CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 71 yo male wiht h/o CABG in [**2186**], PTCA [**2192**], s/p stenting [**2197**]
(unknown anatomy, getting records from the [**Hospital1 756**]), smoking,
HTN, HLD, and diabetes who is presenting with chest discomfort.
The patient reports that the night prior to presentation, he
developed left sided chest pain; dullness without any radiation.
 No associated diaphoresis, but reports slight nausea and
shortness of breath.  The pain was persistent, and did not
respond to SL Nitro.  The pain also progressively worsened over
the course of the day, prompting the patient to call EMS.  EMS
gave to SL NG sprays, with no relief.
.
The patient does not remember if this chest pain is similar to
pain he had in the past prior to his past cardiac events.
Denies any worsening exercise tolerance; the patient reports
being able to walk about one block before getting short of
breath.  Denies any orthopnea, denies PND.  Reports increasing
LE swelling; reports that he has never had swelling like this
before.  Of note, the patient's wife reports that he has been
chest pain free for about one year.
.
Denies any recent travel, no long plane rides.  Up to date with
his cancer screening, as per wife-last colonoscopy 2 years ago,
found polyps.  Is not very active at his baseline; does not like
walking, does not like going outside.
.
He had a stress test (due to chest pain) in [**Month (only) **], which showed
2D echocardiographic evidence of inducible ischemia at achieved
workload single vessel CAD-new regional dysfunction with distal
inferior hypokinesis. LVEF >55%
.
On ROS, the patient denies any recent fevers/chills, no blood in
stools, no changes in bowel movements, no urinary symptoms.
Denies any lightheadedness or dizziness.
.
In the ED, the patient's initial vitals: 97.8 64 138/79 16 95%
RA.  He was initially given 1 L of fluid and treated for COPD
excacerbation with azithromycin, prednisone, and nebulizers.  He
then developed respiratory distress and required NRB.  Repeat
CXR showed ? worsening pulmonary edema and patient was given 20
mg IV lasix.  EKG unchanged from priors, found to have elevated
troponin and started on IV heparin, given ASA.  Received 8 mg
morphine, 1 mg Dilaudid and now chest pain free.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension

MEDICATION ON ADMISSION: 1. Atorvastatin 20 mg PO daily
2. Carvedilol 6.25 mg PO TID
3. Doxazosin 6 mg PO daily
4. Glyburide-Metformin 2.5 mg-500 mg PO BID
5. Hydrochlorothiazide 25 mg PO daily
6. Nifedipine XL 90 mg daily
7. Aspirin 81 mg PO daily
8. Docusate sodium 100 mg PO BID

ALLERGIES: Penicillins / Lisinopril / [**Last Name (un) **]-Angiotensin Receptor Antagonist

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
VS: 117/57 72 16 93% on high flow O2
GENERAL: NAD, pleasant elderly gentleman, breathing comfortably
with face mask on
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Father died in his 70s of heart disease. Brother died in his 70s
of presumed heart disease.

SOCIAL HISTORY: Retired polymer chemist. Married, has one daughter. Smokes one
pack per day for the last 55 years. Drinks alcohol infrequently.
Subendocardial infarction, initial episode of care,Acute on chronic diastolic heart failure,Coronary atherosclerosis of autologous vein bypass graft,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
Subendo infarct, initial,Ac on chr diast hrt fail,Crn ath atlg vn bps grft,Acute kidney failure NOS,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Chr airway obstruct NEC,Tobacco use disorder,BPH w/o urinary obs/LUTS
Admission Date:  [**2199-11-3**]              Discharge Date:   [**2199-11-8**]

Date of Birth:  [**2127-12-1**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / Lisinopril / [**Last Name (un) **]-Angiotensin Receptor Antagonist

Attending:[**First Name3 (LF) 7333**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
1. Cardiac catheterization x2 with thrombectomy and drug eluting
stent to the obtuse marginal artery


History of Present Illness:
71 yo male wiht h/o CABG in [**2186**], PTCA [**2192**], s/p stenting [**2197**]
(unknown anatomy, getting records from the [**Hospital1 756**]), smoking,
HTN, HLD, and diabetes who is presenting with chest discomfort.
The patient reports that the night prior to presentation, he
developed left sided chest pain; dullness without any radiation.
 No associated diaphoresis, but reports slight nausea and
shortness of breath.  The pain was persistent, and did not
respond to SL Nitro.  The pain also progressively worsened over
the course of the day, prompting the patient to call EMS.  EMS
gave to SL NG sprays, with no relief.
.
The patient does not remember if this chest pain is similar to
pain he had in the past prior to his past cardiac events.
Denies any worsening exercise tolerance; the patient reports
being able to walk about one block before getting short of
breath.  Denies any orthopnea, denies PND.  Reports increasing
LE swelling; reports that he has never had swelling like this
before.  Of note, the patient's wife reports that he has been
chest pain free for about one year.
.
Denies any recent travel, no long plane rides.  Up to date with
his cancer screening, as per wife-last colonoscopy 2 years ago,
found polyps.  Is not very active at his baseline; does not like
walking, does not like going outside.
.
He had a stress test (due to chest pain) in [**Month (only) **], which showed
2D echocardiographic evidence of inducible ischemia at achieved
workload single vessel CAD-new regional dysfunction with distal
inferior hypokinesis. LVEF >55%
.
On ROS, the patient denies any recent fevers/chills, no blood in
stools, no changes in bowel movements, no urinary symptoms.
Denies any lightheadedness or dizziness.
.
In the ED, the patient's initial vitals: 97.8 64 138/79 16 95%
RA.  He was initially given 1 L of fluid and treated for COPD
excacerbation with azithromycin, prednisone, and nebulizers.  He
then developed respiratory distress and required NRB.  Repeat
CXR showed ? worsening pulmonary edema and patient was given 20
mg IV lasix.  EKG unchanged from priors, found to have elevated
troponin and started on IV heparin, given ASA.  Received 8 mg
morphine, 1 mg Dilaudid and now chest pain free.

Past Medical History:
1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension

2. CARDIAC HISTORY:
- CABG: [**2186**]
- PERCUTANEOUS CORONARY INTERVENTIONS: PTCA [**2192**], Stent [**2197**]
- PACING/ICD: none
- h/o multifocal atrial tachycardia
3. OTHER PAST MEDICAL HISTORY:
-  BPH

Social History:
Retired polymer chemist. Married, has one daughter. Smokes one
pack per day for the last 55 years. Drinks alcohol infrequently.

Family History:
Father died in his 70s of heart disease. Brother died in his 70s
of presumed heart disease.


Physical Exam:
ADMISSION PHYSICAL EXAM:
VS: 117/57 72 16 93% on high flow O2
GENERAL: NAD, pleasant elderly gentleman, breathing comfortably
with face mask on
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP to edge of mandible
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: crackles [**12-16**] lung fields b/l, decent air movement
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: trace LE edema, + pedal edema b/l
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ DP 2+ PT 2+
Left: Carotid 2+ DP 2+ PT 2+
.
DISCHARGE PHYSICAL EXAM:
VS: 125/60 77 14 98% RA
GENERAL: NAD, pleasant elderly gentleman
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP to edge of mandible
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: minimal crackles at bases, decent air movement
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: trace LE edema, + pedal edema b/l
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ DP 2+ PT 2+
Left: Carotid 2+ DP 2+ PT 2+

Pertinent Results:
ADMISSION LABS:
.
[**2199-11-3**] 02:40PM BLOOD WBC-8.4 RBC-4.12* Hgb-12.0* Hct-36.0*
MCV-87# MCH-29.2 MCHC-33.4 RDW-15.2 Plt Ct-377
[**2199-11-3**] 02:40PM BLOOD PT-13.0 PTT-25.1 INR(PT)-1.1
[**2199-11-3**] 02:40PM BLOOD Glucose-150* UreaN-25* Creat-1.3* Na-139
K-5.1 Cl-104 HCO3-24 AnGap-16
[**2199-11-3**] 02:40PM BLOOD CK-MB-31*
[**2199-11-3**] 02:40PM BLOOD cTropnT-0.43*
.
PERTINENT LABS:
.
[**2199-11-3**] 02:40PM BLOOD CK-MB-31*
[**2199-11-3**] 02:40PM BLOOD cTropnT-0.43*
[**2199-11-4**] 03:17AM BLOOD CK-MB-57* MB Indx-8.3* cTropnT-1.46*
[**2199-11-4**] 09:43AM BLOOD CK-MB-45* MB Indx-7.1* cTropnT-2.25*
[**2199-11-6**] 10:20PM BLOOD CK-MB-2
[**2199-11-7**] 06:35AM BLOOD CK-MB-2
[**2199-11-4**] 03:17AM BLOOD CK(CPK)-687*
[**2199-11-4**] 09:43AM BLOOD CK(CPK)-630*
[**2199-11-4**] 09:43AM BLOOD %HbA1c-6.8* eAG-148*
[**2199-11-4**] 09:43AM BLOOD Triglyc-102 HDL-49 CHOL/HD-2.8 LDLcalc-68
.
DISCHARGE LABS:
.
[**2199-11-7**] 06:35AM BLOOD WBC-7.8 RBC-4.06* Hgb-11.9* Hct-35.2*
MCV-87 MCH-29.2 MCHC-33.7 RDW-14.7 Plt Ct-330
[**2199-11-7**] 06:35AM BLOOD Glucose-168* UreaN-36* Creat-1.1 Na-137
K-4.1 Cl-97 HCO3-28 AnGap-16
[**2199-11-7**] 06:35AM BLOOD CK-MB-2
[**2199-11-7**] 06:35AM BLOOD Calcium-8.8 Phos-4.0 Mg-1.8
.
MICRO/PATH:
.
MRSA SCREEN (Final [**2199-11-6**]):    No MRSA isolated.
.
IMAGING/STUDIES:
.
TTE [**11-3**]:
The left atrium is mildly dilated. Left 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. Trace aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. Mild to moderate ([**12-16**]+) mitral
regurgitation is seen. There is no pericardial effusion.

IMPRESSION: Normal biventricular cavity sizes with preserved
global and regional biventricular systolic function.
Mild-moderate mitral regurgitation. Trace aortic regurgitation.
.
CXR PA/LAT [**11-3**]:
IMPRESSION: Emphysema with superimposed pulmonary edema. Trace
bilateral
pleural effusions.
.
C.CATH [**11-4**]:
FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Thrombus in the vein graft to OM.
3. Small hematoma at arterial puncture site.
.
C.CATH [**11-6**]:
FINAL DIAGNOSIS:
1. Success PCI to the 95% SVG to OM lesion with Promus DES.
2. Patient to remain on aspirin indefinitely and clopidogrel for
at
least 1 year uninterrupted.
3. No complications.

Brief Hospital Course:
71 yo male with h/o CABG in [**2186**], PTCA [**2192**], s/p stenting [**2197**],
smoking, HTN, HLD, and diabetes who is presented with chest pain
and was found to have NSTEMI and acute diastolic CHF
exacerbation.
.
ACTIVE DIAGNOSES:
.
# NSTEMI: Mr. [**Known lastname 71328**] was admitted to the CCU with a chief
complaint of chest pain without ST elevations on EKG and a
significant coronary history including CABG followed by PTCA and
stenting. Cardiac catheterization showed proximal occlusion of
SVG to OM and thrombus. On initial catheterization, no
intervention was attmepted because the interventional team was
not able to protect distal to thrombus for emboli. However,
repeat catheterization was successful with deployment of DES to
the 95% occluded SVG to OM lesion. The patient was started on
aspirin 325mg daily and will need to continue taking this
indefinitely, as well as plavix which he will need for at least
1 year uninterrupted. He was continued on his home carvedilol
and atorvastatin as well. Follow-up appointments were arranged
for him prior to discharge.
.
# Acute Diastolic Congestive Heart Failure Exacerbation: Mr.
[**Known lastname 71328**] was without history of CHF but was hypoxic of NRB on
arrival to CCU with prominent rales on exam, CXR c/w with
pulmonary edema, and peripheral edema. The etiology of his CHF
was thought to be related to his acute MI exacerbated by
administration of 1LNS in the ED. He was diuresed aggressively
until he reached euvolemia clinically and was able to sat in the
high 90's on room air. TTE showed LVEF of >55%. He was counseled
on maintaining a low sodium diet as well as taking daily weights
to monitor his fluid balance. He was continued on carvedilol at
the time of discharge.
.
# Acute on Chronic Kidney Injury: His creatinine on admission
was 1.3 (up from baseline of 1.1). This was likely related to
poor forward flow in the setting of MI and diastolic CHF. His Cr
returned to baseline with diuresis in spite of contrast loads
from two C.Caths.

# COPD:  Pt does not have dx of COPD, but with flattened
diaphragms and parenchymal findings on CXR consistent with COPD
in the context of extensive smoking history. He was given
prednisone/azithromycin in ED for concern of COPD exacerbation
that was later felt to be consistent with CHF exacerbation. He
will likely benefit from formal PFT's as an outpatient and
continued smoking cessation counseling.
.
CHRONIC DIAGNOSES:
.
# Hypertension: Stable. Patient takes Carvedilol, nifedipine,
and Hydrochlorothiazide as an outpatient. He was continued on
carvedilol which was decreased from TID to [**Hospital1 **] dosing and his
home nifedipine and HCTZ were discontinued. His blood pressure
should be re-visited in the outpatient setting.
.
# Hyperlipidemia: Stable with TC of 137 and LDL of 68. His home
atorvastatin was increased to 80mg PO daily.
.
# Diabetes: HbA1c 6.8%. On Glyburide-Metformin as an outpatient.
Was managed with HISS in house and discharged on his home PO
regimen.
.
# BPH: Stable. Continued on doxazosin at the time of discharge.
.
TRANSITIONAL ISSUES:
# He will likely benefit from formal PFT's and continued smoking
cessation.
.
# Changes were made to his anti-hypertensive regimen and this
issue should be revisited during an outpatient visit.

Medications on Admission:
1. Atorvastatin 20 mg PO daily
2. Carvedilol 6.25 mg PO TID
3. Doxazosin 6 mg PO daily
4. Glyburide-Metformin 2.5 mg-500 mg PO BID
5. Hydrochlorothiazide 25 mg PO daily
6. Nifedipine XL 90 mg daily
7. Aspirin 81 mg PO daily
8. Docusate sodium 100 mg PO BID

Discharge Medications:
1. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*
2. carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO twice a day.

3. glyburide-metformin 2.5-500 mg Tablet Sig: One (1) Tablet PO
twice a day: START on SATURDAY [**11-9**]. .
4. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for chest pain.
Disp:*30 Tablet, Sublingual(s)* Refills:*0*
7. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*11*
8. doxazosin 4 mg Tablet Sig: 1.5 Tablets PO HS (at bedtime).
9. metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
Non ST Elevation Myocardial Infarction
Acute on Chronic diastolic congestive heart failure

Secondary diagnosis:
Chronic obstructive pulmonary disease
Diabetes Mellitus


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


Discharge Instructions:
Dear Mr. [**Known lastname 71328**],
.
It was a pleasure taking part in your medical care while you
were in the hospital. You had chest pain and a cardiac
catheterization that showed a large clot in one of the heart
arteries. You required another catheterization to remove the
clot safely and a drug eluting stent was placed to keep the
artery open. It is extremely important that you take plavix
every day to prevent the stent from closing off and causing
another heart attack. Do not stop taking plavix or miss [**First Name (Titles) 691**] [**Last Name (Titles) 11014**]s unless Dr. [**Last Name (STitle) 171**] tells you it is OK.
.
Your blood pressure was a little low while you were in the
hospital so we made some changes to your blood pressure
medicines. If your blood pressure goes back up yuor doctor may
want to restart some of these medicines.
.
You had some fluid in your lungs that was removed with
intravenous medicines. We did not continue these medications.
You will need to weigh yourself every morning, call Dr. [**Last Name (STitle) 171**]
if weight goes up more than 3 lbs in 1 day or 5 pounds in 3
days.
.
The following changes were made to your medication regimen:
1. INCREASE Atorvastatin to 80 mg daily to help your heart
recover from a heart attack.
2. INCREASE aspirin to 325 mg daily to prevent the stent from
clotting off
3. DECREASE carvedilol to 6.25 mg twice a day
3. STOP taking nifedipine and hydrochlorothiazide
4. START taking nitroglycerin only as needed for chest pain at
home. Take one tablet, then wait 5 minutes, then take one more
tablet if you still have the pain. Call 911 for any chest pain
that is still there after 2 nitroglycerin tablets.

Followup Instructions:
Please attend the following appointments:

Department: CARDIAC SERVICES
When: Friday [**11-22**] at 10:30am.
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP [**Telephone/Fax (1) 62**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: [**Hospital **] HEALTHCARE [**Location (un) **]
When: TUESDAY [**2199-11-12**] at 4:30 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD [**Telephone/Fax (1) 4606**]
Building: [**State **] ([**Location (un) 583**], MA) [**Location (un) **]
Campus: OFF CAMPUS     Best Parking: On Street Parking



Completed by:[**2199-11-9**]
{'Subendocardial infarction, initial episode of care,Acute on chronic diastolic heart failure,Coronary atherosclerosis of autologous vein bypass graft,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}


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 Pain

PRESENT ILLNESS: 71 yo male wiht h/o CABG in [**2186**], PTCA [**2192**], s/p stenting [**2197**]
(unknown anatomy, getting records from the [**Hospital1 756**]), smoking,
HTN, HLD, and diabetes who is presenting with chest discomfort.
The patient reports that the night prior to presentation, he
developed left sided chest pain; dullness without any radiation.
 No associated diaphoresis, but reports slight nausea and
shortness of breath.  The pain was persistent, and did not
respond to SL Nitro.  The pain also progressively worsened over
the course of the day, prompting the patient to call EMS.  EMS
gave to SL NG sprays, with no relief.
.
The patient does not remember if this chest pain is similar to
pain he had in the past prior to his past cardiac events.
Denies any worsening exercise tolerance; the patient reports
being able to walk about one block before getting short of
breath.  Denies any orthopnea, denies PND.  Reports increasing
LE swelling; reports that he has never had swelling like this
before.  Of note, the patient's wife reports that he has been
chest pain free for about one year.
.
Denies any recent travel, no long plane rides.  Up to date with
his cancer screening, as per wife-last colonoscopy 2 years ago,
found polyps.  Is not very active at his baseline; does not like
walking, does not like going outside.
.
He had a stress test (due to chest pain) in [**Month (only) **], which showed
2D echocardiographic evidence of inducible ischemia at achieved
workload single vessel CAD-new regional dysfunction with distal
inferior hypokinesis. LVEF >55%
.
On ROS, the patient denies any recent fevers/chills, no blood in
stools, no changes in bowel movements, no urinary symptoms.
Denies any lightheadedness or dizziness.
.
In the ED, the patient's initial vitals: 97.8 64 138/79 16 95%
RA.  He was initially given 1 L of fluid and treated for COPD
excacerbation with azithromycin, prednisone, and nebulizers.  He
then developed respiratory distress and required NRB.  Repeat
CXR showed ? worsening pulmonary edema and patient was given 20
mg IV lasix.  EKG unchanged from priors, found to have elevated
troponin and started on IV heparin, given ASA.  Received 8 mg
morphine, 1 mg Dilaudid and now chest pain free.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension

MEDICATION ON ADMISSION: 1. Atorvastatin 20 mg PO daily
2. Carvedilol 6.25 mg PO TID
3. Doxazosin 6 mg PO daily
4. Glyburide-Metformin 2.5 mg-500 mg PO BID
5. Hydrochlorothiazide 25 mg PO daily
6. Nifedipine XL 90 mg daily
7. Aspirin 81 mg PO daily
8. Docusate sodium 100 mg PO BID

ALLERGIES: Penicillins / Lisinopril / [**Last Name (un) **]-Angiotensin Receptor Antagonist

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
VS: 117/57 72 16 93% on high flow O2
GENERAL: NAD, pleasant elderly gentleman, breathing comfortably
with face mask on
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Father died in his 70s of heart disease. Brother died in his 70s
of presumed heart disease.

SOCIAL HISTORY: Retired polymer chemist. Married, has one daughter. Smokes one
pack per day for the last 55 years. Drinks alcohol infrequently. 

### Response:
{'Subendocardial infarction, initial episode of care,Acute on chronic diastolic heart failure,Coronary atherosclerosis of autologous vein bypass graft,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
