CHIEF COMPLAINT: hypotension

PRESENT ILLNESS: This 69 white male presented to [**Hospital3 3583**] on [**2108-10-16**] with
severe back and flank pain.  He became hypotensive and hypoxic
and was life flighted to [**Hospital1 18**].
He was transferred to the MICU intubated and a CTA of the torso
showed a 7 cm infrarenal AAA without evidence of leak or
rupture.   He ruled in for an MI with a troponin of 2.68 and a
CK of 1099. Cardiac cath on [**10-16**]  revealed 90% LMCA lesion,
occluded LCX, and 80% RCA.  His EF is 35-40%.  Cardiac surgery
was consulted. Vascular surgery took Mr.[**Known lastname 84604**] for exploration
of below-knee popliteal artery with popliteal and tibial
thrombectomies, repair of thrombosed popliteal aneurysm with
reversed saphenous vein graft, and angioscopy and valve
lysis.Once recovered from this procedure, Cardiac surgery
prepared him for surgical coronary artery revascularization and
Aortic Valve Replacement.

MEDICAL HISTORY: 1.Aortic stenosis.
2. Severe 3-vessel coronary artery disease.
3. Status post recent myocardial infarction.
4. History of ruptured abdominal aortic aneurysm in the
    setting of an acute myocardial infarction.
5. Status post Endo AAA repair
6. Chronic obstructive pulmonary disease
7. HTN
8. hyperlipidemia
9. A Fib

MEDICATION ON ADMISSION: MEDICATIONS (obtained from [**Company 4916**] Pharmacy):
Simvastatin 20 mg daily
Captopril 100 mg po bid
Amlodipine 5 mg daily

ALLERGIES: Benzodiazepines

PHYSICAL EXAM: Pulse: 80 Resp: 16  O2 sat: 95%
B/P  Right: 123/75    Left:
Height: 5'[**09**]"    Weight: 92 kg

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: years
Lives with: alone
Occupation: retired
Tobacco: never
ETOH: none
Dissection of aorta, abdominal,Acute combined systolic and diastolic heart failure,Subendocardial infarction, initial episode of care,Cardiogenic shock,Acute respiratory failure,Acute kidney failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Peripheral vascular complications, not elsewhere classified,Acidosis,Bacteremia,Acute venous embolism and thrombosis of internal jugular veins,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Aneurysm of artery of lower extremity,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atrial fibrillation,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Thrombocytopenia, unspecified
Dsct of abdominal aorta,Ac syst/diastol hrt fail,Subendo infarct, initial,Cardiogenic shock,Acute respiratry failure,Acute kidney failure NOS,Food/vomit pneumonitis,Surg comp-peri vasc syst,Acidosis,Bacteremia,Ac embl internl jug vein,Crnry athrscl natve vssl,Aortic valve disorder,Lower extremity aneurysm,Abn react-anastom/graft,Chr airway obstruct NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,Atrial fibrillation,Mth sus Stph aur els/NOS,Thrombocytopenia NOS
Admission Date:  [**2108-10-16**]              Discharge Date:   [**2108-11-13**]

Date of Birth:  [**2039-1-3**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Benzodiazepines

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
hypotension

Major Surgical or Invasive Procedure:
[**2108-11-8**] Coronary artery Bypass GRAFTING X 3 (lEFT INTERNAL
MAMMARY ARTERY GRAFTED TO THE lEFT ANTERIOR DESCENDING.SAPHENOUS
VEIN GRAFTED TO RAMUS/POSTERIOR DESCENDING ARTERY)/AORTIC VALVE
REPLACEMENT (#27mm [**Company 1543**] Ultra Porcine)
[**2108-10-26**] right popliteal thrombectomy/ resect. [**Doctor Last Name **]. aneursym and
fem-[**Doctor Last Name **] BPG
[**2108-10-25**] AAA endovascular stent-grafting


History of Present Illness:
This 69 white male presented to [**Hospital3 3583**] on [**2108-10-16**] with
severe back and flank pain.  He became hypotensive and hypoxic
and was life flighted to [**Hospital1 18**].
He was transferred to the MICU intubated and a CTA of the torso
showed a 7 cm infrarenal AAA without evidence of leak or
rupture.   He ruled in for an MI with a troponin of 2.68 and a
CK of 1099. Cardiac cath on [**10-16**]  revealed 90% LMCA lesion,
occluded LCX, and 80% RCA.  His EF is 35-40%.  Cardiac surgery
was consulted. Vascular surgery took Mr.[**Known lastname 84604**] for exploration
of below-knee popliteal artery with popliteal and tibial
thrombectomies, repair of thrombosed popliteal aneurysm with
reversed saphenous vein graft, and angioscopy and valve
lysis.Once recovered from this procedure, Cardiac surgery
prepared him for surgical coronary artery revascularization and
Aortic Valve Replacement.


Past Medical History:
1.Aortic stenosis.
2. Severe 3-vessel coronary artery disease.
3. Status post recent myocardial infarction.
4. History of ruptured abdominal aortic aneurysm in the
    setting of an acute myocardial infarction.
5. Status post Endo AAA repair
6. Chronic obstructive pulmonary disease
7. HTN
8. hyperlipidemia
9. A Fib


Social History:
Race: Caucasian
Last Dental Exam: years
Lives with: alone
Occupation: retired
Tobacco: never
ETOH: none


Family History:
Noncontributory

Physical Exam:
Pulse: 80 Resp: 16  O2 sat: 95%
B/P  Right: 123/75    Left:
Height: 5'[**09**]"    Weight: 92 kg

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ []
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [x]
Neuro: Disoriented to place, but knows year and president.
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: tr  Left: tr
PT           [**Name (NI) 167**]: tr  Left: tr
Radial       Right: 1+  Left: 1+

Carotid Bruit   Right: no   Left: no


Pertinent Results:
[**2108-11-11**] 02:13AM BLOOD WBC-10.5 RBC-3.37* Hgb-9.9* Hct-29.0*
MCV-86 MCH-29.3 MCHC-34.0 RDW-17.0* Plt Ct-131*
[**2108-10-16**] 12:35AM BLOOD WBC-13.5* RBC-3.38* Hgb-10.1* Hct-30.5*
MCV-90 MCH-29.8 MCHC-33.1 RDW-16.0* Plt Ct-193
[**2108-11-12**] 11:45AM BLOOD PT-24.7* INR(PT)-2.4*
[**2108-10-16**] 12:35AM BLOOD PT-14.4* PTT-20.4* INR(PT)-1.3*
[**2108-11-11**] 02:13AM BLOOD Glucose-110* UreaN-33* Creat-1.6* Na-134
K-4.2 Cl-101 HCO3-23 AnGap-14
[**2108-10-16**] 04:36AM BLOOD Glucose-167* UreaN-38* Creat-1.6* Na-138
K-7.3* Cl-110* HCO3-20* AnGap-15
[**2108-10-31**] 03:37AM BLOOD ALT-74* AST-65* CK(CPK)-105 AlkPhos-74
Amylase-39 TotBili-0.6
[**2108-10-16**] 04:36AM BLOOD ALT-170* AST-348* LD(LDH)-601*
CK(CPK)-1099* AlkPhos-58 TotBili-0.6
[**2108-11-13**] 05:35AM BLOOD WBC-9.8 RBC-3.78* Hgb-11.1* Hct-32.9*
MCV-87 MCH-29.5 MCHC-33.9 RDW-17.3* Plt Ct-155
[**2108-11-13**] 05:35AM BLOOD Plt Ct-155
[**2108-11-13**] 05:35AM BLOOD PT-28.6* INR(PT)-2.8*
[**2108-11-13**] 05:35AM BLOOD Glucose-83 UreaN-34* Creat-1.3* Na-137
K-4.0 Cl-100 HCO3-29 AnGap-12
[**2108-11-7**] 07:25AM BLOOD %HbA1c-5.6
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 84605**] (Complete)
Done
DOB: [**2039-1-3**]
Indication: Aortic valve disease. Atrial fibrillation. Coronary
artery disease. Left ventricular function. Mitral valve disease.
Pericardial effusion. Prosthetic valve function. Valvular heart
disease.
ICD-9 Codes: 427.31, 440.0, V43.3, 424.1, 424.0
Test Information
Date/Time: [**2108-11-8**] at 13:49    Interpret MD: [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**],
MD
Test Type: TEE (Complete)
3D imaging. Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 18397**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2009AW02-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  *1.2 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *1.2 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  5.5 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  30% to 40%  >= 55%
Aorta - Annulus:  2.3 cm  <= 3.0 cm
Aorta - Sinus Level:  3.2 cm  <= 3.6 cm
Aorta - Ascending:  3.4 cm  <= 3.4 cm
Aortic Valve - Peak Gradient:  *55 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  27 mm Hg
Aortic Valve - Valve Area:  *0.6 cm2  >= 3.0 cm2
Findings
Multiplanar reconstructions were generated and confirmed on an
independent workstation.
LEFT ATRIUM: Elongated LA. No spontaneous echo contrast or
thrombus in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. All four pulmonary veins
identified and enter the left atrium.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. A catheter or
pacing wire is seen in the RA. No ASD or PFO by 2D, color
Doppler or saline contrast with maneuvers.
LEFT VENTRICLE: Wall thickness and cavity dimensions were
obtained from 2D images. Top normal/borderline dilated LV cavity
size. Moderately depressed LVEF.
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Normal ascending aorta tube graft. Simple atheroma in
ascending aorta. Mildly dilated descending aorta. Complex (>4mm)
atheroma in the descending thoracic aorta.
AORTIC VALVE: Severely thickened/deformed aortic valve leaflets.
Critical AS (area <0.8cm2). Mild (1+) AR.
MITRAL VALVE: Moderately thickened mitral valve leaflets. Mild
(1+) MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.
PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.
PERICARDIUM: Small to moderate pericardial effusion. No
echocardiographic signs of tamponade.
GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications. Suboptimal image quality - poor echo windows.
REGIONAL LEFT VENTRICULAR WALL MOTION:
     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PRE-BYPASS: The left atrium is elongated. No spontaneous echo
contrast or thrombus is seen in the body of the left atrium or
left atrial appendage. No atrial septal defect or patent foramen
ovale is seen by 2D, color Doppler or saline contrast with
maneuvers. The left ventricular cavity size is top
normal/borderline dilated. Overall left ventricular systolic
function is moderately depressed (LVEF= 3040 %). Right
ventricular chamber size and free wall motion are normal. The
appearance of the ascending aorta is consistent with a normal
tube graft. There are simple atheroma in the ascending aorta.
The descending thoracic aorta is mildly dilated. There are
complex (>4mm) atheroma in the descending thoracic aorta. The
aortic valve leaflets are severely thickened/deformed. There is
critical aortic valve stenosis (valve area <0.8cm2). Mild (1+)
aortic regurgitation is seen. The mitral valve leaflets are
moderately thickened. Mild (1+) mitral regurgitation is seen.
There is a small to moderate sized pericardial effusion. There
are no echocardiographic signs of tamponade.
POST CPB:
1. LV systolic function is mildly improved EF = 45-50 % (No
inotropic support)
2. Preserved RV systolci function
3. Trileafllet bioprosthesis in aortic position. Mechanically
stable and well seated with good leaflet excursion.
4. Trace AI.Peak gradient 18 mm Hg.
5. No other change.
  Electronically signed by [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2108-11-8**] 13:55
Radiology Report CHEST (PORTABLE AP) Study Date of [**2108-11-13**] 7:55
AM
[**Hospital 93**] MEDICAL CONDITION:
   69 year old man s/p avr/cabg and ct removal
Final Report CHEST RADIOGRAPH
INDICATION: Status post CABG and chest tube removal, rule out
pneumothorax.
FINDINGS: As compared to the previous examination, the chest
tubes have been removed. On today's examination, several
millimeters left apical lateral pneumothorax is visible. There
are no signs of tension.
No changes in the appearance of the right lung parenchyma and of
the cardiac and mediastinal silhouette.

A repeat chest film revealed a partially resolved left apical
pneumothorax.




Brief Hospital Course:
The patient is a 69-year-old gentleman who presented with acute
back pain and hypotension which was thought to be due to
contained ruptured abdominal aortic
aneurysm. The patient was resuscitated but in the process of
being resuscitated had suffered an acute myocardial infarction.
The patient was resuscitated appropriately,
treated for his myocardial infarction. Cardiac cath showed
severe left main disease as well as high-grade LAD, circumflex
marginal and right coronary artery disease.
However, due to the patient's acuity and anatomy, he was not
felt to be either a percutaneous interventional candidate nor a
cardiac surgical candidate at that point in time.  He did
recover with medical therapy and it was felt that he should
proceed with Endo AAA repair prior to cardiac surgical repair.
He underwent endo AAA repair on [**10-25**] with Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **], with
right popliteal rescue/revisions on [**10-26**].

[**11-8**] Mr.[**Known lastname 84604**] was taken to the operating room and underwent
an Aortic valve replacement(#27 mm [**Company 1543**] mosaic ultra
bioprosthesis)/Coronary bypass grafting x3 with left internal
mammary artery to the left anterior descending coronary artery;
reversed saphenous vein single graft from the aorta to  the
posterior left  ventricular coronary artery; as well as reversed
saphenous vein single graft from the aorta to the ramus
intermedius coronary artery. Please refer to Dr[**Last Name (STitle) 5305**]
operative report for further details. Cardipulmonary Bypass
Time=140 minutes. Cross Clamp Time= 117 minutes. Postoperatively
he was transferred to the CVICU intibated and sedated in stable
but critical condition requiring pressors to optimize cardiac
hemodynamics. He awoke neurologically intact and was extubated
on POD#1 without incident. He was weaned off pressors and all
lines and drains were discontinued in a timely fashion with
criteria met. Beta-Blocker, Amiodarone for new preop atrial
fibrillation was resumed, along with ASA/statin and gentle
diuresis was initiated. He continued to progress and was
transferred to the step down unit for further monitoring on
POD#3. Anticoagulation was started with Coumadin for his
paroxysmal AFib. Amiodarone was discontinued due to HR in the
50-60 range, but then restarted laterfor adequate rate. Physical
therapy was consulted for evaluation of strength and increased
mobility. It was their recommendation that Mr.[**Known lastname 84604**] go to
rehab for further improvement in  strength and activities of
daily living. The remainder of his postoperative course was
essentially uneventful. He was cleared for discharge to rehab by
CSURG attending on POD5 .Target INR for A Fib is 2.5-3.0. All
follow up appointments were advised. As per patient request,
prior to discharge a new PCP, [**Last Name (NamePattern4) **]. [**First Name (STitle) 50871**] [**Name (STitle) **] was arranged for
follow up. Dr.[**Last Name (STitle) **] follow up per Vascular surgery.


Medications on Admission:
MEDICATIONS (obtained from [**Company 4916**] Pharmacy):
Simvastatin 20 mg daily
Captopril 100 mg po bid
Amlodipine 5 mg daily


Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every six (6) hours as needed for pain.
6. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO every six
(6) hours as needed for pain/temp.
7. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
8. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
9. Warfarin 1 mg Tablet Sig: as directed Tablet PO DAILY (Daily)
as needed for AFib: adjust dose to target INR of 2.5-3.
[**11-13**] dose 1mg.
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
11. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day): 200mg [**Hospital1 **] x1 week then 200mg QD.
13. Vancomycin in Dextrose 1 gram/200 mL Piggyback Sig: One (1)
gm Intravenous Q 24H (Every 24 Hours): thru [**11-16**].
14. Furosemide 10 mg/mL Solution Sig: Twenty (20) mg Injection
Q12H (every 12 hours): x1 week then change to oral dosing.
15. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12
hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
-Aortic stenosis, Severe 3-vessel coronary artery disease- - s/p
CABG x3/AVR.
s/p rt side Exploration of below-knee popliteal artery with
popliteal and tibial thrombectomies.
 Repair of thrombosed popliteal aneurysm with reversed saphenous
vein graft
-Status post recent myocardial infarction.
-history of ruptured abdominal aortic aneurysm in the setting of
an acute myocardial infarction.
Status post Endo AAA repair
Chronic obstructive pulmonary disease
HTN
Hyperlipidemia
RIJ/cephalic vein thrombus
A Fib


Discharge Condition:
good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month, and while taking
narcotics
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
target INR 2.5-3.0 for A Fib and lower extremity thrombus/w
bypass graft


Followup Instructions:
-Dr. [**First Name (STitle) 50871**] [**Name (STitle) **], *new PCP, [**Name10 (NameIs) 648**] [**Name11 (NameIs) **]. [**11-20**] at 2:15pm,
[**Hospital6 733**], [**Location (un) **], South Suite [**Hospital Ward Name 23**]
Building-[**Hospital1 18**]
-Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 914**] in 4 weeks, [**Telephone/Fax (1) **] please call for
[**Telephone/Fax (1) 648**]
-Dr.[**Last Name (STitle) **] follow up [**Last Name (STitle) 648**] in 2 weeks# [**Telephone/Fax (1) 2395**]
Wound check [**Telephone/Fax (1) 648**] [**Hospital Ward Name 121**] 6 as instructed by nurse
([**Telephone/Fax (1) 3071**])
- see Dr. [**Last Name (STitle) **] in [**2-28**] weeks



Completed by:[**2108-11-13**]
{'Dissection of aorta, abdominal,Acute combined systolic and diastolic heart failure,Subendocardial infarction, initial episode of care,Cardiogenic shock,Acute respiratory failure,Acute kidney failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Peripheral vascular complications, not elsewhere classified,Acidosis,Bacteremia,Acute venous embolism and thrombosis of internal jugular veins,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Aneurysm of artery of lower extremity,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atrial fibrillation,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Thrombocytopenia, unspecified'}


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: This 69 white male presented to [**Hospital3 3583**] on [**2108-10-16**] with
severe back and flank pain.  He became hypotensive and hypoxic
and was life flighted to [**Hospital1 18**].
He was transferred to the MICU intubated and a CTA of the torso
showed a 7 cm infrarenal AAA without evidence of leak or
rupture.   He ruled in for an MI with a troponin of 2.68 and a
CK of 1099. Cardiac cath on [**10-16**]  revealed 90% LMCA lesion,
occluded LCX, and 80% RCA.  His EF is 35-40%.  Cardiac surgery
was consulted. Vascular surgery took Mr.[**Known lastname 84604**] for exploration
of below-knee popliteal artery with popliteal and tibial
thrombectomies, repair of thrombosed popliteal aneurysm with
reversed saphenous vein graft, and angioscopy and valve
lysis.Once recovered from this procedure, Cardiac surgery
prepared him for surgical coronary artery revascularization and
Aortic Valve Replacement.

MEDICAL HISTORY: 1.Aortic stenosis.
2. Severe 3-vessel coronary artery disease.
3. Status post recent myocardial infarction.
4. History of ruptured abdominal aortic aneurysm in the
    setting of an acute myocardial infarction.
5. Status post Endo AAA repair
6. Chronic obstructive pulmonary disease
7. HTN
8. hyperlipidemia
9. A Fib

MEDICATION ON ADMISSION: MEDICATIONS (obtained from [**Company 4916**] Pharmacy):
Simvastatin 20 mg daily
Captopril 100 mg po bid
Amlodipine 5 mg daily

ALLERGIES: Benzodiazepines

PHYSICAL EXAM: Pulse: 80 Resp: 16  O2 sat: 95%
B/P  Right: 123/75    Left:
Height: 5'[**09**]"    Weight: 92 kg

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: years
Lives with: alone
Occupation: retired
Tobacco: never
ETOH: none 

### Response:
{'Dissection of aorta, abdominal,Acute combined systolic and diastolic heart failure,Subendocardial infarction, initial episode of care,Cardiogenic shock,Acute respiratory failure,Acute kidney failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Peripheral vascular complications, not elsewhere classified,Acidosis,Bacteremia,Acute venous embolism and thrombosis of internal jugular veins,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Aneurysm of artery of lower extremity,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atrial fibrillation,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Thrombocytopenia, unspecified'}
