CHIEF COMPLAINT: chest pressure

PRESENT ILLNESS: Ms. [**Known lastname 12740**] is a 85yo female with history of HTN, hypothyroidism,
and GERD, who presents from OSH with history of worsening chest
pressure, with concern for ACS, sent to [**Hospital1 18**] for cardiac cath.
Pt states that for the past year, she has had shortness of
breath and chest pressure with ambulation. She describes the
chest pressure as central, substernal, non-radiating pressure,
relieved by rest. She was at her ophthalmologist's office this
Monday, and was noted to have a high blood pressure. She then
spoke with the her PCP regarding her high BP and SOB, and he
recommended she come to the [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] this morning, so he could
evaluate her. She said that for at least the last few weeks to
months, her chest pressure has remained the same: associated
with exertion, walking or doing household chores. In fact, she
walked on the treadmill for 3 mins yesterday, and had to stop
because of chest pressure [**2161-6-8**], that was relieved after 5
minutes of rest. She has had occasional nausea, but denied
vomiting, diaphoresis, presyncope, syncope, palpitations with
this. She has only had one episode of rest pain, which occurred
[**2-4**] nights ago, while she was sitting on her couch watching a
movie. The pressure lasted for 5mins and went away completely.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: - Diabetes, - Dyslipidemia, +
Hypertension
2. CARDIAC HISTORY:
-CABG:  none
-PERCUTANEOUS CORONARY INTERVENTIONS:  as below
-PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
Hypothyroidism
HTN
TAH for fibroids
GERD

MEDICATION ON ADMISSION: Lisinopril 20mg daily
Levothyroxine 0.25mg every other day
Coenzyme Q10
Receives Avastin shots every few weeks for macular degeneration

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL:
VS: 96.9 80 120/91 19 96% 2LNC
GENERAL: WDWN pleasant, elderly female in NAD. Oriented x3.
Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Brother with CABG at 68yo, Mother with history of angina.
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: She lives at home by herself and performs all of her ADL's. She
has a friend near by ([**Name (NI) **]), and is close with her daughter
[**Name (NI) **], who accompanies her here today.
-Tobacco history:  quit 56yrs ago
-ETOH:  very rarely, a few drinks per year
-Illicit drugs:  denies
Subendocardial infarction, initial episode of care,Drug-induced delirium,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Anxiety state, unspecified,Acquired absence of both cervix and uterus,Hypocalcemia,Barbiturates causing adverse effects in therapeutic use
Subendo infarct, initial,Drug-induced delirium,Hypothyroidism NOS,Hypertension NOS,Crnry athrscl natve vssl,Esophageal reflux,Anxiety state NOS,Acq absnce cervix/uterus,Hypocalcemia,Adv eff barbiturates
Admission Date:  [**2162-2-10**]              Discharge Date:   [**2162-2-13**]

Date of Birth:  [**2076-10-2**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1145**]
Chief Complaint:
chest pressure

Major Surgical or Invasive Procedure:
cardiac catheterization with Bare metal stents x7 (3 BMS to OM,
2 BMS to LAD and 2 BMS to LCX)


History of Present Illness:
Ms. [**Known lastname 12740**] is a 85yo female with history of HTN, hypothyroidism,
and GERD, who presents from OSH with history of worsening chest
pressure, with concern for ACS, sent to [**Hospital1 18**] for cardiac cath.
Pt states that for the past year, she has had shortness of
breath and chest pressure with ambulation. She describes the
chest pressure as central, substernal, non-radiating pressure,
relieved by rest. She was at her ophthalmologist's office this
Monday, and was noted to have a high blood pressure. She then
spoke with the her PCP regarding her high BP and SOB, and he
recommended she come to the [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] this morning, so he could
evaluate her. She said that for at least the last few weeks to
months, her chest pressure has remained the same: associated
with exertion, walking or doing household chores. In fact, she
walked on the treadmill for 3 mins yesterday, and had to stop
because of chest pressure [**2161-6-8**], that was relieved after 5
minutes of rest. She has had occasional nausea, but denied
vomiting, diaphoresis, presyncope, syncope, palpitations with
this. She has only had one episode of rest pain, which occurred
[**2-4**] nights ago, while she was sitting on her couch watching a
movie. The pressure lasted for 5mins and went away completely.

Today, at the OSH ED, her initial VS were 202/73, 57, 14, 100%
2LNC. Her BP went up to 232/86. At OSH, pt was found to have ST
depressions II, III, aVF, V4-V6, and ST elevations in aVR, V1,
V2. Trop I 0.23 with normal Cr. CXR at OSH read as no acute
process. She was started on ASA 325mg, nitro patch, plavix load
600mg, Atorvastatin 80mg x1, and Lovenox at OSH. Presented to
[**Hospital1 18**] for cardiac cath.
.
During her cardiac catheterization, she was found to have XXX
stenosis of LCx, and had initially XXX stents to XXXX. However,
she continued to have chest pain, and repeat ECG's showed ST
depressions in II, III, aVF, with II>III, and depressions in
V4-V6, with STE in aVR, and V1-V3. Pt then had XXX stents to LAD
and LCx. Subsequently, she was chest pain free and repeat ECG
showed resolution of ST depressions in II, III, aVF, and
lessened depressions in V4-V6, with mild continued elevation in
aVR. She required nitro gtt for BP control, but was otherwise
hemodynamically stable and chest pain free on transfer to the
CCU for monitoring.
.
On presentation to the CCU, her VS were temp 96.9, BP 120/91, HR
80, RR 19, 96% on 2LNC. She was completely chest pain free and
without complaints.
.
On review of systems, she reports occasional GERD and anxiety.
But otherwise, she denies any prior history of stroke, TIA, deep
venous thrombosis, pulmonary embolism, cough, hemoptysis, black
stools or red stools. She denies recent fevers, chills or
rigors. She denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of paroxysmal
nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope
or presyncope.


Past Medical History:
1. CARDIAC RISK FACTORS: - Diabetes, - Dyslipidemia, +
Hypertension
2. CARDIAC HISTORY:
-CABG:  none
-PERCUTANEOUS CORONARY INTERVENTIONS:  as below
-PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
Hypothyroidism
HTN
TAH for fibroids
GERD


Social History:
She lives at home by herself and performs all of her ADL's. She
has a friend near by ([**Name (NI) **]), and is close with her daughter
[**Name (NI) **], who accompanies her here today.
-Tobacco history:  quit 56yrs ago
-ETOH:  very rarely, a few drinks per year
-Illicit drugs:  denies

Family History:
Brother with CABG at 68yo, Mother with history of angina.
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

Physical Exam:
ADMISSION PHYSICAL:
VS: 96.9 80 120/91 19 96% 2LNC
GENERAL: WDWN pleasant, elderly female in NAD. Oriented x3.
Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP non-elevated
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RRR, normal S1, S2. No murmurs, no S3 or S4
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB anteriorly,
without appreciated crackles or wheezes though limited given pt
lying down
ABDOMEN: +BS, Soft, NTND. No HSM or tenderness. No abdominal
bruits.
EXTREMITIES: no edema, dressing in place on left groin without
bleeding or evidence of hematoma. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ DP 2+ PT 2+
Left: Carotid 2+ DP 2+ PT 2+
Neuro: alert and oriented, CN II-XII intact, intact to light
sensation throughout
.
DISCHARGE PHYSICAL:
Temp Max: 98.4  Temp current: 97.7 HR: 55-60 RR: 16-18 BP:
106-202/52-74  O2 Sat: 99% RA
Gen: alert, anxious, walking around room
HEENT: supple, no JVD
CV: RRR, +S1 S2, no M/R/G
RESP: CTAB without wheezes or crackles
ABD: +BS, soft, NT/ND
EXTR: no peripheral edema, 2+ DP pulses bilaterally; right groin
with ecchymoses, but without bruit
NEURO: Alert, oriented, no halluciations
Skin: ecchymoses on right groin and abdomen
Access: PIV
Tubes: none

Pertinent Results:
ADMISSION LABS:
Hct 37 WBC 7.1 Plt 269
Na 134 K 4.3 Cl 103 HCO3 25 BUN 14 Cr 0.8
.
DISCHARGE LABS:
Hct 37.5 WBC 8.4 Plt 269
Na 143 K 3.9 Cl 108 HCO3 23 BUN 17 Cr 0.8
.
PERTINENT LABS:
CE'S:
[**2-10**]  9pm: CK-MB 5 Trop 0.11
[**2-11**] 4am: CK-MB 10 MBI 12.8 Trop 0.12
[**2-11**] 2pm: CK-MB 15 MBI 10.8 Trop 0.33
[**2-11**] 10pm:CK-MB 11 MBI 7.7  Trop 0.40
A1C: 5.9
LIPID PANEL: Total 222 LDL 145 HDL 58 TG 93

.
STUDIES:
CARDIAC CATH [**2162-2-10**]: PRELIM
COMMENTS:
1. Selective coronary angiography in this right dominant system
demonstrated two vessel disease. The LMCA had a 30% ostial
stenosis. The
LAD had a 70% proximal stenosis. The Cx had a 90% long mid
vessel
stenosis as well as a distal 80% stenosis. The RCA had a very
posterior
origin and was difficult to engage but had only minimal plaquing

throughout.
2. Limited resting hemodynamics revealed a central aortic
pressure of
157/62 mmHg. There was elevated left sided filling pressures
with an
LVEDP of 30 mmHg.
3. Careful pullback of the catheter from the LV to the aorta
revealed no
transvalvular gradient.
4. Successful stenting of the mid LCx with a MiniVision OTW
2.0x23
mm bare-metal stent (BMS) overlapped with a Minivision OTW
2.0x12 mm
BMS (distally). Successful stenting of the LCx distal to new
stents with
two overlapping MiniVision OTW 2.0x12 mm bare-metal stents.
Successful
stenting of the distal LCx/OM1 with a MiniVision 2.0x8 mm BMS.
Final
angiography revealed normal TIMI 3 flow, no angiographically
apparent
dissection and 0% residual stenosis in the new stents deployed.
(see
PTCA comments)
5. Successful stenting of the proximal-mid LAD with two
separated
MiniVision OTW 2.0x12 mm bare-metal stent (BMS). Final
angiography
revealed normal TIMI 3 flow, no angiographically apparent
dissection and
0% residual stenosis in the new stents. (see PTC comments)
6. R 6Fr femoral artery angioseal closure deviced deployed
without
complications. (see PTCA comments)

FINAL DIAGNOSIS:
1. Two vessel coronary artery disease.
2. Moderate left ventricular diastolic dysfunction.
3. Successful stenting of the prox-mid LAD and mid-distal
LCx/OM1 with
multiple bare-metal stents. (see PTCA comments)
4. Dynamic changes in the diameter of the ostium of the left
main and
catheter dampening consfor 18 hours post procedure
4. ASA indefinitely; plavix (clopidogrel) 75 mg daily for at
least one
month for bare-metal stents (see PTCA comments)
5. R 6Fr femoral artery angioseal closure device deployed
without
complications (see PTCA comments)

.
TTE [**2162-2-11**]: PRELIM
Conclusions
The left and right atria are normal in size. Lefft ventricular
wall thickness, cavity size and regional/global systolic
function are normal (LVEF >55%). Right ventricular chamber size
and free wall motion are normal. The aortic valve leaflets (3)
are mildly thickened but aortic stenosis is not present. No
aortic regurgitation is seen. No mitral regurgitation is seen.
The tricuspid valve leaflets are mildly thickened. There is mild
pulmonary artery systolic hypertension.

IMPRESSION: nomal biventricular systolic function.
.
CXR [**2162-2-11**]:
FINDINGS: The lung volumes are normal. Borderline size of the
cardiac
silhouette without pulmonary edema. No pleural effusions.
Minimal bilateral symmetrical apical thickening. Normal
appearance of the hilar and mediastinal structures.
.
MICRO:
UCx [**2162-2-11**]: URINE CULTURE (Final [**2162-2-12**]):    NO GROWTH.


Brief Hospital Course:
HOSPITAL COURSE:
Ms. [**Known lastname 12740**] is a 85yo female with history of HTN, hypothyroidism,
and GERD, who presents from OSH with history of worsening chest
pain, concern for [**Hospital 61476**] transferred to [**Hospital1 18**] for cardiac cath,
now s/p 7 BMS to LCx and LAD. Pt is hemodynamically stable, and
transferred to CCU for close monitoring.
.
ACTIVE ISSUES:
.
# CORONARIES:  Differential included ACS vs. demand ischemia [**2-3**]
uncontrolled HTN. Pt's anginal symptoms seemed to be stable in
nature rather than increasing or crescendo in nature to suggest
unstable plaque. Pt had been severely hypertensive with LVH
findings suggested on ECG. Pt went to cardiac cath with 2 stents
initially to LCx; however, pain continued post-procedure, with
concern for spasm of left main given elevations in aVR. Pt
subsequently had 3 more stents placed to LCx and 2 to LAD.
Cardiac enzymes were cycled and peaked post-procedure and
down-trended. She was started on ASA 325, Plavix 75mg daily,
Atorvastatin 80mg daily, and Integrilin for 18hrs. She was
started on metoprolol for beta blockade. ACEI was initially held
given large dye load and concern for contrast-induced
nephropathy. This was restarted as below. TTE demonstrated
preserved biventricular systolic function. A1c was sent for risk
factor stratification and was 5.9. Lipid panel was sent and
showed LDL of 145. She was continued on Atorvstatin 80mg daily.
PT consult was placed. She remained completely chest pain free.
She was discharged to continue ASA, Plavix, Atorvastatin,
Lisinopril and Metoprolol succinate.
.
# PUMP:  No history of heart failure. Pt appeared euvolemic with
elevation of JVP and clear lungs. CXR demonstrated no evidence
of pulmonary edema. As above, TTE demonstrated preserved
systolic function.
.
# RHYTHM: Initial ECG at OSH and prior to cardiac cath
demonstrated shortened PR interval, with question of possible
junction rhythm. Repeat ECG's demonstrated sinus rhythm. She was
monitored on telemetry without events.
.
# HTN: Pt presented with hypertensive urgency with SBP to 230 at
OSH. On transfer, blood pressure improved from cath, on nitro
gtt. She required titration of nitro gtt for control. We were
able to wean off the nitro. As above, ACEI was initially held
given large dye load and concern for development of
contrast-induced nephropathy. She was started on metoprolol
succinate 25mg daily. Lisinopril dose was increased to 40mg
daily. She was instructed to follow-up with her PCP for further
BP management.
.
# Large dye load: Received 440cc of contrast.  Pt was started on
IVF due to concern for contrast-induced nephropathy. Cr and
lytes were monitored and remained stable without Cr bump. Pt had
dark urine on hospital day 2, with RBC's in urine attributed to
foley placement, and negative UCx. Urine output remained normal
and discoloration resolved. Cr remained normal. As above, ACEI
was initially held and restarted prior to discharge.
.
# Nausea/HA: likely [**2-3**] nitro and relatively low BP, and nausea
likely also [**2-3**] GERD. Resolved after BP better control. Started
on H2 blocker for GERD with improved. symptoms.
.
INACTIVE ISSUES:
.
# Hypothyroidism: continue home regimen of levothyroxine 25mcg
qod.
.
# GERD: Pt had symptoms prior to admission. She was started
Ranitidine 150mg po bid, with improvement of her symptoms.
.
TRANSITIONAL CARE:
1. CODE: FULL
2. FOLLOW-UP: PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **]
3. MEDICAL MANAGEMENT:
- Started ASA 325mg, Plavix 75mg daily, Atorvastatin 80mg daily,
Metoprolol XL 25mg daily; Increased dose of Lisinopril from 20mg
daily to 40mg daily
- Pt instructed to have f/u labs to monitor Cr/lytes on
increased dose of ACEI with PCP; also to discuss further
uptitration of BP meds as needed

Medications on Admission:
Lisinopril 20mg daily
Levothyroxine 0.25mg every other day
Coenzyme Q10
Receives Avastin shots every few weeks for macular degeneration

Discharge Medications:
1. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO EVERY
OTHER DAY (Every Other Day).
5. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*2*
7. coenzyme Q10  Oral
8. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) tablet
Sublingual every 5 min for total of 2 doses: call 911 or Dr.
[**Last Name (STitle) **] for any chest pain.
Disp:*25 tablets* Refills:*0*
9. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Non St Elevation Myocardial Infarction
Hypertension
Delerium


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Ms. [**Known lastname 12740**],

It was a pleasure taking care of you during this admission.
You had a small heart attack and needed a cardiac
catheterization. We found many blockages in your heart arteries
and you received a total of 7 stents during the course of 2
catheterizations. An echocardiogram showed that your heart is
functioning well. Your blood pressure was high so we gave you
some intravenous medicine to help lower it. You were confused
overnight, perhaps from a sleeping pill called trazadone. Do not
take this medicine again. You received a large dose of dye
during the catheterizations so we are concerned that your kidney
function will worsen. So far, that has not happenend but we will
need to follow your kidney function closely after you leave. You
will follow up with Dr. [**Last Name (STitle) **] on Monday.

We made the following changes to your medicines:
1. Start taking aspirin and Plavix (clopidogrel) daily to keep
all the stents open. This is extremely important to prevent
another heart attack or even death if the stents suddenly
closed. Do not stop taking aspirin and Plavix unless Dr. [**Last Name (STitle) **]
tells you it is OK.
2.Start using nitroglycerin if you have any chest pain or
trouble breathing similar to the symptoms that preceded your
hospitalization. You can take 2 nitroglycerin tablets under your
tongue 5 minutes apart. Please call 911 for any pain or severe
trouble breathing.
3. Start taking Atorvastatin to lower your cholesterol
4. Start taking Metoprolol to lower your heart rate and blood
pressure
5. Start taking Ranitidine to prevent stomach upset from the
Plavix and aspirin
6. We increased the dose of your lisinopril from 20mg daily to
40mg daily to help control your blood pressure.

**Again, it is very important to have your blood checked on
Monday with Dr. [**Last Name (STitle) 89629**] to check for your kidney function and
electrolytes now that we increased the Lisinopril. You may also
need additional blood pressure medication or increased doses.
Please discuss this with Dr. [**Last Name (STitle) **].

Followup Instructions:
Name: [**Last Name (LF) **],[**First Name3 (LF) 251**] T.
Location: [**Hospital3 **] INTERNAL MEDICINE ASSOCIATES
Address: [**Street Address(2) 4472**], [**Apartment Address(1) 4473**], [**Hospital1 **],[**Numeric Identifier 9331**]
Phone: [**Telephone/Fax (1) 4475**]
Appointment: Monday [**2-15**] at 2PM



Completed by:[**2162-2-13**]
{'Subendocardial infarction, initial episode of care,Drug-induced delirium,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Anxiety state, unspecified,Acquired absence of both cervix and uterus,Hypocalcemia,Barbiturates causing adverse effects in therapeutic use'}


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 pressure

PRESENT ILLNESS: Ms. [**Known lastname 12740**] is a 85yo female with history of HTN, hypothyroidism,
and GERD, who presents from OSH with history of worsening chest
pressure, with concern for ACS, sent to [**Hospital1 18**] for cardiac cath.
Pt states that for the past year, she has had shortness of
breath and chest pressure with ambulation. She describes the
chest pressure as central, substernal, non-radiating pressure,
relieved by rest. She was at her ophthalmologist's office this
Monday, and was noted to have a high blood pressure. She then
spoke with the her PCP regarding her high BP and SOB, and he
recommended she come to the [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] this morning, so he could
evaluate her. She said that for at least the last few weeks to
months, her chest pressure has remained the same: associated
with exertion, walking or doing household chores. In fact, she
walked on the treadmill for 3 mins yesterday, and had to stop
because of chest pressure [**2161-6-8**], that was relieved after 5
minutes of rest. She has had occasional nausea, but denied
vomiting, diaphoresis, presyncope, syncope, palpitations with
this. She has only had one episode of rest pain, which occurred
[**2-4**] nights ago, while she was sitting on her couch watching a
movie. The pressure lasted for 5mins and went away completely.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: - Diabetes, - Dyslipidemia, +
Hypertension
2. CARDIAC HISTORY:
-CABG:  none
-PERCUTANEOUS CORONARY INTERVENTIONS:  as below
-PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
Hypothyroidism
HTN
TAH for fibroids
GERD

MEDICATION ON ADMISSION: Lisinopril 20mg daily
Levothyroxine 0.25mg every other day
Coenzyme Q10
Receives Avastin shots every few weeks for macular degeneration

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL:
VS: 96.9 80 120/91 19 96% 2LNC
GENERAL: WDWN pleasant, elderly female in NAD. Oriented x3.
Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Brother with CABG at 68yo, Mother with history of angina.
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: She lives at home by herself and performs all of her ADL's. She
has a friend near by ([**Name (NI) **]), and is close with her daughter
[**Name (NI) **], who accompanies her here today.
-Tobacco history:  quit 56yrs ago
-ETOH:  very rarely, a few drinks per year
-Illicit drugs:  denies 

### Response:
{'Subendocardial infarction, initial episode of care,Drug-induced delirium,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Anxiety state, unspecified,Acquired absence of both cervix and uterus,Hypocalcemia,Barbiturates causing adverse effects in therapeutic use'}
