CHIEF COMPLAINT: Dyspnea

PRESENT ILLNESS: Ms. [**Known lastname 4249**] is a 77-year-old female with known atrial
fibrillation, CHF, depressed EF to 35% who presented with
shortness of breath worsening over two weeks. She came in to [**Hospital1 **]
for a planned PMIBI today. She became very SOB during the test
and O2 sats went to 85% on RA. Her sats came up w/ O2. She was
sent to the ER.  She stated that she has had increasing DOE for
the past 3 weeks (since last hospitalization). She denied
PND,orthopnea, fever, or chills. She complained productive cough
that has been getting better over the past couple of weeks (she
was treated w/ Z-pack and ceftriaxone for a presumed PNA during
last admission for similar symptoms from [**Date range (1) 14790**].) No LE
swelling. She does not know what her baseline dry weight is.
.
In the ED, initial vitals: 98.2, 76, 113/81, 28, 95% on 4L. She
was given lasix 40 mg X 1. She was admitted for CHF
exacerbation. On arrival to the floor, she was no longer feeling
SOB.
.
ROS:
(+) as per hpi; may have lost some weight recently but unsure
how much
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied chest pain or tightness, palpitations. Denied
nausea, vomiting, diarrhea, constipation or abdominal pain. No
recent change in bowel or bladder habits. No dysuria. Denied
arthralgias or myalgias.
.

MEDICAL HISTORY: - hypertension
- Systolic heart failure (EF 30%)
- atrial fibrillation (recently started on amiodarone as
out-patient)
- DJD
- TAH
- Normocytic anemia

MEDICATION ON ADMISSION: aspirin 81 mg daily
lisinopril 20 mg daily
Coumadin 2 mg nightly
Norvasc 5 mg daily
pravastatin 20 mg daily
metoprolol 37.5 mg twice daily
Lasix 40 mg daily
amiodarone 200 mg daily
.
Allergies: NKDA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: tm 99.0, hr 97 afib, bp 140/77, rr 20, sat 98 RA
GEN: NAD, Awake A&O x3, pleasant
HEENT: NC/AT, EOMI, MMM
Cards: nl S1 & S2. No m/r/g
Resp: decrease R sided breath sounds, scattered crackles
diffusely
2 Chest tubes in place on right side.
Abdomen: + bs, soft, nt/nd
Extremities: trace lower ext edema b/l, DP 2+ b/l
Neuro: A&O x3

FAMILY HISTORY: No family members with hx of TB

SOCIAL HISTORY: She lives in [**Location 669**] with her son. Denies current tobacco,
alcohol, or IVDA. Is able to ambulate and take care of herself
at home.
Chronic systolic heart failure,Acute kidney failure, unspecified,Hemorrhage complicating a procedure,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia
Chr systolic hrt failure,Acute kidney failure NOS,Hemorrhage complic proc,Atrial fibrillation,Hypertension NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2107-8-12**]              Discharge Date:   [**2107-9-1**]

Date of Birth:  [**2030-4-12**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2234**]
Chief Complaint:
Dyspnea

Major Surgical or Invasive Procedure:
[**8-24**] Video-assisted thoracic surgery, right pleural biopsy and
flexible bronchoscopy with bronchoalveolar lavage.
.
[**8-27**] Right VATS hemothorax evacuation.


History of Present Illness:
Ms. [**Known lastname 4249**] is a 77-year-old female with known atrial
fibrillation, CHF, depressed EF to 35% who presented with
shortness of breath worsening over two weeks. She came in to [**Hospital1 **]
for a planned PMIBI today. She became very SOB during the test
and O2 sats went to 85% on RA. Her sats came up w/ O2. She was
sent to the ER.  She stated that she has had increasing DOE for
the past 3 weeks (since last hospitalization). She denied
PND,orthopnea, fever, or chills. She complained productive cough
that has been getting better over the past couple of weeks (she
was treated w/ Z-pack and ceftriaxone for a presumed PNA during
last admission for similar symptoms from [**Date range (1) 14790**].) No LE
swelling. She does not know what her baseline dry weight is.
.
In the ED, initial vitals: 98.2, 76, 113/81, 28, 95% on 4L. She
was given lasix 40 mg X 1. She was admitted for CHF
exacerbation. On arrival to the floor, she was no longer feeling
SOB.
.
ROS:
(+) as per hpi; may have lost some weight recently but unsure
how much
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied chest pain or tightness, palpitations. Denied
nausea, vomiting, diarrhea, constipation or abdominal pain. No
recent change in bowel or bladder habits. No dysuria. Denied
arthralgias or myalgias.
.

Past Medical History:
- hypertension
- Systolic heart failure (EF 30%)
- atrial fibrillation (recently started on amiodarone as
out-patient)
- DJD
- TAH
- Normocytic anemia

Social History:
She lives in [**Location 669**] with her son. Denies current tobacco,
alcohol, or IVDA. Is able to ambulate and take care of herself
at home.

Family History:
No family members with hx of TB

Physical Exam:
VS: tm 99.0, hr 97 afib, bp 140/77, rr 20, sat 98 RA
GEN: NAD, Awake A&O x3, pleasant
HEENT: NC/AT, EOMI, MMM
Cards: nl S1 & S2. No m/r/g
Resp: decrease R sided breath sounds, scattered crackles
diffusely
2 Chest tubes in place on right side.
Abdomen: + bs, soft, nt/nd
Extremities: trace lower ext edema b/l, DP 2+ b/l
Neuro: A&O x3


Pertinent Results:
Admission Labs:
[**2107-8-12**] 11:50PM   CK(CPK)-67
[**2107-8-12**] 11:50PM   CK-MB-NotDone cTropnT-0.01
[**2107-8-12**] 04:30PM   GLUCOSE-112* UREA N-24* CREAT-1.0 SODIUM-142
POTASSIUM-3.5 CHLORIDE-98 TOTAL CO2-32 ANION GAP-16
[**2107-8-12**] 04:30PM   estGFR-Using this
[**2107-8-12**] 04:30PM   CK(CPK)-73
[**2107-8-12**] 04:30PM   CK-MB-NotDone cTropnT-<0.01 proBNP-2151*
[**2107-8-12**] 04:30PM   WBC-5.3 RBC-3.82* HGB-12.0 HCT-34.4* MCV-90
MCH-31.5 MCHC-35.0 RDW-15.7*
[**2107-8-12**] 04:30PM   NEUTS-79.6* LYMPHS-13.9* MONOS-4.9 EOS-1.6
BASOS-0
[**2107-8-12**] 04:30PM   PLT COUNT-151
[**2107-8-12**] 04:30PM   PT-15.3* PTT-29.7 INR(PT)-1.4*
[**2107-8-11**] 03:50PM   PT-14.4* INR(PT)-1.3*
.
[**8-12**] PMIBI:
INTERPRETATION:
Left ventricular cavity size is moderately enlarged.
Rest and stress perfusion images reveal a moderate fixed
inferolateral wall perfusion defect and a moderate fixed apical
wall perfusion defect.
Gated images reveal global hypokinesis.
The calculated left ventricular ejection fraction is 36%.
Compared with the study of [**2104-2-20**], there are no changes in
the perfusion defects seen. However, cavity size is enlarged
with reduced function compared to prior study.
IMPRESSION: 1. Moderate fixed inferolateral wall and a moderate
fixed apical wall perfusion defect. No significant change from
prior study. 2. There has been an increase in dilatation of left
ventricle with global hypokinesis and reduced function. (EF=
36%).
.
[**8-12**] Stress 61% of HR:
INTERPRETATION: This 77 yo woman with CHF and Afib was referred
for
evaluation of CAD and shortness of breath. Patient presented
with
difficulty breathing that has been bothering her for about a
week. Lungs were clear to auscultation pre-procedure. The
patient was infused with 0.142mg/kg/min of Persantine over 4
minutes. No neck, back, arm or chest discomfort was reported
during the procedure. No significant ST segment changes were
noted in the presence of baseline ST-T wave abnormalities. The
rhythm was atrial fibrillation with occasional isolated
multifocal VPDs and one V.couplet in recovery. Hemodynamic
response to infusion was appropriate. 2 minutes post-MIBI
injection, the patient was given 125mg of IV aminophylline.
Patient's SaO2 post-procedure was 85%. Following administration
of 4L of O2 NC, SaO2 improved to 97%.
IMPRESSION: No anginal type symptoms or ischemic EKG changes.
Nuclear
report sent separately.
.
[**2107-8-14**] CT Chest:
CT CHEST WITHOUT IV CONTRAST: There has been interval increase
in size of the right-sided pleural effusion which now is
moderate to large in size. There is also new extension of
effusion along the right horizontal fissure. There is new mild
pericardial effusion. The left lung is unremarkable with no
evidence of effusion. There is a small stable ground glass
nodular density within the right middle lobe measuring 7 mm.
There is no hilar lymphadenopathy. Within the mediastinum, there
is an enlarged lymph node measuring 13 mm along the pretracheal
nodal chain seen best on series 2, image 17. There is no hilar
lymphadenopathy. The heart is markedly enlarged as demonstrated
previously. The main pulmonary arteries are enlarged.  There is
a 2.6-cm right mid-pole simple renal cyst and a 3.9-cm left
mid-pole simple renal cyst.
IMPRESSION:
1. Increase in size of right pleural effusion, now moderate to
large.
2. New mild pericardial effusion.
3. No evidence of pneumonia.
4. Stable cardiomegaly.
5. Bilateral simple renal cysts.
6. Single nonspecific enlarged 13 mm mediastinal lymph node.
.
[**2107-8-22**] CT CHEST WITH AND WITHOUT IV CONTRAST: There has been
interval decrease in the right effusion, which is small to
moderate in size. The anteromedial and posteromedial components
are loculated and there layering high attenuation material in
the posteromedial component. There are no enhancing pleural
nodules or masses. There is impaction of a right upper lobe
segmental bronchus, and there is layering fluid in the right and
left main bronchi. There is peribronchiolar nodular density in
the right upper lobe, not visualized on the previous study.
There is a 6 mm subpleural right upper lobe nodular density (5,
18), not definitely visualized on the previous study. Band- like
linear density in the right middle and right lower lobe is
compatible with atelectasis.  There is a borderline enlarged
right pretracheal lymph node, now measuring 10 mm in short axis.
There are no enlarged hilar or axillary lymph nodes. The
thoracic aortic caliber is normal, with mild calcification.
There is global cardiomegaly, to the greatest degree involving
the left atrium. There is no pericardial effusion.  ABDOMEN:
There are two left renal cortical hypodensities and one right
renal cortical hypodensity, measuring up to 4.3 cm in the left
upper renal cortex. one of which is too small to characterize in
the left interpolar region and the others of which are
compatible with cysts. Gallstones are noted.  OSSEOUS
STRUCTURES: There are no findings suspicious for malignancy.
There is mild dextroconvex thoracic scoliosis with moderate
endplate osteophytes.
IMPRESSION:  1. Small-to-moderate, partially loculated right
pleural effusion with a small amount of layering hemorrhage
posteromedially in lower right chest.  2. Right upper lobe
peribronchiolar nodules, compatible with aspiration or
infection. Minimal layering fluid in the bronchi may suggest
aspiration over infection.  3. Right upper lobe nodule is likely
inflammatory in nature. However, a followup CT is recommended in
[**1-25**] months to assess for resolution and to exclude a small focus
of bronchoalveolar cell carcinoma.
.
[**8-12**] CXR:
FINDINGS: Portable upright chest radiograph is obtained. Low
lung volumes limit evaluation. There is persistent right-sided
pleural effusion, with probable atelectasis of portions of both
the right middle and lower lobes. Left basilar opacity likely
represents subsegmental atelectasis. No definite pleural
effusion is seen on the left. Prominence of pulmonary
vasculature is noted, slightly asymmetrically increased on the
right, which may in part be due to patient rotation. Findings
likely indicate underlying congestion. The heart size is
difficult to assess but appears mildly enlarged. Tortuosity of
the thoracic aorta is noted. There is no pneumothorax.
IMPRESSION:
Cardiomegaly, with pulmonary vascular congestion. Stable right
pleural effusion, likely with atelectasis of right middle and
lower lobe segments. Left basilar atelectasis.
.
CXR [**2107-8-27**]:
Single AP view of the chest is obtained on [**2107-8-27**] at 14:05 and
is compared with the prior radiograph performed at 10:15 the
same day.  There appears to be a small collection of air
adjacent to the site of the pleural tubes and the chest on the
right side.  No apical pneumothorax is visualized.  Loculated
fluid on the right side appears unchanged.  Appearances of the
left chest are unchanged.
IMPRESSION:
Small focal collection of air near the site of the insertion of
the pleural tubes.
.
PATHOLOGY
[**2107-8-18**]
Pleural fluid: NEGATIVE FOR MALIGNANT CELLS. Reactive
mesothelial cells and abundant inflammatory cells.
.
[**2107-8-24**]
Pleural fluid: NEGATIVE FOR MALIGNANT CELLS.  Highly cellular
sample with morphologically reactive lymphoid infiltrate and
blood.  Few, if any mesothelial cells are seen.
.
[**2107-8-24**]
Pleural biospy:
GROSS: A frozen section diagnosis by Dr. [**Last Name (STitle) **]. Fu reads
"Granulomatous inflammation, non-necrotizing on cut sections; no
malignancy identified; final diagnosis pending permanent
section."
DIAGNOSIS:
I.  Pleural biopsy:
-  Numerous non-caseating granulomas with rare foci of
caseation.
II.  Parietal pleural biopsy:
-  Numerous non-caseating granulomas with rare foci of
caseation.
-  Special stains performed on block B.  No micro-organisms are
seen on AFB stain.  Fungal stains, particularly PAS-D reveal
rare fungal forms.
.


Brief Hospital Course:
Ms. [**Known lastname 4249**] is a 77 year old woman with cardiomyopathy and
systolic dysfunction (EF 36%), chronic atrial fibrillation on
coumadin, hypertension, and hyperlipidemia who was admitted on
[**2107-8-12**] with dyspnea likely secondary to a right pleural
effusion of unknown etiology.  Status post VATs for a pleural
biopsy, her hospital course was complicated by a right
hemothorax which was drained in the OR and with subsequent chest
tubes.
.
#. R pleural effusion (unknown etiology):  Sarcoid or fungal
infection was most likely underlying cause of the pleural
effusion and associated granulomatous inflammation seen on VATS.
 Briefly, the R pleural effusion was present on admission and
did not change in size.  Given that it was unilateral, it was
decided she should undergo thoracentesis.  This was delayed a
few days given her INR took some time to normalize after
coumadin was discontinued.  Thoracentesis on [**8-17**] revealed a
serosanguinous effusion that was exudative in nature and had a
lymphocytic predominance.  There were no mesothelial cells.  The
nature of the effusion raised the differential of pleural TB,
rheumatologic disease, lymphoma, and sarcoid.   RF and [**Doctor First Name **] were
negative.  PPD was negative as was AFB smear/culture of pleural
fluid.  Serum LDH was nl and there was no evidence of
lymphadenopathy on imaging.  In the meantime, the pt reported
feeling significantly better since undergoing thoracentesis.
Within a few days, however, it seemed the effusion was returning
to a small to moderate degree.   By [**2103-8-22**] it had taken a
loculated appearance with some hemorrhagic layering.  Given the
exudative effusion and the lack of diagnosis, it was recommended
the patient undergo VATS for evacuation of the effusion and
pleural biopsy.  She underwent VATS on [**2107-8-24**], this revealed
granulomatous inflammation.  Infectious disease was consulted
and recommended the patient be ruled out for TB and be placed in
respiratory precautions although, at the time her presentation
and imaging was not consistent with TB.  She was subsequently
ruled out for TB with 3 negative sputums, and pathological
evaluation of the pleural tissue revealed mostly noncaseating
granulomas.  Assays (including serologies) for Histoplasmosis,
Blastomycosis, Paracoccidioides, Coccidioides, and Aspergillus
were sent, and the patient was scheduled for outpatient followup
with the infectious disease consultant who saw her during this
hospitalization.  Sarcoid was also possible despite the ACE
value which was within normal limits.  The patient was advised
to followup with her PCP for further workup of sarcoid.
.
# Hemothorax: On [**2107-8-26**], her blood pressure dropped to SBP
60-70 and her hematocrit dropped from 28 to 22.  This was in the
setting of a supratherapeutic INR.  She was urgently taken to
the OR where she had 750 mL of blood evacuated and two chest
tubes placed.  She went to the MICU overnight for observation.
She received two units of PRBC and remained hemodynamically
stable.  She was then transferred back to the floor.  Chest tube
drainage at the bedside was minimal, and the patient's
hematocrit remained stable.  Coumadin was held until discharge
and then restarted with close outpatient followup of INR.
.
# Chronic systolic CHF: The patient has a known depressed EF of
36%.  The dyspnea on presentation was originally thought to be
due to a CHF exacerbation; however, further evaluation suggested
the R pleural effusion was the most likely cause of the SOB.
For most of the [**Hospital 228**] hospital stay she appeared euvolemic:
no JVD or peripheral edema.  Mild crackles on lung exam
resolved.  She was maintained on her home dosage of furosemide
40 mg daily and fluid and sodium restricted.  An ACE-i
(Lisinopril 5 mg daily) was initially held given the patient's
recent mild renal failure but it was restarted and prescribed at
discharge.
.
# Afib: Coumadin was held in the setting of the hemothorax.
Amiodarone was stopped on admission for work up of pleural
effusion; it was not restarted pending further outpatient workup
of pleural effusion.   The patient's atrial fibrillation was
adequately rate controlled in house on metoprolol tartrate; upon
discharge, she was given metoprolol succinate 200 mg daily,
which is beneficial in the setting of a depressed EF.  Coumadin
2 mg qHS was restarted upon discharge.
.
# Renal insufficiency: She transiently had mildly elevated
creatinine in setting of low hematocrit (possible hypoperfusion)
but her creatinine normalized to 0.8-0.9 upon discharge.  As
mentioned above, the ACE-inhibitor was held until the renal
insufficiency resolved.
.
# Hyperlipidemia: Continued Pravastatin 20 mg daily.
.
# Prophylaxis: DVT prophylaxis was provided with pneumoboots.
The patient was maintained on a bowel regimen.
.
# FEN: She was given a low-sodium, cardiac diet.  She adhered to
1.5 L fluid restriction.
.
# Access: PIVs
.
# Code Status: presumed Full
.
# Dispo: Home with services and scheduled followup appointment
with ID, cardiology, and PCP.

Medications on Admission:
aspirin 81 mg daily
lisinopril 20 mg daily
Coumadin 2 mg nightly
Norvasc 5 mg daily
pravastatin 20 mg daily
metoprolol 37.5 mg twice daily
Lasix 40 mg daily
amiodarone 200 mg daily
.
Allergies: NKDA

Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Pravastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*60 Tablet Sustained Release 24 hr(s)* Refills:*2*
4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Warfarin 2 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

6. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Primary
Pleural effusion
Hemothorax
.
Secondary
Atrial fibrillation
Hypertension
Hyperlipidemia


Discharge Condition:
Hemodynamically stable. Ambulatory.


Discharge Instructions:
You were admitted to hospital with shortness of breath.  A fluid
collection was noted on your lungs.  A procedure called VATS,
video assisted thoracic surgery, was performed.  You then
developed a collection of blood on your lungs called a
hemothorax.  The blood on your lungs was drained in the
operating room with chest tubes and you subsequently improved.
You were noted to have granulomas on a biopsy of your pleural
tissue.  The cause of this lung disease is unclear and may be a
fungal infection, sarcoidosis, or another cause.  It is
important for you to followup with the following appointments
scheduled for you (listed below) to complete the workup of your
lung disease.
.
For congestive heart failure managment, it is very important
that you follow the instructions given:
- weigh yourself daily and call your doctor if your weight
increases by > 3 pounds
- follow a low-salt diet
- restrict your fluid intake to 1.5 liters per day
.
Please note the following medication changes:
1.  Norvasc and amiodarone were discontinued.  Please stop
taking these medications.
2.  The dosage of lisinopril was decreased to 5 mg daily.
3.  The metoprolol you were taking at home was discontinued.  It
was replaced by a new medication, Toprol XL (metoprolol XL), 200
mg daily.  It is a longer acting medication and will improve
your heart function.
.
Otherwise, resume your home medications.
.
Please keep all followup appointments.
.
Please seek medical attention immediately if you develop fever,
chills, increased shortness of breath, chest pain, have a cough
productive of blood, become increasingly fatigued, or notice any
bleeding from the sites where your chest tubes were removed.
Please also contact a physician or go to the [**Name (NI) **] for any other
concerning symptoms.

Followup Instructions:
1.  You have been scheduled for a followup appointment with your
primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], on Friday, [**9-2**], at
10:45 AM. His office telephone is [**Telephone/Fax (1) 3581**].
.
2.  Please follow-up with your cardiologist, [**Name6 (MD) 1918**] [**Name8 (MD) **],
MD, at the following scheduled appointment: Date/Time:[**2107-9-8**]
11:20 AM.  His office is located in the [**Hospital Ward Name 23**] Clinical Center
at [**Hospital1 18**], and his office may be reached at [**Telephone/Fax (1) 902**].
.
3.  You have been scheduled for a followup appointment with
infectious disease specialist, [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 7447**], MD, on
Date/Time:[**2107-9-12**] 9:00 AM.  His clinic is located in Suite G of
the [**Hospital Unit Name **] basement located at [**Hospital1 18**] [**Hospital Ward Name 517**] across
from the Emergency Deparment.  The clinic address is [**Last Name (NamePattern1) 8028**], and his clinic phone number is [**Telephone/Fax (1) 457**].
{'Chronic systolic heart failure,Acute kidney failure, unspecified,Hemorrhage complicating a procedure,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}


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: Dyspnea

PRESENT ILLNESS: Ms. [**Known lastname 4249**] is a 77-year-old female with known atrial
fibrillation, CHF, depressed EF to 35% who presented with
shortness of breath worsening over two weeks. She came in to [**Hospital1 **]
for a planned PMIBI today. She became very SOB during the test
and O2 sats went to 85% on RA. Her sats came up w/ O2. She was
sent to the ER.  She stated that she has had increasing DOE for
the past 3 weeks (since last hospitalization). She denied
PND,orthopnea, fever, or chills. She complained productive cough
that has been getting better over the past couple of weeks (she
was treated w/ Z-pack and ceftriaxone for a presumed PNA during
last admission for similar symptoms from [**Date range (1) 14790**].) No LE
swelling. She does not know what her baseline dry weight is.
.
In the ED, initial vitals: 98.2, 76, 113/81, 28, 95% on 4L. She
was given lasix 40 mg X 1. She was admitted for CHF
exacerbation. On arrival to the floor, she was no longer feeling
SOB.
.
ROS:
(+) as per hpi; may have lost some weight recently but unsure
how much
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied chest pain or tightness, palpitations. Denied
nausea, vomiting, diarrhea, constipation or abdominal pain. No
recent change in bowel or bladder habits. No dysuria. Denied
arthralgias or myalgias.
.

MEDICAL HISTORY: - hypertension
- Systolic heart failure (EF 30%)
- atrial fibrillation (recently started on amiodarone as
out-patient)
- DJD
- TAH
- Normocytic anemia

MEDICATION ON ADMISSION: aspirin 81 mg daily
lisinopril 20 mg daily
Coumadin 2 mg nightly
Norvasc 5 mg daily
pravastatin 20 mg daily
metoprolol 37.5 mg twice daily
Lasix 40 mg daily
amiodarone 200 mg daily
.
Allergies: NKDA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: tm 99.0, hr 97 afib, bp 140/77, rr 20, sat 98 RA
GEN: NAD, Awake A&O x3, pleasant
HEENT: NC/AT, EOMI, MMM
Cards: nl S1 & S2. No m/r/g
Resp: decrease R sided breath sounds, scattered crackles
diffusely
2 Chest tubes in place on right side.
Abdomen: + bs, soft, nt/nd
Extremities: trace lower ext edema b/l, DP 2+ b/l
Neuro: A&O x3

FAMILY HISTORY: No family members with hx of TB

SOCIAL HISTORY: She lives in [**Location 669**] with her son. Denies current tobacco,
alcohol, or IVDA. Is able to ambulate and take care of herself
at home. 

### Response:
{'Chronic systolic heart failure,Acute kidney failure, unspecified,Hemorrhage complicating a procedure,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}
