
lymphadenopathy.  He has not had chemotherapy since 2/[**2103**].
Esophageal stents placed for local recurrence most recently in
3/[**2103**]. [**7-5**] barium swallow shows widely patent esophagus with
adequate stent placement. There was initial concern for
microperforation of the esophagus on CT scan, however, barium
swallow showed widely patent esophagus in proper place with no
evidence of communication of the esophagus with the air.
Vomiting was controlled with antiemetics and then resolved.  His
diet was gradually advanced to regular solid foods.
.
# Chest pain:  Pt. has baseline pain in the setting of his
esophageal ca for which he is on fentanyl patch and dilaudid.
EKG was obtained in the ED which was largely unchanged from
prior, but ED sent cardiac enzymes out of concern for possible
very mild lateral lead ST depressions (<1mm V4-V5 on review of
EKG).  CEs were negative x 2 (pt was ruled out for MI).
Suspiscion very low for ACS and CTA negative for new PE to
suggest as cause of pain. His dose of Fentanyl patch with
increased during hospitalization and he tolerated Dilaudid po
for breakthrough pain upon discharge.


Medications on Admission:
Lovenox 100 mg b.i.d.
Lipitor 10 mg daily
Protonix 40 mg b.i.d.
Toprol-XL 50 mg daily
Colace 100 mg b.i.d.
Remeron 15 mg daily
Ativan 1 mg q.h.s. p.r.n.
Reglan 10 mg q.6h. p.r.n.
Dilaudid 2-6 mg q.4h. p.r.n. pain
fentanyl patch 100 mcg q.72h

Discharge Medications:
1. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime). Tablet(s)
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
Disp:*135 Tablet(s)* Refills:*2*
4. Enoxaparin 100 mg/mL Syringe Sig: One (1) injection
Subcutaneous Q12H (every 12 hours). injection
5. Mirtazapine 15 mg Tablet Sig: 1.5 Tablets PO HS (at bedtime).
Disp:*45 Tablet(s)* Refills:*2*
6. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 4 days.
Disp:*4 Tablet(s)* Refills:*0*
7. Fentanyl 75 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours).
Disp:*10 Patch 72 hr(s)* Refills:*2*
8. Hydromorphone 4 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
9. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia.
10. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed.
11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
12. Tessalon Perles 100 mg Capsule Sig: One (1) Capsule PO every
eight (8) hours as needed for cough for 2 weeks.
Disp:*50 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
1.) Right-sided pleural effusion
2.) Esophageal cancer
3.) Atrial tachycardia


Discharge Condition:
afebrile, displaying stable vital signs, tolerating po


Discharge Instructions:
You were admitted because of a fever and difficulty breathing.
A large amount of pfluid was found by yout right lung, which was
drained.  You then underwent talc pleurodesis to help prevent
this from happening again.  While you were in the hospital you
also had an upper endoscopy when showed that your esophageal
stent was open.
.
Please continue to take all medications as prescribed and keep
all health care appointments.
.
If you have difficulty breathing, trouble swallowing, worsening
pain, abdominal pain, nausea, vomiting or fever, or if your
condition worsens in any way, seek immediate medical attention.


Followup Instructions:
You have the following appointment with Dr. [**Last Name (STitle) 3274**] on
[**8-3**]:
.
You should also make an appointment to see Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 171**] with
cardiology within 2-3 weeks after discharge from the hospital,
at ([**Telephone/Fax (1) 1987**]
.
Provider: [**First Name8 (NamePattern2) 251**] [**Name11 (NameIs) **], MD Phone:[**0-0-**]
Date/Time:[**2104-7-29**] 9:30
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 6050**], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2104-7-29**] 9:30


                             [**First Name8 (NamePattern2) 251**] [**Name8 (MD) **] MD [**MD Number(1) 3282**]
{'Unspecified pleural effusion,Pneumonitis due to inhalation of food or vomitus,Malignant neoplasm of other specified part of esophagus,Hyposmolality and/or hyponatremia,Other specified cardiac dysrhythmias,Anemia, unspecified,Mixed hyperlipidemia,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism'}


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: SOB

PRESENT ILLNESS: 53yoM with h/o metastatic esophageal cancer s/p esophageal stent
(most recently stented [**1-/2104**]) and PE diagnosed in [**10/2103**] for
which he is on lovenox presents with 2 days worsening SOB,
cough, chills/sweats, vomiting at home.  Pt reports that he
started coughing, wretching and vomiting early 2days PTA. Since
then, he has been tolerating minimal PO.  Slept the night in the
chair for fear that lying down would worsen his sx.  Vomiting
and wretching continued intermittently and he became
increasingly SOB and thus, presented to [**Hospital1 18**] for further
evaluation and management.  He denies hematemesis.  He endorses
chest pain [**7-4**] intermittently which is unchanged compared to
baseline pain for which he is on fentanyl patch and dilaudid.
He has had ongoing intermittent dry cough over the past several
weeks which has has remained stable and has not become markedly
worse over the past 2-3days; he denies sputum production.  His
SOB has progressed such that he was feeling winded with any
exertion and was noting increasing SOB even at rest. Denies
orthopnea currently, however.  No abdominal pain nor diarrhea.
No dysuria/hematuria.
.
In the ED, initial vitals revealed T 101.9, HR 139, BP 88/palp,
RR 23, O2 sat 89% RA.  He received 3L IVFs to which his SBP
improved to 90s.  He was complaining of chest pain (although
appears c/w his baseline pain thought [**12-28**] to his esophag. ca)
and EKG revealed minimal ST depressions in lateral leads; CK
negative and troponin 0.02.  His hct was noted to be 24 in the
ED and out of concern for possible ischemia, he was ordered for
2U prbcs.  A CTA chest was performed which showed no e/o PE, but
did reveal what appears to be esophageal microperforation.  It
also demonstrated worsening right sided pleural effusion.
Thoracic surgery was consulted and recommended broad spectrum
antibiotics and chest tube for drainage of right pleural
effusion.  He received levofloxacin and flagyl in the ED prior
to his transfer to the ICU.
.
ROS: +SOB although he reports it is much improved from initial
presentation and is approaching his baseline, Denies subjective
fever, chills, +nausea, vomiting (non bloody, +bile), +dry
cough.  No abd pain. Last BM [**7-3**]. Reports BMs darker than in the
past, but without gross blood.  Decreased urination over the
past 24 hours. No HA/lightheadedness/changes in vision. No LE
edema.

MEDICAL HISTORY: PMH:
1. Metastatic adenocarcinoma of esophagus. Five cycles of
cisplatin and 5-FU completed [**9-/2102**], some with concurrent
radiation therapy, followed by consolidation chemotherapy alone
and also CyberKnife radiation therapy to left pelvic metastasis
in [**10-29**]. Course c/b RUE DVT related to his line. In [**7-/2103**],
Mr. [**Known lastname 13144**] began to experience difficulty swallowing,
evaluation revealed local recurrence. He was referred to Dr.
[**Last Name (STitle) **] who removed as much of the mass as possible. Started
irinotecan 65 mg/m2 day one and day eight and cisplatin 30 mg/m2
days one and day eight of three-week cycle [**2103-10-23**]. Developed
PE [**2103-11-18**], since then is on Lovenox.
Changed to Taxotere [**1-2**] due to insufficient palliative response
in esophagus despite apparent systemic control; currently s/p
Cycle 1 Week 3 of Taxotere.
2. Hyperlipidemia
3. PE as above
h/o afib w/ rvr in setting of pericard effusion and window

MEDICATION ON ADMISSION: Lovenox 100 mg b.i.d.
Lipitor 10 mg daily
Protonix 40 mg b.i.d.
Toprol-XL 50 mg daily
Colace 100 mg b.i.d.
Remeron 15 mg daily
Ativan 1 mg q.h.s. p.r.n.
Reglan 10 mg q.6h. p.r.n.
Dilaudid 2-6 mg q.4h. p.r.n. pain
fentanyl patch 100 mcg q.72h

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:  T 97.3  BP 111/64  HR 103 ST  RR 21 O2sat 100% 3L NC
Gen:  Pale, chronically ill appearing man in NAD
HEENT:  Dry MM, pale conjunctivae
Neck:  No cervical LAD appreciated
CV:  Sinus tachy, no mrg appreciated
Resp:  No increased WOB noted.  Decreased BS right lung [**12-29**] way
up, fine rales left lung base, no wheezes nor rhonchi
appreciated
Abd:  +BS, soft, NT, ND
Ext:  2+ DP/PT pulses b/l, no c/c/e
Neuro:  CN 2-12, strength, sensation grossly intact

FAMILY HISTORY: Mother had ovarian cancer at age 54, father MI age 48. Multiple
family members on mother's side with 'cancers' 3
brothers/sisters in good health.

SOCIAL HISTORY: married and lives w/ wife, 17 and 13-yo sons, works in IT, never
smoked. Nonsmoker, occasional EtOH.  Last worked [**1-2**].  Has
recently started driving again.  Independent w/ ADLs at home. 

### Response:
{'Unspecified pleural effusion,Pneumonitis due to inhalation of food or vomitus,Malignant neoplasm of other specified part of esophagus,Hyposmolality and/or hyponatremia,Other specified cardiac dysrhythmias,Anemia, unspecified,Mixed hyperlipidemia,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism'}
