CHIEF COMPLAINT: Asymptomatic

PRESENT ILLNESS: 51 year old male who has a history of a heart murmur for his
entire life. Has had echocardiograms the last couple of years
after increasing intensity of his mitral regurgitation murmur
was
noted. Recent echocardiograms have shown severe mirtral
regurgitation with a flail P2 and torn chordae. He is currently
asymptomatic but given state of his regurgitation along with
dilated left atrium he was referred to Dr. [**Last Name (STitle) **] for
evaluation
in [**2110-1-19**]. He returns now for preadmission testing for
surgery on [**2110-6-9**].

MEDICAL HISTORY: Mitral Regurgitation
Hypertension
Hypercholesterolemia
Past Surgical History
s/p Left ACL surgery

MEDICATION ON ADMISSION: Pravastatin 40mg daily
Lisinopril 5mg daily

ALLERGIES: Penicillins

PHYSICAL EXAM: Admission Physical Exam
Pulse: 80 Resp: 18  O2 sat: 99%
B/P  Right: 144/77   Left: 150/82
Height: 5'[**09**]"  Weight: 185 lbs

FAMILY HISTORY: +Premature coronary artery disease
Father MI < 55 []       Mother < 65 [X] CABG in 50's
Father with CABG in 60's. Uncles with CABGs.

SOCIAL HISTORY: Lives with: Wife
Contact: Wife              Phone #
Occupation: Firefighter
Cigarettes: Smoked no [X] yes [] last cigarette _____ Hx:
Other Tobacco use: Denies
ETOH: < 1 drink/week [] [**2-25**] drinks/week [X] >8 drinks/week []
Illicit drug use: Denies
Mitral valve disorders,Rupture of chordae tendineae,Mechanical complication due to heart valve prosthesis,Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Other iatrogenic hypotension,Volume depletion, unspecified,Family history of ischemic heart disease,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
Mitral valve disorder,Chordae tendinae rupture,Malfunc prosth hrt valve,Hypertension NOS,Pure hypercholesterolem,Anemia NOS,Iatrogenc hypotnsion NEC,Volume depletion NOS,Fam hx-ischem heart dis,Abn react-anastom/graft
Admission Date:  [**2110-6-9**]              Discharge Date:   [**2110-6-18**]

Date of Birth:  [**2058-4-20**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Asymptomatic

Major Surgical or Invasive Procedure:
-Mitral Valve Repair (30mm [**Last Name (un) 3843**]-[**Doctor Last Name **] Ring) [**2110-6-9**]
-Redo sternotomy, Mitral Valve Replacement (#27mm St.[**Male First Name (un) 923**]
Mechanical)[**2110-6-13**]

History of Present Illness:
51 year old male who has a history of a heart murmur for his
entire life. Has had echocardiograms the last couple of years
after increasing intensity of his mitral regurgitation murmur
was
noted. Recent echocardiograms have shown severe mirtral
regurgitation with a flail P2 and torn chordae. He is currently
asymptomatic but given state of his regurgitation along with
dilated left atrium he was referred to Dr. [**Last Name (STitle) **] for
evaluation
in [**2110-1-19**]. He returns now for preadmission testing for
surgery on [**2110-6-9**].


Past Medical History:
Mitral Regurgitation
Hypertension
Hypercholesterolemia
Past Surgical History
s/p Left ACL surgery

Social History:
Lives with: Wife
Contact: Wife              Phone #
Occupation: Firefighter
Cigarettes: Smoked no [X] yes [] last cigarette _____ Hx:
Other Tobacco use: Denies
ETOH: < 1 drink/week [] [**2-25**] drinks/week [X] >8 drinks/week []
Illicit drug use: Denies


Family History:
+Premature coronary artery disease
Father MI < 55 []       Mother < 65 [X] CABG in 50's
Father with CABG in 60's. Uncles with CABGs.


Physical Exam:
Admission Physical Exam
Pulse: 80 Resp: 18  O2 sat: 99%
B/P  Right: 144/77   Left: 150/82
Height: 5'[**09**]"  Weight: 185 lbs

General: Well-developed male in no acute distress
Skin: Dry [X] intact [X]
HEENT: PERRLA [X] EOMI [X]
Neck: Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR, III/VI systolic murmur best heard at apex
Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds
+
[X]
Extremities: Warm [X], well-perfused [X] No Edema
Varicosities: None
Neuro: Grossly intact [X]
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit   Right: -    Left: -


Pertinent Results:
[**2110-6-9**] Intra-op TEE:
PRE-BYPASS: No spontaneous echo contrast is seen in the body of
the left atrium or left atrial appendage. No atrial septal
defect is seen by 2D or color Doppler. Left ventricular wall
thicknesses are normal. The left ventricular cavity is mildly
dilated. Regional left ventricular wall motion is normal.
Overall left ventricular systolic function is normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic stenosis or aortic
regurgitation. The mitral valve leaflets are myxomatous. There
is moderate/severe P2 leaflet mitral valve prolapse. There is
partial P3 mitral leaflet flail. An eccentric, anteriorly
directed jet of severe (4+) mitral regurgitation is seen. There
is no pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person
of the results at time of surgery.

POST-BYPASS:
Biventricular systolic function remains normal. There is a ring
prosthesis in the mitral position. With initial post bypass
loading conditions there was significant [**Male First Name (un) **] with LVOT
velocities >3 m/sec. With volume and increase of SBP from 80 to
110 the [**Male First Name (un) **] decreased, with LVOT gradient ~15 mm Hg. No early
closure of the AV, LVOT patent on 3D images. Trace residual MR.
The study is otherwise unchanged from prebypass
  I [**Male First Name (un) 91932**] that I was present for this procedure in compliance
with HCFA regulations.



[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 91933**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 91934**]
(Complete) Done [**2110-6-13**] at 9:16:45 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
[**Hospital1 18**], Division of Cardiothorac
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2058-4-20**]
Age (years): 52 M  Hgt (in): 70
BP (mm Hg): /  Wgt (lb): 187
HR (bpm):  BSA (m2): 2.03 m2
Indication: H/O cardiac surgery. Left ventricular function.
Mitral valve disease. Preoperative assessment. Shortness of
breath.
ICD-9 Codes: 424.0
Test Information
Date/Time: [**2110-6-13**] at 09:16    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 16164**], MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 6507**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2012AW-:1 Machine: us6
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  1.1 cm  0.6 - 1.1 cm
Left Ventricle - Diastolic Dimension:  *5.9 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  55% to 60%  >= 55%
Left Ventricle - Stroke Volume:  330 ml/beat
Left Ventricle - Peak Resting LVOT gradient:  *43 mm Hg  <= 10
mm Hg
Aorta - Annulus:  2.6 cm  <= 3.0 cm
Aorta - Sinus Level:  3.3 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.9 cm  <= 3.0 cm
Aorta - Ascending:  2.5 cm  <= 3.4 cm
Aorta - Arch:  2.8 cm  <= 3.0 cm
Aorta - Descending Thoracic:  1.9 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  *4.0 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *64 mm Hg  < 20 mm Hg
Aortic Valve - LVOT pk vel:  3.37 m/sec
Aortic Valve - LVOT VTI:  73
Aortic Valve - LVOT diam:  2.4 cm
Mitral Valve - Peak Velocity:  1.7 m/sec
Mitral Valve - Mean Gradient:  6 mm Hg

Findings
LEFT ATRIUM: No spontaneous echo contrast in the body of the [**Name Prefix (Prefixes) **]
[**Last Name (Prefixes) **] LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: No ASD by 2D or color Doppler.

LEFT VENTRICLE: Normal LV wall thickness. Mildly dilated LV
cavity. Normal regional LV systolic function. Overall normal
LVEF (>55%).

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

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. No atheroma in ascending aorta. Normal
aortic arch diameter. No atheroma in aortic arch. Normal
descending aorta diameter.

AORTIC VALVE: Normal aortic valve leaflets (3). No AR.

MITRAL VALVE: Mitral valve annuloplasty ring. [**Male First Name (un) **] of mitral
valve leaflets. No MS. [**Name13 (STitle) 650**] (4+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

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

PERICARDIUM: Trivial/physiologic pericardial effusion.

GENERAL COMMENTS: Written informed consent was obtained from the
patient. The patient was under general anesthesia throughout the
procedure. No TEE related complications. The patient appears to
be in sinus rhythm. Results were personally reviewed with the MD
caring for the patient. See Conclusions for post-bypass data
Conclusions
PRE-BYPASS: No spontaneous echo contrast is seen in the body of
the left atrium or left atrial appendage. No atrial septal
defect is seen by 2D or color Doppler. Left ventricular wall
thicknesses are normal. The left ventricular cavity is mildly
dilated. Regional left ventricular wall motion is normal.
Overall left ventricular systolic function is normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion. The mean LVOT gradient is 16 mmHg. No
aortic regurgitation is seen. A mitral valve annuloplasty ring
is present. There is systolic anterior motion of the mitral
valve leaflets. Severe (4+) mitral regurgitation is seen at a
systolic blood pressure of 100 to 120 mmHg.. Mitral
regurgitation is mild (1+) at a blood pressure of 174/84
achieved by phenylephrine with continued systolic anterior
motion of the mitral valve. There is a trivial/physiologic
pericardial effusion. There is a left pleural effusion. Dr.
[**Last Name (STitle) **] was notified in person of the results at time of
surgery.

POST-BYPASS #1: Patient is in sinus rhythm. The patient is on a
norepinephrine infusion. Left ventricular function is unchanged.
Right ventricular function appears mildly depressed. There is a
well-seated mitral annuloplasty ring in place. The height of the
posterior leaflet of the mitral valve appears smaller compared
to pre-bypass. There is still moderate to severe (3+) mitral
regurgitation at a blood pressure of 95/54. There is still
significant systolic anterior motion of the mitral valve with
turbulent flow through the LVOT suggesting LVOT obstruction.

POST-BYPASS #2: Patient is in sinus rhythm. The patient is on
norepinephrine. Left ventricular function remains unchanged.
Right ventricular function is normal. There is a well-seated
mechanical prosthetic valve in the mitral position.
Characteristic washing jets are seen. No mitral regurgitation is
seen. There is a mean gradient of 2 mmHg at a cardiac output of
4.8 L/min. There is no resting LVOT gradient. The aorta is
intact post-decannulation.

Prebypass exam and post bypass exam #1 reviewed by Dr [**First Name (STitle) 6507**],
[**Doctor Last Name 4901**], [**Last Name (un) 16164**] and [**Location (un) **]. Post #2 reviewed by Dr [**Last Name (STitle) 16164**] and [**First Name7 (NamePattern1) **]
  [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 91932**] that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 16164**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2110-6-13**] 12:05


?????? [**2101**] CareGroup IS. All rights reserved.

[**2110-6-17**] 04:40AM BLOOD WBC-7.8 RBC-2.67* Hgb-8.0* Hct-25.2*
MCV-94 MCH-30.1 MCHC-31.9 RDW-13.8 Plt Ct-240
[**2110-6-9**] 11:52AM BLOOD WBC-15.4*# RBC-3.72* Hgb-11.5*#
Hct-34.5*# MCV-93 MCH-30.9 MCHC-33.3 RDW-12.9 Plt Ct-115*
[**2110-6-17**] 04:40AM BLOOD PT-23.1* INR(PT)-2.2*
[**2110-6-9**] 11:52AM BLOOD PT-12.5 PTT-26.5 INR(PT)-1.2*
[**2110-6-17**] 04:40AM BLOOD Glucose-102* UreaN-21* Creat-0.8 Na-140
K-5.4* Cl-104 HCO3-31 AnGap-10
[**2110-6-9**] 11:52AM BLOOD UreaN-15 Creat-0.7 Na-139 K-4.7 Cl-108
HCO3-23 AnGap-13
[**2110-6-18**] 04:45AM BLOOD Hct-28.5*
[**2110-6-18**] 12:45PM BLOOD PT-25.8* PTT-66.2* INR(PT)-2.5*
[**2110-6-18**] 04:45AM BLOOD UreaN-19 Creat-0.8 Na-138 K-5.4* Cl-101

Brief Hospital Course:
Mr.[**Known lastname **] was brought to the Operating Room on [**2110-6-9**] where
he underwent Mitral Valve Repair (#30mm CE ring)with Dr.
[**Last Name (STitle) **].  Overall the patient tolerated the procedure well and
post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring.
POD 1 found the patient extubated, alert and oriented and
breathing comfortably.  He awoke neurologically intact.  He
remained on Neo for hemodynamic support and was slow to wean
off. On POD 2, Mr.[**Known lastname **] had increasing oxygen requirements
and continued to require pressor support. Trans thoracic Echo
per Cardiology revealed well seated mitral valve annuloplasty
ring. Hyperdynamic left ventricular systolic function with at
least moderate resting left ventricular outflow tract
obstruction secondary to systolic anterior motion of the mitral
valve leaflets. Moderate to severe mitral regurgitation. He was
volume resuscitated for [**Male First Name (un) **] and beta-blockade optimized as BP
tolerated. Mr.[**Known lastname **] did not progress. Repeat trans thoracic
echo [**2110-6-12**] compared with the prior study of [**2110-6-11**] per
Cardiology, the LVOT obstruction was minimally decreased (from
56 mmHg to 46 mmHg). Severe mitral regurgitation now readily
apparent; previously it was moderate to severe. Dr.[**Last Name (STitle) **]
discussed with Mr.[**Known lastname **] the need for reoperation in the AM to
address this, and the likelihood of a mitral valve replacement.
On [**2110-6-13**] he was taken to the operating room and underwent a
mitral valve replacement with #27mm mechanical valve. Please see
operative report for further surgical details. He tolerated the
procedure well and was transferred to the CVICU for hemodynamic
monitoring and recovery. He required pressor support and was
ultimately weaned off. [**6-14**] he awoke neurologically intact and
was extubated. Beta blocker was initiated and the patient was
gently diuresed toward the preoperative weight. Anticoagulation
was initiated for his mechanical valve. All lines and drains
were discontinued per protocol. He made progress and was
transferred to the telemetry floor for further recovery.  The
patient was evaluated by the physical therapy service for
assistance with strength and mobility.  By the time of discharge
on POD #9 and #5 the patient was ambulating freely, the wound
was healing and pain was controlled with oral analgesics.  The
patient was discharged to home with VNA services. All follow up
appointments were advised.

Medications on Admission:
Pravastatin 40mg daily
Lisinopril 5mg daily


Discharge Medications:
1. aspirin 81 mg [**Month/Year (2) 8426**], Delayed Release (E.C.) Sig: One (1)
[**Month/Year (2) 8426**], Delayed Release (E.C.) PO DAILY (Daily).
Disp:*60 [**Month/Year (2) 8426**], Delayed Release (E.C.)(s)* Refills:*2*
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. pravastatin 20 mg [**Month/Year (2) 8426**] Sig: Two (2) [**Month/Year (2) 8426**] PO DAILY
(Daily).
Disp:*60 [**Month/Year (2) 8426**](s)* Refills:*2*
4. ranitidine HCl 150 mg [**Month/Year (2) 8426**] Sig: One (1) [**Month/Year (2) 8426**] PO BID (2
times a day).
Disp:*60 [**Month/Year (2) 8426**](s)* Refills:*2*
5. metoprolol tartrate 25 mg [**Month/Year (2) 8426**] Sig: One (1) [**Month/Year (2) 8426**] PO TID
(3 times a day).
Disp:*90 [**Month/Year (2) 8426**](s)* Refills:*2*
6. potassium chloride 10 mEq [**Month/Year (2) 8426**] Extended Release Sig: One
(1) [**Month/Year (2) 8426**] Extended Release PO BID (2 times a day) for 10 days.
Disp:*20 [**Month/Year (2) 8426**] Extended Release(s)* Refills:*0*
7. Lasix 40 mg [**Month/Year (2) 8426**] Sig: One (1) [**Month/Year (2) 8426**] PO twice a day for 10
days.
Disp:*20 [**Month/Year (2) 8426**](s)* Refills:*0*
8. hydromorphone 2 mg [**Month/Year (2) 8426**] Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*50 [**Month/Year (2) 8426**](s)* Refills:*0*
9. ibuprofen 600 mg [**Month/Year (2) 8426**] Sig: One (1) [**Month/Year (2) 8426**] PO Q6H (every 6
hours) as needed for pain.
Disp:*50 [**Month/Year (2) 8426**](s)* Refills:*0*
10. warfarin 5 mg [**Month/Year (2) 8426**] Sig: One (1) [**Month/Year (2) 8426**] PO ONCE (Once) for
1 doses.
Disp:*1 [**Month/Year (2) 8426**](s)* Refills:*0*
11. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO DAILY (Daily) as needed for constipation.
12. tramadol 50 mg [**Month/Year (2) 8426**] Sig: One (1) [**Month/Year (2) 8426**] PO Q4H (every 4
hours) as needed for pain.
Disp:*50 [**Month/Year (2) 8426**](s)* Refills:*0*
13. warfarin 2.5 mg [**Month/Year (2) 8426**] Sig: [**Name8 (MD) **] MD [**First Name (Titles) 8426**] [**Last Name (Titles) **] once a day: at
4 pm.
Disp:*180 [**Last Name (Titles) 8426**](s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 11485**] VNA

Discharge Diagnosis:
Mitral Regurgitation
Hypertension
Hypercholesterolemia
Past Surgical History
s/p Left ACL surgery


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart
No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments:
Wound Check at Cardiac Surgery Office [**Telephone/Fax (1) 170**]
Surgeon Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] Date/Time:[**2110-7-16**] at 1:30

Cardiologist Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] on [**2110-8-18**] at 3:45

PCP: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 91935**],[**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **] follow INR/Coumadin dosing.
INR indication: Mechanical MVR (#27mm St.[**Male First Name (un) 923**])
INR goal: 2.5-3.5
Please fax results to: Attention Dr.[**Last Name (STitle) **], fax# [**Telephone/Fax (1) 91936**]
phone# [**Telephone/Fax (1) 86343**]
**First draw [**2110-6-19**]

Please call to schedule the following:
Primary Care Dr. [**Last Name (STitle) 91935**],[**First Name3 (LF) **] R. [**Telephone/Fax (1) 86343**] in [**4-24**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2110-6-18**]
{'Mitral valve disorders,Rupture of chordae tendineae,Mechanical complication due to heart valve prosthesis,Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Other iatrogenic hypotension,Volume depletion, unspecified,Family history of ischemic heart disease,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'}


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: Asymptomatic

PRESENT ILLNESS: 51 year old male who has a history of a heart murmur for his
entire life. Has had echocardiograms the last couple of years
after increasing intensity of his mitral regurgitation murmur
was
noted. Recent echocardiograms have shown severe mirtral
regurgitation with a flail P2 and torn chordae. He is currently
asymptomatic but given state of his regurgitation along with
dilated left atrium he was referred to Dr. [**Last Name (STitle) **] for
evaluation
in [**2110-1-19**]. He returns now for preadmission testing for
surgery on [**2110-6-9**].

MEDICAL HISTORY: Mitral Regurgitation
Hypertension
Hypercholesterolemia
Past Surgical History
s/p Left ACL surgery

MEDICATION ON ADMISSION: Pravastatin 40mg daily
Lisinopril 5mg daily

ALLERGIES: Penicillins

PHYSICAL EXAM: Admission Physical Exam
Pulse: 80 Resp: 18  O2 sat: 99%
B/P  Right: 144/77   Left: 150/82
Height: 5'[**09**]"  Weight: 185 lbs

FAMILY HISTORY: +Premature coronary artery disease
Father MI < 55 []       Mother < 65 [X] CABG in 50's
Father with CABG in 60's. Uncles with CABGs.

SOCIAL HISTORY: Lives with: Wife
Contact: Wife              Phone #
Occupation: Firefighter
Cigarettes: Smoked no [X] yes [] last cigarette _____ Hx:
Other Tobacco use: Denies
ETOH: < 1 drink/week [] [**2-25**] drinks/week [X] >8 drinks/week []
Illicit drug use: Denies 

### Response:
{'Mitral valve disorders,Rupture of chordae tendineae,Mechanical complication due to heart valve prosthesis,Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Other iatrogenic hypotension,Volume depletion, unspecified,Family history of ischemic heart disease,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'}
