CHIEF COMPLAINT: Transfer from OSH for cath
SOB, Chest pain

PRESENT ILLNESS: 53 y/o M with T2DM, hyperlipidemia, hypertension and known CAD,
s/p 3 x 18mm Cypher stent to D1 and 2.5 x 18 mm Cypher stent to
OM1 in 7/[**2168**]. He also is status post shoulder surgery recently
complicated by a DVT in the right lower leg (3/[**2170**]). He was
transferred here to [**Hospital1 18**] on [**2170-5-15**] after being admitted to [**Hospital1 **]
[**Location (un) 620**] for chest pain and dyspnea. He ruled out for a MI but
underwent cardiac catheterization where he was found to have 95%
lesion in the D2, 60% mid LAD lesion, 60% prox LAD, and a 45%
proximal RCA. He subsequently underwent successful, complicated
Cullotte stenting of the LAD and D2. It was suggested that
because it was such a complicated stenting that a relook in [**3-27**]
months would not be unreasonable. He was admitted to [**Hospital1 **] [**Location (un) 620**]
on [**2170-7-9**] with complaints of shortness of breath and chest pain
for three days. He also reported vomiting in the am on occasion.
He reports being symptom free for ~3 months after prior cath,
has been having [**8-2**] crushing chest pain with walking [**1-24**] block
(could walk 3.5 miles previously) associated with SOB. Has also
been having pain now with rest. Subsides in 15 minutes without
intervention. + PND, + chronic LE swelling, no orthopnea.
At [**Hospital1 **] Neeham he had an ultrasound of his leg but recurrent DVT
was not seen. He ruled out for a MI. He underwent echocardiogram
which demonstrated an EF of 55-60%, a mildly dilated LA, normal
sized LV with nl function, normal valves. He had one episode of
CP 2 days prior to transfer treated successfully with 1Sl NTG.
He is transferred to [**Hospital1 18**] transferred for a relook cardiac
catheterization. This patient is noted by his nurse to be
intermittently incontinent for no apparent reason. He is legally
blind and lives alone. Apparently on discharge in [**2170-4-24**] he
was extremely resistent to having even one visit by a visiting
nurse. He will need to be transitioned to coumadin and may
benefit from social service referral to encourage home service
involvement.

MEDICAL HISTORY: CAD S/P MI in [**2167**] S/P DES to OM2, and D1 in [**2168**]
Diabetes
Diabetic retinopthy (legally blind)
Diabetic neuropathy
HTN
Hyperlipidemia
Sleep apnea
Appendectomy
S/P rotator cuff surgery [**2170-4-12**]
Right leg DVT
Severe left ventricular diastolic heart failure

MEDICATION ON ADMISSION: Oxycontin SR 10 mg PO Q6H PRN pain
Novalog SS
Neurontin 300 mg PO BID
Lasix 80 mg PO daily
Colace
Plavix 75 mg PO daily
Lisinopril 40 mg PO daily
Coumadin 6 mg PO daily
ASA 325 mg PO daily
Coreg 12.5 mg PO BID
Zetia 10 mg PO daily
70/30 Insulin
Metformin 1000mg [**Hospital1 **]

ALLERGIES: Penicillins / Atorvastatin / Protamine

PHYSICAL EXAM: VS 235lbs 118/72 61 98% RA
Gen: Obese man in NAD
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Legally blind, conjunctiva injected, face flushed
Neck: Supple, thick neck, unable to appreciate neck veins.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Distant heart sounds.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Obese. Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
Ext: Trace non-pitting ankle edema. Right groin site c/d/i, no
bruit, no hematoma. Left foot cool. Decreased sensation b/l.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Tatoo
left forearm.

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. Diabetes mellitus in family.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse, drinks 1-2 beers per
week. Pt lives alone has home health aide. Walks with walking
cane.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Iatrogenic pneumothorax,Chronic diastolic heart failure,Unspecified pleural effusion,Pulmonary collapse,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Other and unspecified hyperlipidemia,Old myocardial infarction,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Legal blindness, as defined in U.S.A.,Unspecified sleep apnea,Polyneuropathy in diabetes,Other specified cardiac dysrhythmias,Other iatrogenic hypotension,Long-term (current) use of anticoagulants,Personal history of allergy to penicillin,Dermatitis due to drugs and medicines taken internally,Anticoagulant antagonists and other coagulants causing adverse effects in therapeutic use
Crnry athrscl natve vssl,Intermed coronary synd,Iatrogenic pneumothorax,Chr diastolic hrt fail,Pleural effusion NOS,Pulmonary collapse,DMII ophth nt st uncntrl,Diabetic retinopathy NOS,Hyperlipidemia NEC/NOS,Old myocardial infarct,Hypertension NOS,Hx-ven thrombosis/embols,Legal blindness-usa def,Sleep apnea NOS,Neuropathy in diabetes,Cardiac dysrhythmias NEC,Iatrogenc hypotnsion NEC,Long-term use anticoagul,Hx-penicillin allergy,Drug dermatitis NOS,Adv eff coagulants
Admission Date:  [**2170-7-12**]              Discharge Date:   [**2170-7-18**]

Date of Birth:  [**2117-1-8**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Atorvastatin / Protamine

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Transfer from OSH for cath
SOB, Chest pain

Major Surgical or Invasive Procedure:
Cardiac Catheterization [**2170-7-12**]
off-pump CABGx2 (LIMA>LAD, SVG>Diag) [**2170-7-13**]


History of Present Illness:
53 y/o M with T2DM, hyperlipidemia, hypertension and known CAD,
s/p 3 x 18mm Cypher stent to D1 and 2.5 x 18 mm Cypher stent to
OM1 in 7/[**2168**]. He also is status post shoulder surgery recently
complicated by a DVT in the right lower leg (3/[**2170**]). He was
transferred here to [**Hospital1 18**] on [**2170-5-15**] after being admitted to [**Hospital1 **]
[**Location (un) 620**] for chest pain and dyspnea. He ruled out for a MI but
underwent cardiac catheterization where he was found to have 95%
lesion in the D2, 60% mid LAD lesion, 60% prox LAD, and a 45%
proximal RCA. He subsequently underwent successful, complicated
Cullotte stenting of the LAD and D2. It was suggested that
because it was such a complicated stenting that a relook in [**3-27**]
months would not be unreasonable. He was admitted to [**Hospital1 **] [**Location (un) 620**]
on [**2170-7-9**] with complaints of shortness of breath and chest pain
for three days. He also reported vomiting in the am on occasion.
He reports being symptom free for ~3 months after prior cath,
has been having [**8-2**] crushing chest pain with walking [**1-24**] block
(could walk 3.5 miles previously) associated with SOB. Has also
been having pain now with rest. Subsides in 15 minutes without
intervention. + PND, + chronic LE swelling, no orthopnea.
At [**Hospital1 **] Neeham he had an ultrasound of his leg but recurrent DVT
was not seen. He ruled out for a MI. He underwent echocardiogram
which demonstrated an EF of 55-60%, a mildly dilated LA, normal
sized LV with nl function, normal valves. He had one episode of
CP 2 days prior to transfer treated successfully with 1Sl NTG.
He is transferred to [**Hospital1 18**] transferred for a relook cardiac
catheterization. This patient is noted by his nurse to be
intermittently incontinent for no apparent reason. He is legally
blind and lives alone. Apparently on discharge in [**2170-4-24**] he
was extremely resistent to having even one visit by a visiting
nurse. He will need to be transitioned to coumadin and may
benefit from social service referral to encourage home service
involvement.


Past Medical History:
CAD S/P MI in [**2167**] S/P DES to OM2, and D1 in [**2168**]
Diabetes
Diabetic retinopthy (legally blind)
Diabetic neuropathy
HTN
Hyperlipidemia
Sleep apnea
Appendectomy
S/P rotator cuff surgery [**2170-4-12**]
Right leg DVT
Severe left ventricular diastolic heart failure

Cardiac Risk Factors: Diabetes, Dyslipidemia, Hypertension


Social History:
Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse, drinks 1-2 beers per
week. Pt lives alone has home health aide. Walks with walking
cane.

Family History:
There is no family history of premature coronary artery disease
or sudden death. Diabetes mellitus in family.

Physical Exam:
VS 235lbs 118/72 61 98% RA
Gen: Obese man in NAD
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Legally blind, conjunctiva injected, face flushed
Neck: Supple, thick neck, unable to appreciate neck veins.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Distant heart sounds.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Obese. Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
Ext: Trace non-pitting ankle edema. Right groin site c/d/i, no
bruit, no hematoma. Left foot cool. Decreased sensation b/l.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Tatoo
left forearm.

Pulses:
Right: DP 1+ PT dopplerable
Left: DP dopplerable PT dopplerable


Pertinent Results:
[**2170-7-18**] 05:23AM BLOOD Hct-24.0*
[**2170-7-17**] 10:51AM BLOOD Hct-22.1*
[**2170-7-17**] 05:35AM BLOOD WBC-13.8* RBC-2.53* Hgb-8.0* Hct-23.2*
MCV-92 MCH-31.7 MCHC-34.6 RDW-15.1 Plt Ct-303
[**2170-7-16**] 01:44AM BLOOD WBC-17.3* RBC-2.92* Hgb-9.0* Hct-27.2*
MCV-93 MCH-30.7 MCHC-32.9 RDW-15.2 Plt Ct-245
[**2170-7-18**] 05:23AM BLOOD PT-13.4 INR(PT)-1.2*
[**2170-7-17**] 10:51AM BLOOD PT-12.8 INR(PT)-1.1
[**2170-7-14**] 02:43AM BLOOD PT-14.1* PTT-26.8 INR(PT)-1.2*
[**2170-7-18**] 05:23AM BLOOD K-4.9
[**2170-7-17**] 05:35AM BLOOD K-4.7
[**2170-7-16**] 01:44AM BLOOD Glucose-257* UreaN-28* Creat-1.1 Na-135
K-5.2* Cl-100 HCO3-28 AnGap-12

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 69993**] (Complete)
Done [**2170-7-13**] at 10:54:44 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **]
Division of Cardiothoracic [**Doctor First Name **]
[**First Name (Titles) **] [**Last Name (Titles) **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2117-1-8**]
Age (years): 53 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Abnormal ECG. Chest pain. Coronary artery disease.
Hypertension.
ICD-9 Codes: 786.51, 440.0
Test Information
Date/Time: [**2170-7-13**] at 10:54    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5209**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW4-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%

Findings
LEFT ATRIUM: Normal LA size. No spontaneous echo contrast is
seen in the LAA. No thrombus in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. A catheter or
pacing wire is seen in the RA and extending into the RV. No ASD
by 2D or color Doppler.

LEFT VENTRICLE: Wall thickness and cavity dimensions were
obtained from 2D images. Normal LV wall thickness. Normal LV
cavity size.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Normal aortic arch diameter. Simple
atheroma in aortic arch. Normal descending aorta diameter.
Simple atheroma in descending aorta.

AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve leaflets (3). No AS. No AR.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR.
Mildly thickened mitral valve leaflets. No mass or vegetation on
mitral valve. Mild mitral annular calcification. No MS.
Physiologic MR (within normal limits).

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. The patient received antibiotic prophylaxis. The
TEE probe was passed with assistance from the anesthesioology
staff using a laryngoscope. No TEE related complications.
Suboptimal image quality. Results were personally reviewed with
the MD caring for the patient.

Conclusions
Off_Pump CABG:1. The left atrium is normal in size. No
spontaneous echo contrast is seen in the left atrial appendage.
No thrombus is seen in the left atrial appendage.
2. No atrial septal defect is seen by 2D or color Doppler.
3. Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal.
4. Right ventricular chamber size and free wall motion are
normal.
5. There are simple atheroma in the aortic arch. There are
simple atheroma in the descending thoracic aorta.
6. There are three aortic valve leaflets. The aortic valve
leaflets (3) are mildly thickened. There is no aortic valve
stenosis. No aortic regurgitation is seen.
7. The mitral valve appears structurally normal with trivial
mitral regurgitation. The mitral valve leaflets are mildly
thickened. No mass or vegetation is seen on the mitral valve.
Physiologic mitral regurgitation is seen (within normal limits).
Dr. [**Last Name (STitle) **] was notified in person of the results.
8. Transient RWMA seen with LAD, OM occlusion with acceptable
bp, SvO2, and CO throughout.

Radiology Report CHEST (PA & LAT) Study Date of [**2170-7-17**] 9:12 AM



[**Last Name (LF) **],[**First Name3 (LF) **] CSURG FA6A [**2170-7-17**] SCHED
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 69994**]
Reason: re-eval left apical ptx



[**Hospital 93**] MEDICAL CONDITION:
   53 year old man with
REASON FOR THIS EXAMINATION:
   re-eval left apical ptx



Final Report
CLINICAL HISTORY: 53-year-old male with left apical
pneumothorax.

AP & lateral chest radiograph compared to [**2170-7-16**] shows
small left
apical pneumothorax minimally decreased in size compared to
prior exam. The
remainder of the exam is essentially unchanged. Again seen is
stable moderate
cardiomegaly and normal postoperative widening of the
mediastinum which is
decreased in size compared to the immediate postoperative
radiographs. Small
left pleural effusion and retrocardiac atelectasis is stable.
Tip of a right
internal jugular central venous line overlies the distal SVC.
Note is made of
normal retrosternal fluid collection with tiny locule of air,
unchanged.

The study and the report were reviewed by the staff radiologist.


DR. [**First Name8 (NamePattern2) **] [**Name (STitle) 7410**]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
Approved: TUE [**2170-7-17**] 10:37 PM



Brief Hospital Course:
Cath here with near occlusion of stents. Csurg was consulted and
he underwent preoperative workup.
He was taken to the operating room  on [**7-13**] where he underwent a
CABG x 3. He was transferred to the ICU in stable condition.
Postoperatively he was noted to have an allergic reaction, with
total baody rash and hypotension which was treated with benadryl
and pepcid IV, and resolved.  Unsure of cause but platelets had
just completed and protamine infusing when reaction noted, blood
bank notified and worked up for platelet reaction. Anesthesia
has recommended outpatient allergy/skin testing to potentially
confirm protamine reaction.
Additional left chest tube was placed for a large left pleural
effusion. He was extubated on POD #1. He was transferred to the
floor on POD #2. Chest tubes and wires were pulled per protocol.
Post pull chest xray showed a small left apical pneumothorax
which remained stable on subsequent chest xray. He was restarted
on coumadin with a lovenox bridge for history of DVT. His vein
harvest leg became tender and he was started on a 10 day course
of doxycycline. He should have an ACE wrap on his left leg from
foot to groin. Plavix was dc'd given that he was on coumadin and
aspirin. He was ready for discharge to rehab on POD #5.

Medications on Admission:
Oxycontin SR 10 mg PO Q6H PRN pain
Novalog SS
Neurontin 300 mg PO BID
Lasix 80 mg PO daily
Colace
Plavix 75 mg PO daily
Lisinopril 40 mg PO daily
Coumadin 6 mg PO daily
ASA 325 mg PO daily
Coreg 12.5 mg PO BID
Zetia 10 mg PO daily
70/30 Insulin
Metformin 1000mg [**Hospital1 **]


Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Enoxaparin 100 mg/mL Syringe Sig: One Hundred (100) mg
Subcutaneous Q12H (every 12 hours): please check INR daily,
discontinue lovenox when INR 2.0 or greater.
8. Doxycycline Hyclate 100 mg Capsule Sig: One (1) Capsule PO
Q12H (every 12 hours) for 10 days. Capsule(s)
9. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
10. Travatan 0.004 % Drops Sig: One (1) gtt Ophthalmic daily ().

11. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day).
12. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
13. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
14. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
15. Insulin NPH & Regular Human 100 unit/mL (70-30) Suspension
Sig: Fifty (50) units Subcutaneous with breakfast.
16. Insulin NPH & Regular Human 100 unit/mL (70-30) Suspension
Sig: Fifty (50) units Subcutaneous with dinner.
17. Lasix 80 mg Tablet Sig: One (1) Tablet PO once a day.
18. Insulin Lispro 100 unit/mL Solution Sig: sliding scale units
Subcutaneous four times a day.
19. Coumadin 6 mg Tablet Sig: One (1) Tablet PO once a day for 1
days.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] health care center

Discharge Diagnosis:
CAD s/p CABG
PMH: Chronic diastolic heart failure, HTN, Hyperlipidemia CAD
S/P MI in
[**2167**] S/P DES to OM2, and D1 in [**2168**], Diabetes, Diabetic
retinopthy (legally blind), Diabetic neuropathy, Sleep apnea,
Right leg DVT
PSH: Appendectomy [**8-/2169**], S/P rotator cuff surgery [**2170-4-12**], RLE
vein stripping 15 yrs ago, umbilical hernia repair


Discharge Condition:
Good.


Discharge Instructions:
You may have had an allergic reaction to a medication called
protamine. Please follow up with your primary care doctor for
further testing.
Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.
Shower, no baths, no lotions, creams or powders to incisions.
No lifting more than 10 pounds for 10 weeks.
No driving until follow up with surgeon.

Followup Instructions:
Dr. [**Last Name (STitle) 30197**] [**Telephone/Fax (1) 19980**] 2 weeks
Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 4105**] 2 weeks
Dr. [**First Name (STitle) **] 4 weeks


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2170-7-18**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Iatrogenic pneumothorax,Chronic diastolic heart failure,Unspecified pleural effusion,Pulmonary collapse,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Other and unspecified hyperlipidemia,Old myocardial infarction,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Legal blindness, as defined in U.S.A.,Unspecified sleep apnea,Polyneuropathy in diabetes,Other specified cardiac dysrhythmias,Other iatrogenic hypotension,Long-term (current) use of anticoagulants,Personal history of allergy to penicillin,Dermatitis due to drugs and medicines taken internally,Anticoagulant antagonists and other coagulants 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: Transfer from OSH for cath
SOB, Chest pain

PRESENT ILLNESS: 53 y/o M with T2DM, hyperlipidemia, hypertension and known CAD,
s/p 3 x 18mm Cypher stent to D1 and 2.5 x 18 mm Cypher stent to
OM1 in 7/[**2168**]. He also is status post shoulder surgery recently
complicated by a DVT in the right lower leg (3/[**2170**]). He was
transferred here to [**Hospital1 18**] on [**2170-5-15**] after being admitted to [**Hospital1 **]
[**Location (un) 620**] for chest pain and dyspnea. He ruled out for a MI but
underwent cardiac catheterization where he was found to have 95%
lesion in the D2, 60% mid LAD lesion, 60% prox LAD, and a 45%
proximal RCA. He subsequently underwent successful, complicated
Cullotte stenting of the LAD and D2. It was suggested that
because it was such a complicated stenting that a relook in [**3-27**]
months would not be unreasonable. He was admitted to [**Hospital1 **] [**Location (un) 620**]
on [**2170-7-9**] with complaints of shortness of breath and chest pain
for three days. He also reported vomiting in the am on occasion.
He reports being symptom free for ~3 months after prior cath,
has been having [**8-2**] crushing chest pain with walking [**1-24**] block
(could walk 3.5 miles previously) associated with SOB. Has also
been having pain now with rest. Subsides in 15 minutes without
intervention. + PND, + chronic LE swelling, no orthopnea.
At [**Hospital1 **] Neeham he had an ultrasound of his leg but recurrent DVT
was not seen. He ruled out for a MI. He underwent echocardiogram
which demonstrated an EF of 55-60%, a mildly dilated LA, normal
sized LV with nl function, normal valves. He had one episode of
CP 2 days prior to transfer treated successfully with 1Sl NTG.
He is transferred to [**Hospital1 18**] transferred for a relook cardiac
catheterization. This patient is noted by his nurse to be
intermittently incontinent for no apparent reason. He is legally
blind and lives alone. Apparently on discharge in [**2170-4-24**] he
was extremely resistent to having even one visit by a visiting
nurse. He will need to be transitioned to coumadin and may
benefit from social service referral to encourage home service
involvement.

MEDICAL HISTORY: CAD S/P MI in [**2167**] S/P DES to OM2, and D1 in [**2168**]
Diabetes
Diabetic retinopthy (legally blind)
Diabetic neuropathy
HTN
Hyperlipidemia
Sleep apnea
Appendectomy
S/P rotator cuff surgery [**2170-4-12**]
Right leg DVT
Severe left ventricular diastolic heart failure

MEDICATION ON ADMISSION: Oxycontin SR 10 mg PO Q6H PRN pain
Novalog SS
Neurontin 300 mg PO BID
Lasix 80 mg PO daily
Colace
Plavix 75 mg PO daily
Lisinopril 40 mg PO daily
Coumadin 6 mg PO daily
ASA 325 mg PO daily
Coreg 12.5 mg PO BID
Zetia 10 mg PO daily
70/30 Insulin
Metformin 1000mg [**Hospital1 **]

ALLERGIES: Penicillins / Atorvastatin / Protamine

PHYSICAL EXAM: VS 235lbs 118/72 61 98% RA
Gen: Obese man in NAD
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Legally blind, conjunctiva injected, face flushed
Neck: Supple, thick neck, unable to appreciate neck veins.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Distant heart sounds.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Obese. Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
Ext: Trace non-pitting ankle edema. Right groin site c/d/i, no
bruit, no hematoma. Left foot cool. Decreased sensation b/l.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Tatoo
left forearm.

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. Diabetes mellitus in family.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse, drinks 1-2 beers per
week. Pt lives alone has home health aide. Walks with walking
cane. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Iatrogenic pneumothorax,Chronic diastolic heart failure,Unspecified pleural effusion,Pulmonary collapse,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Other and unspecified hyperlipidemia,Old myocardial infarction,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Legal blindness, as defined in U.S.A.,Unspecified sleep apnea,Polyneuropathy in diabetes,Other specified cardiac dysrhythmias,Other iatrogenic hypotension,Long-term (current) use of anticoagulants,Personal history of allergy to penicillin,Dermatitis due to drugs and medicines taken internally,Anticoagulant antagonists and other coagulants causing adverse effects in therapeutic use'}
