CHIEF COMPLAINT: nausea/vomiting, cerebellar bleed

PRESENT ILLNESS: Ms. [**Known lastname **] is an 88-year-old woman with a history of a-fib on
coumadin who was transfered from [**Hospital6 3105**]
yesterday after she presented with nausea/vomiting and was found
to have a R cerebellar bleed. Per her family she was in her
usual
state of health when they last saw her on Sunday morning for
breakfast. She did not report a headache or any other symptoms
at
that time, but per her family is not one to complain. She had a
scheduled [**Last Name (un) 8509**] eye procedure at [**Last Name (un) 112015**] Eye Associates
yesterday
morning ([**6-8**]). She lives alone and her family did not see her
or
speak with her that morning, but presume she took a cab to the
appointment as she typically does. After the procedure she
reportedly became diaphoretic and dizzy with nausea/vomiting and
was transported to [**Hospital3 **] ED. There she was initially
awake and alert, and reported that she had been having headaches
since the day before and was not feeling well that morning prior
to the procedure. She also complained of dizziness and diffuse
abdominal pain, and continued to have nausea with several
episodes of vomiting. On exam her pupils were equal and
reactive,
face was symmetric, no focal weakness. BP on arrival was 190/90;
did not receive any intervention. CT head was obtained which
revealed a R cerebellar hemorrhage. INR was 2.3, troponin 0.078.
Rest of labs wnl. She was given 10mg vitamin K IV and 2u FFP.
She
then reportedly became more somnolent during evaluation and had
multiple episodes of vomiting. She was intubated for airway
protection and transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: Atrial fibrillation with cardiac arrythmia s/p pacemaker
placement (on warfarin), GERD, esophageal varices
PSH:  s/p pacemaker placement, s/p probable cholecystectomy

MEDICATION ON ADMISSION: Simvastatin 40mg PO qd
Sotalol 80mg PO bid
Omeprazole 20mg PO qd
Coumadin 5mg on Monday/Thursday and 2.5mg on Tues,Weds,Fri,Sat,
Sun

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Exam on Admission:
Vitals:  140/74, 60, 12, 99%
General:  well-nourished, no acute distress, intubated
HEENT:  normocephalic, atraumatic, MMM, intubated, OGT in place
Chest:  lungs clear to auscultation bilaterally
Cardiac:  RRR, no rubs, murmurs, gallops
Abdomen:  soft, non-tender, non-distended, (+) bowel sounds
Extremities: 1+ DPs, no c/c/e

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Lives alone with son nearby. Very independent, walks with walker
but does own shopping, cleaning, bills, etc. No ETOH or tobacco
use.
Intracerebral hemorrhage,Pulmonary congestion and hypostasis,Dysarthria,Atrial fibrillation,Esophageal reflux,Long-term (current) use of anticoagulants,Cardiac pacemaker in situ,Other postprocedural status,Other respiratory abnormalities,Dysphagia, unspecified
Intracerebral hemorrhage,Pulm congest/hypostasis,Dysarthria,Atrial fibrillation,Esophageal reflux,Long-term use anticoagul,Status cardiac pacemaker,Post-proc states NEC,Respiratory abnorm NEC,Dysphagia NOS
Admission Date:  [**2133-6-8**]              Discharge Date:   [**2133-6-16**]


Service: NEUROLOGY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
nausea/vomiting, cerebellar bleed

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Ms. [**Known lastname **] is an 88-year-old woman with a history of a-fib on
coumadin who was transfered from [**Hospital6 3105**]
yesterday after she presented with nausea/vomiting and was found
to have a R cerebellar bleed. Per her family she was in her
usual
state of health when they last saw her on Sunday morning for
breakfast. She did not report a headache or any other symptoms
at
that time, but per her family is not one to complain. She had a
scheduled [**Last Name (un) 8509**] eye procedure at [**Last Name (un) 112015**] Eye Associates
yesterday
morning ([**6-8**]). She lives alone and her family did not see her
or
speak with her that morning, but presume she took a cab to the
appointment as she typically does. After the procedure she
reportedly became diaphoretic and dizzy with nausea/vomiting and
was transported to [**Hospital3 **] ED. There she was initially
awake and alert, and reported that she had been having headaches
since the day before and was not feeling well that morning prior
to the procedure. She also complained of dizziness and diffuse
abdominal pain, and continued to have nausea with several
episodes of vomiting. On exam her pupils were equal and
reactive,
face was symmetric, no focal weakness. BP on arrival was 190/90;
did not receive any intervention. CT head was obtained which
revealed a R cerebellar hemorrhage. INR was 2.3, troponin 0.078.
Rest of labs wnl. She was given 10mg vitamin K IV and 2u FFP.
She
then reportedly became more somnolent during evaluation and had
multiple episodes of vomiting. She was intubated for airway
protection and transferred to [**Hospital1 18**] for further management.

BP on arrival here was 140/74. She was seen by the neurosurgery
service in the ED, at which point her exam was limited by
sedation but revealed pinpoint pupils, intact brain stem
reflexes, purposeful movement of all extremities, and a L
upgoing
toe. A repeat CT at 5:18pm revealed a 2.7 x 3.1 cm R cerebellar
hemorrhage with a small amount of surrounding edema and mild
effacement of the fourth ventricle, overall unchanged from her
prior CT from 11:44am at [**Hospital3 **].

She was admitted to the neurosurgery service overnight for close
monitoring and consideration for possible EVD placement. She was
started on decadron and received an additional 10mg Vitamin K x
2. She was briefly started on a nitroprusside drip but this was
stopped last night and her BP has subsequently been
well-controlled in 130-140's systolic with 2 additional doses of
prn hydralazine. She was extubated last night shortly after
arrival to the ICU and has remained stable on 3L NC. Repeat CT
head this am appeared stable. As no surgical interventions are
currently planned the neurosurgery team requested transfer to
neurology for further management.

She is currently awake, somewhat lethargic but appropriately
arousable. She is able to answer a few yes/no questions and
seems
to understand that she is in the hospital but is unable to tell
us of the events yesterday or why she is here. Speech is
dysarthric and somewhat difficult to understand. She follows
basic commands appropriately and does not appear to have any
evident strength deficits. It is difficult to assess
coordination
given her current lethargy and poor cooperation.

Past Medical History:
Atrial fibrillation with cardiac arrythmia s/p pacemaker
placement (on warfarin), GERD, esophageal varices
PSH:  s/p pacemaker placement, s/p probable cholecystectomy


Social History:
Lives alone with son nearby. Very independent, walks with walker
but does own shopping, cleaning, bills, etc. No ETOH or tobacco
use.


Family History:
noncontributory

Physical Exam:
Physical Exam on Admission:
Vitals:  140/74, 60, 12, 99%
General:  well-nourished, no acute distress, intubated
HEENT:  normocephalic, atraumatic, MMM, intubated, OGT in place
Chest:  lungs clear to auscultation bilaterally
Cardiac:  RRR, no rubs, murmurs, gallops
Abdomen:  soft, non-tender, non-distended, (+) bowel sounds
Extremities: 1+ DPs, no c/c/e

Neuro: (off propofol for 5-10 minutes)
-Mental status: sedated, opens eyes to noxious, does not follow
commands
-Cranial nerves:  pinpoint pupils;(-) doll eyes, corneals
intact,
blinks to threat bilaterally, Face symmetric
-Motor: Moves all extremities purposefully
-Reflexes:  Symmetric 2's at the biceps, brachioradialis,
triceps, patellar, achilles bilaterally, Upgoing toe on L and
downgoing on right.

Physical Exam on Transfer to floor:
General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND
Extremities: No C/C/E bilaterally
Skin: no rashes or lesions noted

Neurologic:
-Mental Status: Awake, somewhat lethargic but easily arousable.
Oriented to self and hospital, does not know name of hospital or
date. Answers a few yes/no questions but otherwise answers
nonsensically. Speech is dysarthric and at times difficult to
understand. Able to follow midline and appendicular commands
with encouragement.

-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 2 to 1mm and brisk. VFF to confrontation.
III, IV, VI: EOMI with a few beats of horizontal nystagmus
maximal on leftward gaze.
V: Facial sensation intact to light touch and cold.
VII: Subtle left lower facial asymmetry.
VIII: Hearing intact to loud voice bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally.
XII: Tongue protrudes in midline.

-Motor: Normal bulk, tone throughout. No adventitious movements,
such as tremor, noted.
Lifts both arms anti-gravity and hold for 10 seconds. Squeezes
both hands strongly.
Lifts both legs anti-gravity. Does not comply with formal
strength testing at this time but appears to be moving all
extremites symmetrically.

-Sensory: Grossly intact to light touch throughout.

-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2  2    2    2   1
R  2  2    2    2   1
Plantar response was flexor on R, extensor on L.

-Coordination: Difficult to assess given lethargy and poor
cooperation, reaches b/l without obvious ataxia but unablet to
perform FNF or HKS currently.

-Gait: Deferred

Physical Exam on Discharge:
Vitals: T 98 BP 143/69 HR 60 RR 16 O2 94 RA
SEE BELOW

Pertinent Results:
[**2133-6-8**] 09:20PM   UREA N-14 CREAT-0.6 SODIUM-141 POTASSIUM-3.1*
CHLORIDE-102
[**2133-6-8**] 09:20PM   PLT COUNT-158
[**2133-6-8**] 09:20PM   PT-12.3 INR(PT)-1.1
[**2133-6-8**] 03:22PM   TYPE-ART RATES-/12 TIDAL VOL-450 PEEP-5
O2-100 PO2-417* PCO2-36 PH-7.50* TOTAL CO2-29 BASE XS-5
AADO2-257 REQ O2-50 INTUBATED-INTUBATED VENT-SPONTANEOU
[**2133-6-8**] 02:25PM   GLUCOSE-154* UREA N-15 CREAT-0.8 SODIUM-144
POTASSIUM-3.6 CHLORIDE-106 TOTAL CO2-23 ANION GAP-19
[**2133-6-8**] 02:25PM   estGFR-Using this
[**2133-6-8**] 02:25PM   cTropnT-<0.01
[**2133-6-8**] 02:25PM   WBC-5.8 RBC-4.12* HGB-12.8 HCT-38.8 MCV-94
MCH-31.0 MCHC-33.0 RDW-14.2
[**2133-6-8**] 02:25PM   NEUTS-77.6* LYMPHS-17.4* MONOS-3.9 EOS-0.9
BASOS-0.2
[**2133-6-8**] 02:25PM   PLT COUNT-149*
[**2133-6-8**] 02:25PM   PT-16.6* PTT-29.2 INR(PT)-1.6*

CT head [**6-8**]:
IMPRESSION:
1.  Right cerebellar intraparenchymal hemorrhage, unchanged from
11:44 a.m., with mild surrounding edema and mild effacement of
the fourth ventricle.  No evidence of supratentorial
hydrocephalus, allowing for atrophy-related enlargement of the
supratentorial ventricles and sulci.
2.  No evidence of an underlying mass, within the limitations of
CT technique. It appears that the patient may not undergo MRI
due to a pacemaker.  A head CTA would be more sensitive than a
routine contrast-enhanced CT for excluding an arteriovenous
malformation, if indicated.
3.  Linear lucency in the right occipital bone, more consistent
with a
prominent nutrient foramen rather than a fracture, particularly
given the lack of any swelling in the overlying scalp.

CT head [**6-9**]:
1. Unchanged appearance of the right cerebellar hemorrhagic
infarction with surrounding edema causing moderate compression
of
the fourth ventricle. The size of the ventricles is unchanged.
2. No evidence of tonsillar herniation.
3. No new hemorrhage.

CXR [**6-9**]:
IMPRESSION: Small bilateral pleural effusions.

Transthoracic echo [**6-9**]:
The left atrium is mildly dilated. Left ventricular wall
thicknesses are normal. The left ventricular cavity size 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) are mildly thickened.
There is no aortic valve stenosis. No aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral regurgitation is seen. The tricuspid valve leaflets are
mildly thickened. There is mild pulmonary artery systolic
hypertension. There is no pericardial effusion.

No cardiac source of embolus identified (other than the history
of atrial fibrillation).

CT head [**6-10**]:
IMPRESSION:
1.  Unchanged appearance of large right cerebellar hemispheric
hematoma,
associated edema and mass effect, with stable compression of the
fourth
ventricle and very mild right-sided upper transtentorial
herniation.
2.  Stable ventricular size, with no definite evidence of
developing
obstructive hydrocephalus.
3.  Stable periventricular hypodensities, most likely the
sequelae of chronic small vessel ischemic disease, although a
component of transependymal migration cannot be completely
excluded.
.
Labs on Discharge:

[**2133-6-15**] 05:45AM BLOOD WBC-6.3 RBC-4.59 Hgb-14.1 Hct-43.2 MCV-94
MCH-30.7 MCHC-32.6 RDW-14.4 Plt Ct-157
[**2133-6-15**] 05:45AM BLOOD Glucose-109* UreaN-19 Creat-0.7 Na-138
K-4.4 Cl-100 HCO3-28 AnGap-14
[**2133-6-15**] 05:45AM BLOOD Calcium-8.9 Phos-3.4 Mg-2.4

Brief Hospital Course:
88-year-old woman with a history of a-fib on coumadin who
developed dizziness, nausea, and vomiting after an eye procedure
and was found to have a R cerebellar hemorrhage of unknown
etiology. She was initially admitted to the ICU under the
neurosurgery service on [**6-8**] but remained stable with no
indication for surgical intervention currently. She was
subsequently transferred to the neurology service on [**6-9**] for
further management.

Neuro:
She was monitored closely with Q2 hour neurochecks and remained
clinically stable. Repeat head CT's on [**6-9**] and [**6-10**] appeared
stable. She had initially been started on Decadron for
prevention of cerebral edema and mannitol was placed at bedside
in case she decompensated secondary to acute cerebral edema.
However, pt did well with no edema and decardron was tapered
slowly over 3 days. BP was monitored closely and treated with
hydralazine and metprolol prn with a goal SBP < 160. Her exam
remained stable, significant for disorientation, dysarthria, and
mild nystagmus on leftward gaze but no apparent strength
deficits or ataxia (although formal testing somewhat limited by
lethargy and poor cooperation). She was initially quite
lethargic and disoriented with very delayed responses and
nonsensical, garbled speech. She is now becoming more alert and
lucid, oriented to self and hospital, and able to answer simple
questions appropriately. She remains somewhat abulic with
significant psychomotor slowing.

At this point the etiology of her hemorrhage is unclear.
Possibilities include hypertensive (no known history although BP
was 190/90 on presentation), underlying mass or AVM, amyloid
angiopathy, or hemorrhagic conversion of infarction (although
does not follow a clear vascular distrubiton). MRI could not be
performed due to her pacemaker.

CV:
She was maintained on telemetry monitoring which revealed atrial
fibrillation, occasionally with RVR. Heart rate was controlled
with metoprolol and diltiazem prn, and she was subsequently
started on metoprolol 25mg PO TID for rate control.  Day prior
to d/c, pt went into afib with RVR, rate up to 140s.  Trated
with metoprolol 2.5mg IV x1 and switched back to her home
sotalol 80mg PO bid and metoprolol was discontinued. HR remained
in 60s.  BP was monitored and controlled closely with prn
hydralazine and metoprolol with a goal SBP < 160. TTE was within
normal limits with no evidence of atrial thrombus or valvular
disease.

PULM:
She was extubated shortly after admission to the ICU and her
respiratory status subsequently remained stable. She was
provided low flow O2 via NC as needed to maintain sats. CXR
showed mild pulmonary edema (after receiving 2u FFP). She
received two doses of lasix 20mg IV and volume status was
monitored closely.

ENDO
She was maintained on fingersticks and insulin sliding scale
with a goal of normoglycemia.

ID:
She remained afebrile throughout her ICU stay. CXR showed small
b/l effusions but no infiltrate. WBC began to trend up, peaking
at 14.2 on [**6-10**]. UA was positive and she was started empirically
on ceftriaxone, but discontinued on [**6-15**] since final urine
culture was not c/w UTI.

FEN:
She was initially maintained NPO given her depressed mental
status and an NGT was placed for medications and nutrition. She
was subsequently seen by speech and swallow and was cleared for
a pureed diet with thin liquids.

PPX:
She was maintained on a bowel regimen and famotidine for GI
prophylaxis. She was maintained on pneumoboots for DVT
prophylaxis. SubQ heparin was initially held in the setting of
her bleed and was restarted on [**6-10**]. She was maintained on fall
and aspiration precautions.

Code Status: FULL (reconfirmed with family [**6-9**])

PENDING RESULTS:
none

TRANSITIONAL CARE ISSUES:
- will need to re-start Coumadin at home dose of 2.5mg on [**2133-6-22**]
- will need INR check on [**6-25**] and titration of dose as needed
- will f/u in stroke clinic on [**2133-8-18**] at 2pm

Medications on Admission:
Simvastatin 40mg PO qd
Sotalol 80mg PO bid
Omeprazole 20mg PO qd
Coumadin 5mg on Monday/Thursday and 2.5mg on Tues,Weds,Fri,Sat,
Sun

Discharge Medications:
1. Docusate Sodium (Liquid) 100 mg PO BID
2. Omeprazole 20 mg PO DAILY
3. Senna 1 TAB PO BID
4. Sotalol 80 mg PO BID
5. Simvastatin 40 mg PO DAILY


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7665**]

Discharge Diagnosis:
right cerebellar hemorrhage


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).

Neurologic Exam ON DAY OF DISCHARGE [**2133-6-15**]:
Appears comfortable. Smiles, says she feels good. Awake and
alert. Oriented to name/hospital. Somewhat slow to respond with
soft speech. Says she would like to get up and walk. Working
with PT, sitting in a chair. Has not yet gotten up to walk.
Follows simple commands reliably. PERRL, EOMI with no nystagmus.
Speech is somewhat hoarse, and soft. Subtle L facial asymmetry
(noted on admission) not prominent on exam today. Hard of
hearing. Power at least anti-gravity in all extremities; no
drift. No ataxia on FNF. No truncal titubation. Sensation
grossly intact to light touch throughout. Toes=Plantar response
was flexor on R, extensor on L. Reflexes [**12-15**] and symmetric in UE
and LEs. Gait deferred (working with PT, attempting to use
walker -- plan for PT at rehab).


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

You came to the hospital with dizziness, confusion and nausea
and we found that you had a small bleed in your brain.  We
monitored you closely and you gradually improved.  While you
were in the hospital, we DID NOT give you Coumadin because we
did not want to exacerbate the bleed in your brain.  However, to
prevent stroke, it is VERY important that you resume taking
Coumadin in 1 week ([**2133-6-22**]) at prior dose.

A physical therapist saw you while you were in the hospital and
recommended that you go to a rehab center to regain strength.

It is VERY important that you call registration at [**Hospital1 771**] to update your information regarding
your primary care doctor, etc.  Please call [**Telephone/Fax (1) 87261**] BEFORE
your neurology appointment.

We have made the following changes to your medications:
STOP
-taking Coumadin for the next week

RE-START
-Coumadin on [**2133-6-22**]

START
- Colace 100mg liquid twice daily for constipation
- Senna 1 tablet twice per day as needed for constipation

Please see your new neurologist, Dr. [**Last Name (STitle) **], as scheduled
below.

It was a pleasure taking care of you, we wish you all the best!

Followup Instructions:
Follow-Up Appointment Instructions

Department: NEUROLOGY
When: TUESDAY [**2133-8-18**] at 2:00 PM
With: [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**Telephone/Fax (1) 2574**]
Building: [**Hospital6 29**] [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

It is VERY important that you call registration at [**Hospital1 771**] to update your information regarding
your primary care doctor, etc.  Please call [**Telephone/Fax (1) 87261**] BEFORE
your neurology appointment.


                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]

Completed by:[**2133-6-16**]
{'Intracerebral hemorrhage,Pulmonary congestion and hypostasis,Dysarthria,Atrial fibrillation,Esophageal reflux,Long-term (current) use of anticoagulants,Cardiac pacemaker in situ,Other postprocedural status,Other respiratory abnormalities,Dysphagia, 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: nausea/vomiting, cerebellar bleed

PRESENT ILLNESS: Ms. [**Known lastname **] is an 88-year-old woman with a history of a-fib on
coumadin who was transfered from [**Hospital6 3105**]
yesterday after she presented with nausea/vomiting and was found
to have a R cerebellar bleed. Per her family she was in her
usual
state of health when they last saw her on Sunday morning for
breakfast. She did not report a headache or any other symptoms
at
that time, but per her family is not one to complain. She had a
scheduled [**Last Name (un) 8509**] eye procedure at [**Last Name (un) 112015**] Eye Associates
yesterday
morning ([**6-8**]). She lives alone and her family did not see her
or
speak with her that morning, but presume she took a cab to the
appointment as she typically does. After the procedure she
reportedly became diaphoretic and dizzy with nausea/vomiting and
was transported to [**Hospital3 **] ED. There she was initially
awake and alert, and reported that she had been having headaches
since the day before and was not feeling well that morning prior
to the procedure. She also complained of dizziness and diffuse
abdominal pain, and continued to have nausea with several
episodes of vomiting. On exam her pupils were equal and
reactive,
face was symmetric, no focal weakness. BP on arrival was 190/90;
did not receive any intervention. CT head was obtained which
revealed a R cerebellar hemorrhage. INR was 2.3, troponin 0.078.
Rest of labs wnl. She was given 10mg vitamin K IV and 2u FFP.
She
then reportedly became more somnolent during evaluation and had
multiple episodes of vomiting. She was intubated for airway
protection and transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: Atrial fibrillation with cardiac arrythmia s/p pacemaker
placement (on warfarin), GERD, esophageal varices
PSH:  s/p pacemaker placement, s/p probable cholecystectomy

MEDICATION ON ADMISSION: Simvastatin 40mg PO qd
Sotalol 80mg PO bid
Omeprazole 20mg PO qd
Coumadin 5mg on Monday/Thursday and 2.5mg on Tues,Weds,Fri,Sat,
Sun

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Exam on Admission:
Vitals:  140/74, 60, 12, 99%
General:  well-nourished, no acute distress, intubated
HEENT:  normocephalic, atraumatic, MMM, intubated, OGT in place
Chest:  lungs clear to auscultation bilaterally
Cardiac:  RRR, no rubs, murmurs, gallops
Abdomen:  soft, non-tender, non-distended, (+) bowel sounds
Extremities: 1+ DPs, no c/c/e

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Lives alone with son nearby. Very independent, walks with walker
but does own shopping, cleaning, bills, etc. No ETOH or tobacco
use. 

### Response:
{'Intracerebral hemorrhage,Pulmonary congestion and hypostasis,Dysarthria,Atrial fibrillation,Esophageal reflux,Long-term (current) use of anticoagulants,Cardiac pacemaker in situ,Other postprocedural status,Other respiratory abnormalities,Dysphagia, unspecified'}
