CHIEF COMPLAINT: Hypotension

PRESENT ILLNESS: History taken with use of Spanish interpretor. The patient is a
53 y/o F with a PMH of fibromyalgia and hypertension presenting
with chest discomfort, shortness of breath and hypotension. The
patient reports that she began to feel increasingly unwell
yesterday when she noted increased fatigue and did not leave her
home. Today she noted dyspnea and dizziness while walking with
her daughter. She had to stop frequently to catch her breath
while walking home and had difficulty ambulating up stairs. She
also reports difficulty swallowing secondary to throat
tightness, with dysphagia to hard solid foods for one month. She
has had symptoms like this before, last time one week ago. She
sleeps on four pillows nightly due to difficulty breathing.
Denies PND. She called EMS for transport to the ED. On arrival
to the ED she complaints of [**10-24**] chest pain with associated
diaphoresis and shortness of breath.
.
In the ED, initial vitals: T 99.6, HR 89, BP 106/60, 98% RA. She
was given zofran 2mg IV, ntg sl, tylenol 1000 mg, ketorolac 30mg
IV. EMS had been concerned about ECG and code STEMI was called.
On arrival to ED, ECG was not felt to be consistent with acute
ischemia. She underwent a FAST scan which was negative for
pericardial effusion. CTA negative for PE or dissection. Her BP
dropped to 80s after reciept of SL NTG. She was given 2L NS
without response in BP. Her BP improved to 90s after 3rd L NS.
She reported continued chest discomfort [**7-24**], which was
reproducible upon palpation of the sternum.
.
On arrival to the MICU, the patient complains of continued
discomfort in her chest and throat.

MEDICAL HISTORY: GERD.
Bilateral carpal tunnel syndrome.
Hypertension
Lumbosacral radiculopathy.
Depression.
Fibromyalgia.
.
SURGICAL HISTORY
Carpal tunnel release.
Cholecystectomy.
Laser surgery on the right eye.

MEDICATION ON ADMISSION: Fluticasone 50 mcg Spray, 2 puff daily
Gabapentin 300 mg Capsule TID
Lisinopril 10 mg Tablet daily
Metoprolol Tartrate 25 mg Tablet [**Hospital1 **]
Nitroglycerin 0.3 mg Tablet, Sublingual PRN
Nortriptyline 50 mg Capsule QHS
Tramadol 50 mg Tablet one or two Tablet(s) by mouth daily as
needed   Aspirin 325 mg Tablet daily
Loratadine 10 mg Tablet daily
Nicotine 7 mg/24 hour Patch 24 hr

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM ON ADMISSION:
Vitals: T 97.3, BP 87/51, RR 16, O2 100% 2L
GEN: alert, oriented X3, NAD
HEENT: MMM, OP clear, patchy alopecia.
CV: RRR, nl s1/s2, no MRG, palpable, reproducible tenderness
along sternum, pulses palp 2+ radial, PT/DP
RESP: CTAB, no WRR
ABD: soft, NT/ND, NABS. Tendeness at epigastrium.
EXT: no edema
.
PHYSICAL EXAM AT DISCHARGE:
Vitals: T 97.9, BP 138/86, RR 18, pulse 77, O2 97%RA
GEN: alert, oriented X3, NAD
HEENT: MMM
CV: RRR, nl s1/s2, no MRG, pulses palp 2+ radial, PT/DP
RESP: CTAB, no WRR
ABD: soft, NT/ND, NABS
EXT: no edema

FAMILY HISTORY: Mother died with liver disease.  Father died at 45 with a heart
attack.  One brother died with renal failure.

SOCIAL HISTORY: She is a widow, her husband was alcoholic and committed suicide
three years ago.  She lives with youngest daughter. The patient
is currently unemployed after being laid off from a foods
service job 6 weeks ago.
Habits: Current tobacco use with 5 cig/daily. No EtOH or IVDU.
Esophageal reflux,Other chest pain,Myalgia and myositis, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypotension, unspecified,Anemia, unspecified,Anxiety state, unspecified,Depressive disorder, not elsewhere classified
Esophageal reflux,Chest pain NEC,Myalgia and myositis NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Hypotension NOS,Anemia NOS,Anxiety state NOS,Depressive disorder NEC
Admission Date:  [**2150-9-8**]              Discharge Date:   [**2150-9-11**]

Date of Birth:  [**2096-12-6**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 689**]
Chief Complaint:
Hypotension

Major Surgical or Invasive Procedure:
none


History of Present Illness:
History taken with use of Spanish interpretor. The patient is a
53 y/o F with a PMH of fibromyalgia and hypertension presenting
with chest discomfort, shortness of breath and hypotension. The
patient reports that she began to feel increasingly unwell
yesterday when she noted increased fatigue and did not leave her
home. Today she noted dyspnea and dizziness while walking with
her daughter. She had to stop frequently to catch her breath
while walking home and had difficulty ambulating up stairs. She
also reports difficulty swallowing secondary to throat
tightness, with dysphagia to hard solid foods for one month. She
has had symptoms like this before, last time one week ago. She
sleeps on four pillows nightly due to difficulty breathing.
Denies PND. She called EMS for transport to the ED. On arrival
to the ED she complaints of [**10-24**] chest pain with associated
diaphoresis and shortness of breath.
.
In the ED, initial vitals: T 99.6, HR 89, BP 106/60, 98% RA. She
was given zofran 2mg IV, ntg sl, tylenol 1000 mg, ketorolac 30mg
IV. EMS had been concerned about ECG and code STEMI was called.
On arrival to ED, ECG was not felt to be consistent with acute
ischemia. She underwent a FAST scan which was negative for
pericardial effusion. CTA negative for PE or dissection. Her BP
dropped to 80s after reciept of SL NTG. She was given 2L NS
without response in BP. Her BP improved to 90s after 3rd L NS.
She reported continued chest discomfort [**7-24**], which was
reproducible upon palpation of the sternum.
.
On arrival to the MICU, the patient complains of continued
discomfort in her chest and throat.


Past Medical History:
GERD.
Bilateral carpal tunnel syndrome.
Hypertension
Lumbosacral radiculopathy.
Depression.
Fibromyalgia.
.
SURGICAL HISTORY
Carpal tunnel release.
Cholecystectomy.
Laser surgery on the right eye.


Social History:
She is a widow, her husband was alcoholic and committed suicide
three years ago.  She lives with youngest daughter. The patient
is currently unemployed after being laid off from a foods
service job 6 weeks ago.
Habits: Current tobacco use with 5 cig/daily. No EtOH or IVDU.

Family History:
Mother died with liver disease.  Father died at 45 with a heart
attack.  One brother died with renal failure.

Physical Exam:
PHYSICAL EXAM ON ADMISSION:
Vitals: T 97.3, BP 87/51, RR 16, O2 100% 2L
GEN: alert, oriented X3, NAD
HEENT: MMM, OP clear, patchy alopecia.
CV: RRR, nl s1/s2, no MRG, palpable, reproducible tenderness
along sternum, pulses palp 2+ radial, PT/DP
RESP: CTAB, no WRR
ABD: soft, NT/ND, NABS. Tendeness at epigastrium.
EXT: no edema
.
PHYSICAL EXAM AT DISCHARGE:
Vitals: T 97.9, BP 138/86, RR 18, pulse 77, O2 97%RA
GEN: alert, oriented X3, NAD
HEENT: MMM
CV: RRR, nl s1/s2, no MRG, pulses palp 2+ radial, PT/DP
RESP: CTAB, no WRR
ABD: soft, NT/ND, NABS
EXT: no edema


Pertinent Results:
LABORATORY RESULTS:
.
[**2150-9-8**] 12:00PM BLOOD WBC-6.0 RBC-3.81* Hgb-10.8* Hct-33.1*
MCV-87 MCH-28.4 MCHC-32.7 RDW-14.2 Plt Ct-306
[**2150-9-8**] 10:04PM BLOOD Hct-30.7*
[**2150-9-9**] 05:10AM BLOOD WBC-3.9* RBC-3.48* Hgb-9.4* Hct-30.8*
MCV-88 MCH-27.1 MCHC-30.7* RDW-13.5 Plt Ct-236
[**2150-9-10**] 05:00AM BLOOD WBC-4.2 RBC-3.67* Hgb-10.1* Hct-31.7*
MCV-87 MCH-27.6 MCHC-31.9 RDW-13.5 Plt Ct-250
[**2150-9-11**] 05:25AM BLOOD WBC-4.7 RBC-3.63* Hgb-10.0* Hct-31.1*
MCV-86 MCH-27.7 MCHC-32.3 RDW-13.6 Plt Ct-247
[**2150-9-8**] 12:00PM BLOOD PT-12.0 PTT-26.2 INR(PT)-1.0
[**2150-9-8**] 12:00PM BLOOD Fibrino-229
[**2150-9-8**] 12:00PM BLOOD UreaN-10 Creat-0.9
[**2150-9-9**] 05:10AM BLOOD Glucose-94 UreaN-8 Creat-0.7 Na-136 K-4.7
Cl-107 HCO3-21* AnGap-13
[**2150-9-10**] 05:00AM BLOOD Glucose-129* UreaN-9 Creat-0.7 Na-140
K-4.2 Cl-106 HCO3-27 AnGap-11
[**2150-9-11**] 05:25AM BLOOD Glucose-124* UreaN-9 Creat-0.7 Na-141
K-3.7 Cl-103 HCO3-31 AnGap-11
[**2150-9-8**] 12:00PM BLOOD CK(CPK)-130
[**2150-9-8**] 07:12PM BLOOD ALT-29 AST-26 CK(CPK)-109 AlkPhos-52
TotBili-0.2
[**2150-9-9**] 05:10AM BLOOD ALT-32 AST-34 CK(CPK)-103 AlkPhos-52
TotBili-0.2
[**2150-9-8**] 12:00PM BLOOD Lipase-30
[**2150-9-8**] 07:12PM BLOOD CK-MB-3 cTropnT-<0.01
[**2150-9-9**] 05:10AM BLOOD CK-MB-3 cTropnT-<0.01
[**2150-9-10**] 05:00AM BLOOD Calcium-9.2 Phos-3.6 Mg-2.0
[**2150-9-11**] 05:25AM BLOOD Calcium-8.9 Phos-4.2 Mg-1.9
[**2150-9-9**] 05:10AM BLOOD Cortsol-0.6*
[**2150-9-10**] 05:21AM BLOOD Cortsol-6.0
[**2150-9-10**] 05:58AM BLOOD Cortsol-13.9
[**2150-9-10**] 06:58AM BLOOD Cortsol-17.8
[**2150-9-11**] 05:25AM BLOOD Cortsol-5.1
[**2150-9-8**] 12:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2150-9-8**] 10:55PM BLOOD Type-[**Last Name (un) **] pO2-169* pCO2-41 pH-7.36
calTCO2-24 Base XS--1 Comment-GREEN TOP
[**2150-9-8**] 12:16PM BLOOD Glucose-113* Lactate-2.7* Na-136 K-4.3
Cl-101 calHCO3-24
[**2150-9-8**] 10:55PM BLOOD Lactate-1.2
[**2150-9-10**] 05:21AM BLOOD ACTH - FROZEN-PND
.
[**2150-9-8**] 2:20 pm URINE CULTURE (Final [**2150-9-9**]): NO GROWTH.
[**2150-9-8**]: Blood Culture: No growth
[**2150-9-9**]: Blood Culture: No growth
.
STUDIES:
.
EKG [**2150-9-8**]: Tracing #1: Sinus rhythm. ST-T wave configuration
suggests early repolarization pattern but clinical correlation
is suggested. Compared to the previous tracing of [**2150-4-29**] no
significant change.
EKG [**2150-9-8**]: Tracing #2: Sinus rhythm. ST-T wave configuration
suggests early repolarization pattern but clinical correlation
is suggested. Compared to the previous tracing of same date no
significant change.
EKG [**2150-9-8**]: Tracing #3: Sinus rhythm. ST-T wave configuration
suggests early repolarization pattern but clinical correlation
is suggested. Compared to the previous tracing of same date no
significant change.
EKG [**2150-9-8**]: Tracing #4: Sinus rhythm. ST-T wave configuration
suggests early repolarization pattern but clinical correlation
is suggested. Compared to the previous tracing of same date no
significant change.
CXR [**2150-9-8**]: IMPRESSION: There is no evidence of pneumonia or
CHF.
There is no pneumothorax or pleural effusion. The heart is
mildly enlarged. The aorta is tortuous. There is no definite
acute displaced fracture.
.
CTA [**2150-9-8**]: IMPRESSION: Limited study due to technique. No
definite pulmonary embolism within the main, primary, lobar or
large segmental branches of the pulmonary artery. Cardiomegaly.
Incidentally noted aberrant right subclavian artery.
.
CT HEAD [**2150-9-8**]: IMPRESSION: No definite acute intracranial
abnormality.
.
UGI AIR w/o KUB: [**2150-9-10**]: IMPRESSION: IMPRESSION: Small amount
of penetration into the vestibule. No aspiration into the
airway. Prominent cricopharyngeus impression with free passage
of a barium tablet.

Brief Hospital Course:
53 y/o F with a PMH of fibromyalgia and hypertension presenting
with chest discomfort, shortness of breath, admitted for
hypotension.
.
# HYPOTENSION: SBP 106 at ED triage, dropped to 80s after nitro
SL, and stable in 100-110s after 3L IVF. SBP in 100-110s is
likely relative hypotension given her h/o HTN. However, she
remains well-perfused on exam, with Cr and lactate within normal
limits.
.
Unclear etiology. Initial concern for ACS, aortic dissection, or
PE, but CE negative and stable, ECG unchanged from prior, and
CTA negative. Arm pain could represent atypical CP, but likely
MSK/fibromyalgia since it is exacerbated with movement and
consistent with past arm pain. Volume depletion is possible but
pt does not seem overtly volume down on exam or labs. Some
improvement in ED with 2.6L of IVF but little change with final
500cc in MICU followed by autodiuresis, which indicates adequate
fluid status but persistent relative hypotension. Minimal
evidence of significant infection-- no fever, tachycardia. WBC
down and lymphocytosis on [**9-9**], so viral infection is possible.
However, vasodilation due to infection is unlikely since she
does not meet SIRS criteria aside from WBC. BCx and UCx pending.
Abx held give lack of evidence of infection. Blood loss possible
given GERD symptoms and Hct down from 39.1 on [**6-23**] from 39.1 to
33 at admission and to 30.7 on [**9-9**]. Thus, GI bleed in setting
of gastritis is possible, but she denies changes to bowel
movement, guaiac was negative,and Hct has stabilized. Medication
effect from metoprolol and lisinopril less likely since patient
was adamant about adhering to the prescribed doses.
Nitroglycerin effect unlikely to cause prolonged hypotension.
Adrenal insufficiency is possible given hypotension and
borderline low sodium. Random cortisol level was low but pt
responded appropriately to cosyntropin stimulation test.
Outpatient hypertensives were held. Pt then became hypertensive
and her metoprolol was restarted at low dose and pt monitored.
Blood pressures remained stable and at discharge was 138/86.
.
# Chest Discomfort: Likely due to GERD given ascending
retrosternal burn, throat pain/tightness c/w prior experiences
with GERD. GI cocktail with some effect. +/-MSK or
costochondritis, especially given arm pain this AM. As noted,
cardiac etiology less likely given unchanged EKG and negative
CE. However, other cardiac etiologies including unstable angina,
coronary vasospasm. Should follow up with outpatient
cardiologist to see if catheterization is planned. A
pharmacologic sestamibi stress test or similar CVD work up may
be warranted given recent increase in health care
visits/hospitalizations associated with chest pain. Significant
anxiety given loss of job could exacerbate chest pain and cause
sensation of SOB, throat tightness, weakness. Dysphagia to hard
solids with history of GERD is suspicious for esophageal
stricture/adhesion or esophageal spasm. Barium swallow was
performed showing no obstruction or esophageal pathology. PPI
and GI cocktail prn started and patient discharged on famotidine
10mg tablet [**Hospital1 **].
.
# ANEMIA: Hct down from 39.1 on [**6-23**] to 33 at admission and to
30.7 on [**9-9**], then stable at 30.8. No clinical signs of poor
perfusion, Cr stable. However, history of GERD could be
associated with GI bleed in the setting of gastritis, although
guaiac was negative and she denies changes to BM per above.
Hemolysis less likely given normal tbili.
.
# ANXIETY/DEPRESSION: Worse in past 6 months following loss of
her job, with worsening insomnia, headaches and anxious mood
(per daughter, patient does not endorse) in the last month. No
outpatient anxiolytics. Will likely defer to outpatient care
providers, but would consider outpatient start of SSRI.
.
# FIBROMYALGIA: Continued gabapentin and nortriptyline
.
# FEN - regular diet, replete lytes PRN
.
# Ppx - heparin sc, pneumoboots
.
# ACCESS - PIV X2
.
# DISPO - Home

Medications on Admission:
Fluticasone 50 mcg Spray, 2 puff daily
Gabapentin 300 mg Capsule TID
Lisinopril 10 mg Tablet daily
Metoprolol Tartrate 25 mg Tablet [**Hospital1 **]
Nitroglycerin 0.3 mg Tablet, Sublingual PRN
Nortriptyline 50 mg Capsule QHS
Tramadol 50 mg Tablet one or two Tablet(s) by mouth daily as
needed   Aspirin 325 mg Tablet daily
Loratadine 10 mg Tablet daily
Nicotine 7 mg/24 hour Patch 24 hr


Discharge Medications:
1. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2)
Spray Nasal DAILY (Daily).
2. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
3. Tramadol 50 mg Tablet Sig: 1-2 Tablets PO once a day as
needed for pain.
4. Famotidine 10 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
6. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
7. Nortriptyline 50 mg Capsule Sig: One (1) Capsule PO at
bedtime.
8. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
active GERD


Discharge Condition:
stable


Discharge Instructions:
You were admitted to the hospital because of chest discomfort
and a low blood pressure. Your chest discomfort is most likely
due to your GERD and less likely due to a [**Last Name **] problem. It is
recommended that you follow up with your cardiologist to confirm
this. Your blood pressure normalized after we withheld your
medications and gave you fluids and can be restarted.

Famotidine was added to your home medications and is to be taken
twice a day. The rest of your home medications can be continued
as outpatient.

Please keep your scheduled appointments or contact the provider
[**Name9 (PRE) 67751**] you need to reschedule.

Please contact the hospital or your doctor if you should
experience a fever of greater than 101, shortness of breath or
chest pain.


Followup Instructions:
Please contact the provider if you should need to
reschedule/cancel any of your appointments.

Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2150-10-1**] 3:20
Provider: [**First Name11 (Name Pattern1) 1569**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 4012**], MD Phone:[**Telephone/Fax (1) 1144**]
Date/Time:[**2150-10-30**] 2:40
Provider: [**First Name8 (NamePattern2) 11595**] [**Last Name (NamePattern1) 11596**], MD Phone:[**Telephone/Fax (1) 2226**] Date/Time:[**2150-11-6**]
1:00

Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 16624**], MD Phone:[**Telephone/Fax (1) 1803**]
Date/Time:[**2150-10-12**] 2:00



Completed by:[**2150-9-11**]
{'Esophageal reflux,Other chest pain,Myalgia and myositis, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypotension, unspecified,Anemia, unspecified,Anxiety state, unspecified,Depressive disorder, not elsewhere classified'}


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: Hypotension

PRESENT ILLNESS: History taken with use of Spanish interpretor. The patient is a
53 y/o F with a PMH of fibromyalgia and hypertension presenting
with chest discomfort, shortness of breath and hypotension. The
patient reports that she began to feel increasingly unwell
yesterday when she noted increased fatigue and did not leave her
home. Today she noted dyspnea and dizziness while walking with
her daughter. She had to stop frequently to catch her breath
while walking home and had difficulty ambulating up stairs. She
also reports difficulty swallowing secondary to throat
tightness, with dysphagia to hard solid foods for one month. She
has had symptoms like this before, last time one week ago. She
sleeps on four pillows nightly due to difficulty breathing.
Denies PND. She called EMS for transport to the ED. On arrival
to the ED she complaints of [**10-24**] chest pain with associated
diaphoresis and shortness of breath.
.
In the ED, initial vitals: T 99.6, HR 89, BP 106/60, 98% RA. She
was given zofran 2mg IV, ntg sl, tylenol 1000 mg, ketorolac 30mg
IV. EMS had been concerned about ECG and code STEMI was called.
On arrival to ED, ECG was not felt to be consistent with acute
ischemia. She underwent a FAST scan which was negative for
pericardial effusion. CTA negative for PE or dissection. Her BP
dropped to 80s after reciept of SL NTG. She was given 2L NS
without response in BP. Her BP improved to 90s after 3rd L NS.
She reported continued chest discomfort [**7-24**], which was
reproducible upon palpation of the sternum.
.
On arrival to the MICU, the patient complains of continued
discomfort in her chest and throat.

MEDICAL HISTORY: GERD.
Bilateral carpal tunnel syndrome.
Hypertension
Lumbosacral radiculopathy.
Depression.
Fibromyalgia.
.
SURGICAL HISTORY
Carpal tunnel release.
Cholecystectomy.
Laser surgery on the right eye.

MEDICATION ON ADMISSION: Fluticasone 50 mcg Spray, 2 puff daily
Gabapentin 300 mg Capsule TID
Lisinopril 10 mg Tablet daily
Metoprolol Tartrate 25 mg Tablet [**Hospital1 **]
Nitroglycerin 0.3 mg Tablet, Sublingual PRN
Nortriptyline 50 mg Capsule QHS
Tramadol 50 mg Tablet one or two Tablet(s) by mouth daily as
needed   Aspirin 325 mg Tablet daily
Loratadine 10 mg Tablet daily
Nicotine 7 mg/24 hour Patch 24 hr

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM ON ADMISSION:
Vitals: T 97.3, BP 87/51, RR 16, O2 100% 2L
GEN: alert, oriented X3, NAD
HEENT: MMM, OP clear, patchy alopecia.
CV: RRR, nl s1/s2, no MRG, palpable, reproducible tenderness
along sternum, pulses palp 2+ radial, PT/DP
RESP: CTAB, no WRR
ABD: soft, NT/ND, NABS. Tendeness at epigastrium.
EXT: no edema
.
PHYSICAL EXAM AT DISCHARGE:
Vitals: T 97.9, BP 138/86, RR 18, pulse 77, O2 97%RA
GEN: alert, oriented X3, NAD
HEENT: MMM
CV: RRR, nl s1/s2, no MRG, pulses palp 2+ radial, PT/DP
RESP: CTAB, no WRR
ABD: soft, NT/ND, NABS
EXT: no edema

FAMILY HISTORY: Mother died with liver disease.  Father died at 45 with a heart
attack.  One brother died with renal failure.

SOCIAL HISTORY: She is a widow, her husband was alcoholic and committed suicide
three years ago.  She lives with youngest daughter. The patient
is currently unemployed after being laid off from a foods
service job 6 weeks ago.
Habits: Current tobacco use with 5 cig/daily. No EtOH or IVDU. 

### Response:
{'Esophageal reflux,Other chest pain,Myalgia and myositis, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypotension, unspecified,Anemia, unspecified,Anxiety state, unspecified,Depressive disorder, not elsewhere classified'}
