CHIEF COMPLAINT: positive stress test ; chest pain during hypertension to 220/110

PRESENT ILLNESS: Mr. [**Known lastname 27218**] is a 69 yo M w/ h/o HTN and significant tobacco
use, who had a severe headache on [**2131-4-19**] without associated
symptoms (including weakness, visual changes), and was found to
be hypertensive to 220/110.  He was transferred via ambulence to
[**Hospital 1474**] Hospital and in route complained of right sided chest
discomfort, associated with dyspnea and diaphoreiss. By report
he was administered SL NTG and nitro paste with improvement in
BP and chest discomfort.  He subsequently underwen ETT with
pMIBI which demonstrated a perfusion deficit at rest and was
referred to [**Hospital1 18**] for cardiac catheterization and renal artery
angiogram.
.
Mr. [**Known lastname 27218**] also reports decreased exercise tolerance over the
past several months - previously he would be able to climb
several flights of stairs without difficulty; he currently gets
extremely dypsneic after 10 steps (<1 flight); no associated CP,
N, or diahphoresis.  He denies orthopnea and PND.
.
He denies history of angina or CAD.
.
Mr. [**Known lastname 27218**] [**Last Name (Titles) 1834**] cardiac catheterization today and was
found to have 3VD, and a CABG is now planned.  He took a dose of
plavix this morning.
.
ROS: denies recent illness, fevers, hematuria, melena, bloody
stools, abdominal pain, LE swelling.  Reports 8lb intentional
weight loss (healthier diet)
Referred for CABG .

MEDICAL HISTORY: HTN
GERD
Bladder ca s/p excision x 2 and the BCG treatment
Syncopal episodes x 3 (episodes accompanied by diaphoresis and
nausea) with the last episode many years ago
H/O pneumonia x 3
Depression
Chronic back problems including disc herniation, s/p disc
surgery
Anxiety
COPD
BPH

MEDICATION ON ADMISSION: Lasix  20 mg daily
Minoxidil 25 mg daily
Detrol 4 mg daily
Ranitidine 300 mg [**Hospital1 **]
Atenolol 25 mg [**Hospital1 **]
Pro-Chlor 20 mEq daily
Plavix 75 mg daily (pt started 2 weeks ago but stopped 4 days
ago
and will restart 4/20/070)
Celexa 40 mg daily
Endocet 5/325 mg prn
ASA 81 mg daily
Proscar 5 mg daily
Imdur 30 mg daily
NTG 0.4 mg sl

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 138/61  51  16  100% RA  5'[**35**]" Wt:220 lbs
Gen: NAD, smiling
HEENT: aniecteric, PERRL, EOMI, MMM, no JVD, no bruits
CV: regular rhythm, ~60, no M/R/G
Chest: CTAB
Abd: Soft, NT/ND
R Groin: dressing C/D/I, no bruit or thrill
Ext: 2+ DP pulses bilaterally
Neuro: A&Ox3, fluent speech, normal ambulation, MAE

FAMILY HISTORY: Noncontributory (h/o cancer)

SOCIAL HISTORY: Married, lives with his wife, 5 children.  He is a retired truck
driver and currently helps out in his son??????s restaurant.
+tobacco 1ppd x 55 years.  Occasional EtOH. No illicits
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Tobacco use disorder,Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of malignant neoplasm of bladder
Crnry athrscl natve vssl,Intermed coronary synd,Chr airway obstruct NEC,Hypertension NOS,Tobacco use disorder,Esophageal reflux,BPH w/o urinary obs/LUTS,Hx of bladder malignancy
Admission Date:  [**2131-4-30**]              Discharge Date:   [**2131-5-8**]

Date of Birth:  [**2061-8-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
positive stress test ; chest pain during hypertension to 220/110


Major Surgical or Invasive Procedure:
Cardiac Catheterization [**2131-4-30**]
CABGx5 (LIMA-LAD,SVG-Diag,SVG-OM1,SVG-OM2,SVG-PDA)[**5-4**]


History of Present Illness:
Mr. [**Known lastname 27218**] is a 69 yo M w/ h/o HTN and significant tobacco
use, who had a severe headache on [**2131-4-19**] without associated
symptoms (including weakness, visual changes), and was found to
be hypertensive to 220/110.  He was transferred via ambulence to
[**Hospital 1474**] Hospital and in route complained of right sided chest
discomfort, associated with dyspnea and diaphoreiss. By report
he was administered SL NTG and nitro paste with improvement in
BP and chest discomfort.  He subsequently underwen ETT with
pMIBI which demonstrated a perfusion deficit at rest and was
referred to [**Hospital1 18**] for cardiac catheterization and renal artery
angiogram.
.
Mr. [**Known lastname 27218**] also reports decreased exercise tolerance over the
past several months - previously he would be able to climb
several flights of stairs without difficulty; he currently gets
extremely dypsneic after 10 steps (<1 flight); no associated CP,
N, or diahphoresis.  He denies orthopnea and PND.
.
He denies history of angina or CAD.
.
Mr. [**Known lastname 27218**] [**Last Name (Titles) 1834**] cardiac catheterization today and was
found to have 3VD, and a CABG is now planned.  He took a dose of
plavix this morning.
.
ROS: denies recent illness, fevers, hematuria, melena, bloody
stools, abdominal pain, LE swelling.  Reports 8lb intentional
weight loss (healthier diet)
Referred for CABG .

Past Medical History:
HTN
GERD
Bladder ca s/p excision x 2 and the BCG treatment
Syncopal episodes x 3 (episodes accompanied by diaphoresis and
nausea) with the last episode many years ago
H/O pneumonia x 3
Depression
Chronic back problems including disc herniation, s/p disc
surgery
Anxiety
COPD
BPH

Social History:
Married, lives with his wife, 5 children.  He is a retired truck
driver and currently helps out in his son??????s restaurant.
+tobacco 1ppd x 55 years.  Occasional EtOH. No illicits

Family History:
Noncontributory (h/o cancer)

Physical Exam:
138/61  51  16  100% RA  5'[**35**]" Wt:220 lbs
Gen: NAD, smiling
HEENT: aniecteric, PERRL, EOMI, MMM, no JVD, no bruits
CV: regular rhythm, ~60, no M/R/G
Chest: CTAB
Abd: Soft, NT/ND
R Groin: dressing C/D/I, no bruit or thrill
Ext: 2+ DP pulses bilaterally
Neuro: A&Ox3, fluent speech, normal ambulation, MAE

Pertinent Results:
[**2131-4-30**] 10:33AM BLOOD WBC-6.3 RBC-4.50* Hgb-12.6* Hct-35.9*
MCV-80* MCH-27.9 MCHC-35.0 RDW-15.2 Plt Ct-193
[**2131-4-30**] 10:33AM BLOOD Glucose-98 UreaN-21* Creat-1.0 Na-137
K-4.1 Cl-107 HCO3-24 AnGap-10
[**2131-4-30**] 10:33AM BLOOD ALT-8 AST-12 AlkPhos-63 TotBili-0.5
[**2131-4-30**] 10:33AM BLOOD %HbA1c-5.1
.
Recent testing:
[**2131-4-24**]: Echo showed a normal LV size and function.  EF of
60-65%.  The valves were all normal with trace TR.  Pulmonary
systolic pressure was estimated to be 30-35%. [**2131-4-20**]: Nuclear
stress test where the patient exercised for 6 minutes 57 seconds
on [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] protocol stopping due to shortness of breath and leg
pain.  He achieved 68% of his predicted target heart rate.  He
did not develop any arrhythmias or chest pain.  The nuclear
images demonstrated a normal sized left ventricle. There was a
moderate sized reversible perfusion abnormality involving the
anteroapical and septal portion left ventricle. There was also a
question of a small reversible abnormality involving the
inferolateral portion left ventricle.  The left ventricular wall
motion was normal.  The LVEF was 62%.
.
[**2131-4-30**] Cardiac Catheterization
COMMENTS:
1.  Coronary angiography of this right dominant system revealed
severe three vessel coronary artery disease.  The left main
coronary artery had no angiographically apparent flow limiting
stenoses.  The LAD was ectatic proximally and occluded in the
mid segment after a small diagonal.  The LCX had a 90% stenosis
of the OM1 proximally and a 50% followed by a 70% stenosis in
the proximal and mid segment of the OM2. The RCA had a 90%
stenosis in the mid PDA.
2.  Limited resting hemodynamics revealed mildly to moderately
elevated left sided filling pressures (LVEDP was 18 mm Hg).
Systemic arterial pressure was normal (aortic pressure was
121/73 mm Hg).  There was no significant gradient across the
aortic valve upon pullback of the catheter from the left
ventricle to the ascending aorta.
3.  Left ventriculography revealed a contrast calculated
ejection
fraction of 65%.  No mitral regurgitation was noted. 4.
Bilateral selective renal angiography demonstrated widely patent
renal arteries.
FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Normal left ventricular systolic function.
3. Mildly to moderately elevated left sided filling pressures.
4. No angiographically apparent renal artery stenosis.
.
Pulmonary Function Tests:
[**2131-5-8**] 06:25AM BLOOD WBC-7.3 RBC-3.17* Hgb-9.1* Hct-26.3*
MCV-83 MCH-28.7 MCHC-34.6 RDW-15.5 Plt Ct-201#
[**2131-5-8**] 06:25AM BLOOD Plt Ct-201#
[**2131-5-8**] 06:25AM BLOOD Glucose-101 UreaN-14 Creat-1.3* K-5.1

Cardiology Report ECHO Study Date of [**2131-5-4**]



PATIENT/TEST INFORMATION:
Indication: Chest pain. Coronary artery disease. Hypertension.
Status: Inpatient
Date/Time: [**2131-5-4**] at 10:41
Test: TEE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2007AW2-:
Test Location: Anesthesia West OR cardiac
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **]

MEASUREMENTS:
Left Ventricle - Septal Wall Thickness: *1.5 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Ejection Fraction: 45% to 50% (nl >=55%)
Aorta - Ascending: *3.7 cm (nl <= 3.4 cm)
Aortic Valve - Peak Velocity: 1.4 m/sec (nl <= 2.0 m/sec)

INTERPRETATION:

Findings:

LEFT ATRIUM: Normal LA size. No spontaneous echo contrast in the
body of the
LA. No spontaneous echo contrast or thrombus in the body of the
[**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA.

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

LEFT VENTRICLE: Mild symmetric LVH with normal cavity size. Mild
symmetric
LVH. Normal LV cavity size. Mild regional LV systolic
dysfunction. No LV
mass/thrombus. Mildly depressed LVEF. Transmitral Doppler and
TVI c/w normal
LV diastolic function. No resting LVOT gradient.

LV WALL MOTION: Regional LV wall motion abnormalities include:
anterior apex -
hypo;

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

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


AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve
leaflets. No AS. Trace AR.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR. Mild
mitral
annular calcification. No MS. Physiologic MR (within normal
limits).

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with
physiologic PR.

PERICARDIUM: Trivial/physiologic pericardial effusion.

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

Conclusions:
PRE-CPB: 1.The left atrium is normal in size. No spontaneous
echo contrast is
seen in the body of the left atrium. No spontaneous echo
contrast or thrombus
is seen in the body of the left atrium or left atrial appendage.
No atrial
septal defect is seen by 2D or color Doppler.
2. There is mild symmetric left ventricular hypertrophy with
normal cavity
size. There is mild symmetric left ventricular hypertrophy. The
left
ventricular cavity size is normal. There is mild regional left
ventricular
systolic dysfunction with apical anterior hypokinesis.. No
masses or thrombi
are seen in the left ventricle. Overall left ventricular
systolic function is
mildly depressed. Transmitral Doppler and tissue velocity
imaging are
consistent with normal LV diastolic function.
3. Right ventricular chamber size and free wall motion are
normal.
4. The ascending aorta is mildly dilated at a maximum of 3.7.
There are simple
atheroma in the aortic arch. There are simple atheroma in the
descending
thoracic aorta.
5. There are three aortic valve leaflets. The aortic valve
leaflets are mildly
thickened. There is no aortic valve stenosis. Trace aortic
regurgitation is
seen.
6. The mitral valve appears structurally normal with trivial
mitral
regurgitation. Physiologic mitral regurgitation is seen (within
normal
limits).
7. There is a trivial/physiologic pericardial effusion.
POST-CPB: Patient is on phenylephrine infusion. Preserved
biventricular
systolic function with improvement of the anteroapical
hypokinetic segment.
LVEF now 55%. Trace MR. Aortic contour is normal post
decannulation.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD on [**2131-5-4**] 15:02.

[**Location (un) **] PHYSICIAN:



([**Numeric Identifier 27219**])
   RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2131-5-7**] 11:20 AM

CHEST (PA & LAT)

Reason: r/o ptx

[**Hospital 93**] MEDICAL CONDITION:
69 yoM s/p CABG and CT removal
REASON FOR THIS EXAMINATION:
r/o ptx
TWO VIEW CHEST OF [**2131-5-7**].

COMPARISON: [**2131-5-4**]

INDICATION: Chest tube removal.

Various lines and tubes have been removed since the prior
radiograph, and a very small left apical pneumothorax has
developed. Cardiac and mediastinal contours are within normal
limits for postoperative status of the patient. Small pleural
effusions and minor bibasilar atelectasis are noted. These
findings are superimposed upon subtle likely more chronic
peripheral and basilar interstitial lung disease.

On the lateral view, small air-fluid level is present in the
retrosternal region likely representing an anterior
hydropneumothorax, and additional air is present in the
retrosternal region, an expected postoperative finding given the
time interval since surgery.

IMPRESSION: Small left pneumothorax following tube removal.
Bibasilar atelectasis and small pleural effusions.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5785**]
Approved: MON [**2131-5-7**] 1:12 PM





Brief Hospital Course:
A/P: this is a 69 yo M w/ h/o HTN and significant tobacco use,
who presents for cardiac catheterization after abnormal
perfusion scan, which revealed 3VD, prompting CABG.
.
#CAD:
-medication regiment modified: continue ASA, BB, imdur;
minoxidil discontinued and ACEI started.
.
#HTN: well controlled on BB, imdur, and ACEI
.
#BPH: continue proscar
.
#Bladder spasm s/p surgery and BCG tx: continue detrol
.
#GERD: continue ranitidine
.
#Depression/Anxiety: continue celexa
.
#h/o syncope: by report worked up extensively at [**Hospital1 1474**] w/o
diagnosis
-carotid U/S normal
-no events on telemetry
.
#COPD: per patient, recent diagnosis based on CXR at [**Hospital1 1474**]
during last hospitalization, not on any active medications
-no wheeze, no respiratory distress, good O2 sat
-PFTs performed and carotid U/S showed no significant stenoses.

 [**Hospital1 **] cabg x5 with Dr. [**Last Name (STitle) 914**] on [**5-4**]. Transferred to the
CSRU in stable condition on titrated phenylephrine and propofol
drips.Extubated that evening and transferred to the floor on POD
#1 to begin increasing his activity level. Chest tubes and
pacing wires removed on POD #3.Nicotine patch continued. Made
good progress and cleared for discharge to home with VNA on POD
#4. Pt. is to make all follow-up appts. as per discharge
instructions.

Medications on Admission:
Lasix  20 mg daily
Minoxidil 25 mg daily
Detrol 4 mg daily
Ranitidine 300 mg [**Hospital1 **]
Atenolol 25 mg [**Hospital1 **]
Pro-Chlor 20 mEq daily
Plavix 75 mg daily (pt started 2 weeks ago but stopped 4 days
ago
and will restart 4/20/070)
Celexa 40 mg daily
Endocet 5/325 mg prn
ASA 81 mg daily
Proscar 5 mg daily
Imdur 30 mg daily
NTG 0.4 mg sl

Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours): 20mg [**Hospital1 **] x7days then
20mg QD x10 days.
Disp:*24 Tablet(s)* Refills:*0*
2. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours): 20 meq
[**Hospital1 **] x 7 days then
20meq QD x 10 days.
Disp:*48 Capsule, Sustained Release(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
7. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
8. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily) for 2 weeks.
Disp:*14 Patch 24 hr(s)* Refills:*0*
9. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
11. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. Citalopram 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
13. Detrol 2 mg Tablet Sig: Two (2) Tablet PO once a day.
14. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Coronary Artery Disease, s/p CABGx5
PMH:Hypertension,Hyperlipidemia,GERD,Bladder
CA,Depression,COPD,BPH


Discharge Condition:
good


Discharge Instructions:
keep wounds clean and dry. OK to shower, no bathing or swimming.

Take all medications as prescribed.
Call for any fever, redness or drainage from wounds
no driving for one month
no lifting greater than 10 pounds for 10 weeks

Followup Instructions:
wound clinic in 2 weeks ( [**Hospital Ward Name 121**] 2)
Dr [**Name (NI) 23019**] in [**2-10**] weeks
Dr [**Last Name (STitle) 914**] in 4 weeks [**Telephone/Fax (1) 170**]



Completed by:[**2131-5-8**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Tobacco use disorder,Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of malignant neoplasm of bladder'}


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: positive stress test ; chest pain during hypertension to 220/110

PRESENT ILLNESS: Mr. [**Known lastname 27218**] is a 69 yo M w/ h/o HTN and significant tobacco
use, who had a severe headache on [**2131-4-19**] without associated
symptoms (including weakness, visual changes), and was found to
be hypertensive to 220/110.  He was transferred via ambulence to
[**Hospital 1474**] Hospital and in route complained of right sided chest
discomfort, associated with dyspnea and diaphoreiss. By report
he was administered SL NTG and nitro paste with improvement in
BP and chest discomfort.  He subsequently underwen ETT with
pMIBI which demonstrated a perfusion deficit at rest and was
referred to [**Hospital1 18**] for cardiac catheterization and renal artery
angiogram.
.
Mr. [**Known lastname 27218**] also reports decreased exercise tolerance over the
past several months - previously he would be able to climb
several flights of stairs without difficulty; he currently gets
extremely dypsneic after 10 steps (<1 flight); no associated CP,
N, or diahphoresis.  He denies orthopnea and PND.
.
He denies history of angina or CAD.
.
Mr. [**Known lastname 27218**] [**Last Name (Titles) 1834**] cardiac catheterization today and was
found to have 3VD, and a CABG is now planned.  He took a dose of
plavix this morning.
.
ROS: denies recent illness, fevers, hematuria, melena, bloody
stools, abdominal pain, LE swelling.  Reports 8lb intentional
weight loss (healthier diet)
Referred for CABG .

MEDICAL HISTORY: HTN
GERD
Bladder ca s/p excision x 2 and the BCG treatment
Syncopal episodes x 3 (episodes accompanied by diaphoresis and
nausea) with the last episode many years ago
H/O pneumonia x 3
Depression
Chronic back problems including disc herniation, s/p disc
surgery
Anxiety
COPD
BPH

MEDICATION ON ADMISSION: Lasix  20 mg daily
Minoxidil 25 mg daily
Detrol 4 mg daily
Ranitidine 300 mg [**Hospital1 **]
Atenolol 25 mg [**Hospital1 **]
Pro-Chlor 20 mEq daily
Plavix 75 mg daily (pt started 2 weeks ago but stopped 4 days
ago
and will restart 4/20/070)
Celexa 40 mg daily
Endocet 5/325 mg prn
ASA 81 mg daily
Proscar 5 mg daily
Imdur 30 mg daily
NTG 0.4 mg sl

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 138/61  51  16  100% RA  5'[**35**]" Wt:220 lbs
Gen: NAD, smiling
HEENT: aniecteric, PERRL, EOMI, MMM, no JVD, no bruits
CV: regular rhythm, ~60, no M/R/G
Chest: CTAB
Abd: Soft, NT/ND
R Groin: dressing C/D/I, no bruit or thrill
Ext: 2+ DP pulses bilaterally
Neuro: A&Ox3, fluent speech, normal ambulation, MAE

FAMILY HISTORY: Noncontributory (h/o cancer)

SOCIAL HISTORY: Married, lives with his wife, 5 children.  He is a retired truck
driver and currently helps out in his son??????s restaurant.
+tobacco 1ppd x 55 years.  Occasional EtOH. No illicits 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Tobacco use disorder,Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of malignant neoplasm of bladder'}
