CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: Of note, pt is a poor historian. 68 y/o M with PMHx significant
for h/o atrial fibrillation, COPD, HTN, PVD, HLD, liver disease,
and ? h/o PE, who presented to the [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] with chest
pain and shortness of breath. Pt reports that he was initially
diagnosed with a PE approximately 2.5 months ago at [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **]. He had been on coumadin; however, he reports that his
coumadin had been stopped a few weeks ago for unclear reasons
(with plans to restart soon). Pt reports that when his visiting
nurse was at his house today, he reported some chest pain and
shortness of breath. Describes chest pain as pressure-like and
located in the left chest. It was associated with shortness of
breath and lightheadedness but no diaphoresis or nausea. It
lasted approximately 15 seconds. Pt reports similar episodes
over the past several months ever since he was diagnosed with
the PE. Each episode lasts anyhwere from 5 seconds to several
minutes. The visiting nurse [**First Name (Titles) 12690**] [**Last Name (Titles) **] and the patient was
brought to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] for further evaluation.
.
In the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) **], the patient underwent a CT chest which
showed a stable PE in the RLL. There was some concern regarding
anticoagulation in this patient because he had a previous
hospitalization at [**Hospital1 18**] in [**8-30**] that was complicated by GI
bleeding. Therefore, he was transferred to [**Hospital1 18**] for further
management of his anticoagulation. On arrival to the [**Hospital1 18**] ED,
the patient's VS were 96.8; 144/90; 106; 16; 99% on 4L. He was
guaiac negative. He was started on lovenox for anticoagulation
and received his first dose (90 mg SC) at 00:00 on [**2146-11-5**]. Lab
wokr in the ED was significant for a sodium of 132 and a
negative set of CEs. No further imaging was performed. ECG was
not significant changed from prior. He was admitted for further
evaluataion. VS prior to transfer: 126/83 99 19 96%2L.
.
On arrival to the floor, the patient's VS were T 97.9; BP
122/83; HR 100; RR 20; SaO2 100% on 2L. He denied any current
chest pain or shortness of breath. He denied any other
complaints at this time. Of note, pt did report some LLE pain
(calf and shin) recently that has since resolved.
.
.
Review of sytems:
(+) Per HPI. The patient also reported some chronic R-sided
weakness. He also complained of recent episodes of epistaxis.
(-) Denies fever, chills, night sweats, recent weight changes.
Denies rhinorrhea, or nasal congestion. Denies cough,
palpitations. Denies nausea, vomiting, diarrhea, constipation,
abdominal pain. Denies change in bladder habits, dysuria. Denies
arthralgias or myalgias.

MEDICAL HISTORY: - h/o atrial Fibrillation
- s/p Pacer ([**Company 1543**] DDD)
- COPD
- Hypertension
- PVD s/p Aortobifemoral bypass
- Hyperlipidemia
- Chronic liver disease [**2-22**] EtOH (sober now)
- Anemia: h/o maroon stools; colonoscopy in [**2146**] with
hemorrhoids, colon polyps, adenoma
- h/o epistaxis
- history of AAA that was repaired in 07
- h/o PE ~2-3 months ago per pt. Notes from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] mention
PE and imaging from today mentions stable PE. However, no
records at [**Hospital1 18**] mention PE.
- Wedge fractures - Noted in lumbar region on CT scan
- prolonged hospitalization at [**Hospital1 18**] in [**8-30**] for epiglottitis
requiring cric/trach, with hospital course complicated by GI
bleeding and pseudonomas bacteremia

MEDICATION ON ADMISSION: - Aspirin 325 mg daily
- Nicotine 7 mg patch
- Protonix 40 mg daily
- Revatio 10 mg [**Hospital1 **]
- Calcium + D 600/400 daily
- Venotlin 90 mcg QID
- Advair 250/50 [**Hospital1 **]
- Simvstatin 80 mg daily
- Metoprolol 12.5 mg [**Hospital1 **]
- MVI
- Folic Acid 1 mg daily
- Digoxin 125 mcg daily
- Famotidine 20 mg daily

ALLERGIES: Seroquel / Fentanyl / Flagyl

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
T 97.9; BP 122/83; HR 100; RR 20; SaO2 100% on 2L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: Supple, JVP ~6cm
Lungs: Diminished BS throughout, some scattered wheezes. No
rales or rhonchi.
CV: Distant HS. Regular rate and rhythm, normal S1 + S2, no
murmurs, rubs, gallops.
Abdomen: Soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly.
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema. No calf tenderness.
Neuro: Chronic weakness in the RUE and RLE. Otherwise grossly
non-focal.

FAMILY HISTORY: father and mother both died of CAD, dad died after age >50

SOCIAL HISTORY: - Unemployed. Used to work in the stockroom at the [**Location (un) **]
Corportation. Lives alone. Has a scooter at home.
- Health care proxy is his friend [**Name (NI) 892**] [**Name (NI) 16471**], (c) [**Telephone/Fax (1) 106834**],
(h) [**Telephone/Fax (1) 106835**].
- Tobacco: used to smoke 1.5 ppd x ~50 years. Quit 3 months ago.
Coronary atherosclerosis of native coronary artery,Chronic pulmonary embolism,Intermediate coronary syndrome,Hyposmolality and/or hyponatremia,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Fitting and adjustment of cardiac pacemaker,Peripheral vascular disease, unspecified,Other specified disorders of liver,Other and unspecified hyperlipidemia,Long-term (current) use of anticoagulants,Elevated prostate specific antigen [PSA],Osteoporosis, unspecified
Crnry athrscl natve vssl,Chr pulmonary embolism,Intermed coronary synd,Hyposmolality,Atrial fibrillation,Chr airway obstruct NEC,Hypertension NOS,Ftng cardiac pacemaker,Periph vascular dis NOS,Liver disorders NEC,Hyperlipidemia NEC/NOS,Long-term use anticoagul,Elvtd prstate spcf antgn,Osteoporosis NOS
Admission Date:  [**2146-11-5**]              Discharge Date:   [**2146-11-18**]

Date of Birth:  [**2078-1-10**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Seroquel / Fentanyl / Flagyl

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
[**2146-11-7**] - Cardiac catheterization
[**2146-11-11**] - Coronary artery bypass grafting x4: With the left
internal mammary artery to left anterior descending artery and
reverse saphenous vein graft to the posterior descending artery,
the first and second obtuse marginal artery.


History of Present Illness:
Of note, pt is a poor historian. 68 y/o M with PMHx significant
for h/o atrial fibrillation, COPD, HTN, PVD, HLD, liver disease,
and ? h/o PE, who presented to the [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] with chest
pain and shortness of breath. Pt reports that he was initially
diagnosed with a PE approximately 2.5 months ago at [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **]. He had been on coumadin; however, he reports that his
coumadin had been stopped a few weeks ago for unclear reasons
(with plans to restart soon). Pt reports that when his visiting
nurse was at his house today, he reported some chest pain and
shortness of breath. Describes chest pain as pressure-like and
located in the left chest. It was associated with shortness of
breath and lightheadedness but no diaphoresis or nausea. It
lasted approximately 15 seconds. Pt reports similar episodes
over the past several months ever since he was diagnosed with
the PE. Each episode lasts anyhwere from 5 seconds to several
minutes. The visiting nurse [**First Name (Titles) 12690**] [**Last Name (Titles) **] and the patient was
brought to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] for further evaluation.
.
In the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) **], the patient underwent a CT chest which
showed a stable PE in the RLL. There was some concern regarding
anticoagulation in this patient because he had a previous
hospitalization at [**Hospital1 18**] in [**8-30**] that was complicated by GI
bleeding. Therefore, he was transferred to [**Hospital1 18**] for further
management of his anticoagulation. On arrival to the [**Hospital1 18**] ED,
the patient's VS were 96.8; 144/90; 106; 16; 99% on 4L. He was
guaiac negative. He was started on lovenox for anticoagulation
and received his first dose (90 mg SC) at 00:00 on [**2146-11-5**]. Lab
wokr in the ED was significant for a sodium of 132 and a
negative set of CEs. No further imaging was performed. ECG was
not significant changed from prior. He was admitted for further
evaluataion. VS prior to transfer: 126/83 99 19 96%2L.
.
On arrival to the floor, the patient's VS were T 97.9; BP
122/83; HR 100; RR 20; SaO2 100% on 2L. He denied any current
chest pain or shortness of breath. He denied any other
complaints at this time. Of note, pt did report some LLE pain
(calf and shin) recently that has since resolved.
.
.
Review of sytems:
(+) Per HPI. The patient also reported some chronic R-sided
weakness. He also complained of recent episodes of epistaxis.
(-) Denies fever, chills, night sweats, recent weight changes.
Denies rhinorrhea, or nasal congestion. Denies cough,
palpitations. Denies nausea, vomiting, diarrhea, constipation,
abdominal pain. Denies change in bladder habits, dysuria. Denies
arthralgias or myalgias.


Past Medical History:
- h/o atrial Fibrillation
- s/p Pacer ([**Company 1543**] DDD)
- COPD
- Hypertension
- PVD s/p Aortobifemoral bypass
- Hyperlipidemia
- Chronic liver disease [**2-22**] EtOH (sober now)
- Anemia: h/o maroon stools; colonoscopy in [**2146**] with
hemorrhoids, colon polyps, adenoma
- h/o epistaxis
- history of AAA that was repaired in 07
- h/o PE ~2-3 months ago per pt. Notes from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] mention
PE and imaging from today mentions stable PE. However, no
records at [**Hospital1 18**] mention PE.
- Wedge fractures - Noted in lumbar region on CT scan
- prolonged hospitalization at [**Hospital1 18**] in [**8-30**] for epiglottitis
requiring cric/trach, with hospital course complicated by GI
bleeding and pseudonomas bacteremia


Social History:
- Unemployed. Used to work in the stockroom at the [**Location (un) **]
Corportation. Lives alone. Has a scooter at home.
- Health care proxy is his friend [**Name (NI) 892**] [**Name (NI) 16471**], (c) [**Telephone/Fax (1) 106834**],
(h) [**Telephone/Fax (1) 106835**].
- Tobacco: used to smoke 1.5 ppd x ~50 years. Quit 3 months ago.

- Alcohol: per records, hx of heavy EtOH use. Quit 9 months ago.

- Illicits: none

Family History:
father and mother both died of CAD, dad died after age >50

Physical Exam:
ADMISSION PHYSICAL EXAM
T 97.9; BP 122/83; HR 100; RR 20; SaO2 100% on 2L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: Supple, JVP ~6cm
Lungs: Diminished BS throughout, some scattered wheezes. No
rales or rhonchi.
CV: Distant HS. Regular rate and rhythm, normal S1 + S2, no
murmurs, rubs, gallops.
Abdomen: Soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly.
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema. No calf tenderness.
Neuro: Chronic weakness in the RUE and RLE. Otherwise grossly
non-focal.


Pertinent Results:
ADMISSION PHYSICAL EXAM
[**2146-11-4**] 11:14PM BLOOD WBC-10.6 RBC-4.18*# Hgb-12.5* Hct-37.5*
MCV-90# MCH-29.9# MCHC-33.4 RDW-15.6* Plt Ct-265
[**2146-11-4**] 11:14PM BLOOD Neuts-67.4 Lymphs-21.8 Monos-7.1 Eos-2.6
Baso-1.0
[**2146-11-4**] 11:14PM BLOOD PT-14.2* PTT-27.1 INR(PT)-1.2*
[**2146-11-4**] 11:14PM BLOOD Glucose-92 UreaN-14 Creat-1.0 Na-132*
K-4.6 Cl-103 HCO3-21* AnGap-13

CARDIAC ENZYMES
[**2146-11-4**] 11:14PM BLOOD cTropnT-LESS THAN
[**2146-11-5**] 01:10PM BLOOD CK-MB-3 cTropnT-<0.01
[**2146-11-5**] 01:10PM BLOOD CK(CPK)-45*
[**2146-11-5**] 09:00PM BLOOD CK-MB-3 cTropnT-<0.01
[**2146-11-5**] 09:00PM BLOOD CK(CPK)-42*
[**2146-11-6**] 05:40AM BLOOD CK-MB-3 cTropnT-<0.01
[**2146-11-6**] 05:40AM BLOOD CK(CPK)-47
[**2146-11-6**] 01:45PM BLOOD CK-MB-3 cTropnT-<0.01
[**2146-11-6**] 01:45PM BLOOD CK(CPK)-50

Carotid Ultrasound [**2146-11-10**]
Findings are consistent with less than 40% stenosis bilaterally.

RUQ ULTRASOUND ([**2146-11-8**])-
1. Mild dilatation of the extrahepatic common duct and of the
pancreatic duct. This diatation is of unknown etiology. The
pancreatic duct is noted to be also dilated, but smaller than on
the CT of [**2146-8-21**]. No intrahepatic biliary dilatation noted.

2. Ectatic aorta measuring up to 2.8 cm at the widest diameter.
3. Small non obstructing stone in the left kidney.

CARDIAC CATH ([**2146-11-7**]) -
1. Selective coronary angiography in this right dominant system
demonstrated left main and two vessel coronary artery disease.
The LMCA
had a 60% stenosis in the distal vessel.  There was an 80%
ostial LAD
stenosis.  The LCx had a 40% stenosis at the origin.  The RCA
was
calcified with a 90% stenosis in the mid-vessel.
2. Resting hemodynamics revealed normal right and left sided
filling
pressures with RVEDP 10 mmHg and LVEDP 14 mmHg.  There was high
normal
pulmonary arterial systolic pressure with PASP 32mmHg.  The
cardiac
index was preserved at 2.47 l/min/m2.  There was normotension of
the
systemic arterial pressure 134/79 mmHg.
3. There was no evidence of gradient on careful pullback of the
angled
pigtail catheter from the left ventricle to the ascending aorta.

4. Left ventriculography was deferred.

Pulmonary function testing
SPIROMETRY 12:52 PM Pre drug Post drug
       Actual Pred %Pred
FVC     4.41 5.02 88
FEV1    2.63 3.37 78
MMF     1.07 2.93 37
FEV1/FVC   60 67 89


Brief Hospital Course:
Mr. [**Known lastname 63108**] was admitted to the [**Hospital1 18**] on [**2146-11-5**] for further
management of his chest pain. Heparin was continued for
anticoagulation given his history of atrial fibrillation and
pulmonary embolism. He r/o for MI, but underwent cath which
revealed severe 3VD. PATs completed and he underwent surgery on
[**11-11**] with Dr. [**Last Name (STitle) **]. Transferred to the CVICU in stable condition
on epinephrine and phenylephrine drips. .Extubated later that
day. PICC line placed for access. Required neo drip and
treatment of recurrent A Fib. Transferred to the step down unit
on POD # 5 to begin increasing his activity level. Chest tubes
and pacing wires removed per protocol. Gently diuresed toward
his preop weight. Coumadin was resumed per Dr. [**Last Name (STitle) **] for treament
of PAF and PE (diagnosed at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in [**2146-8-21**]).
Cleared by Dr. [**Last Name (STitle) **] for discharge to [**Hospital 70637**] Rehab on POD #7.

Medications on Admission:
- Aspirin 325 mg daily
- Nicotine 7 mg patch
- Protonix 40 mg daily
- Revatio 10 mg [**Hospital1 **]
- Calcium + D 600/400 daily
- Venotlin 90 mcg QID
- Advair 250/50 [**Hospital1 **]
- Simvstatin 80 mg daily
- Metoprolol 12.5 mg [**Hospital1 **]
- MVI
- Folic Acid 1 mg daily
- Digoxin 125 mcg daily
- Famotidine 20 mg daily


Discharge Medications:
1. sildenafil 20 mg Tablet Sig: 0.5 Tablet PO BID (2 times a
day).
2. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
3. digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. nicotine 7 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
5. Calcium 600 + D(3) 600-400 mg-unit Tablet Sig: One (1) Tablet
PO once a day.
6. simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
7. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. famotidine 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

12. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
13. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours): do
not crush.
14. midodrine 5 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day).
15. tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
16. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*65 Tablet(s)* Refills:*0*
17. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day) for 1 months.
18. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day): sc injection.
19. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
20. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
for 7 days then decrease to 200mf po daily ongoing.
21. guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed for cough.
22. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: [**1-22**]
Puffs Inhalation Q6H (every 6 hours).
23. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
24. fluticasone-salmeterol 100-50 mcg/dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
25. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
26. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily).
27. Coumadin 2.5 mg Tablet Sig: as directed for AFIB/PE Tablet
PO once a day: based on INR
goal INR 2.5.
28. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) ml
Injection three times a day: Stop when INR therapeutic.


Discharge Disposition:
Extended Care

Facility:
Maplewood Care & Rehabilitation Center - [**Location (un) 32944**]

Discharge Diagnosis:
coronary artery disease s/p cabg
- h/o atrial Fibrillation
- s/p Pacer ([**Company 1543**] DDD)
- COPD
- Hypertension
- PVD s/p Aortobifemoral bypass
- Hyperlipidemia
- Chronic liver disease [**2-22**] EtOH (sober now)
- Anemia: h/o maroon stools; colonoscopy in [**2146**] with
hemorrhoids, colon polyps, adenoma
- h/o epistaxis
- history of AAA that was repaired in 07
- h/o PE ~2-3 months ago per pt. Notes from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] mention
PE and imaging from today mentions stable PE. However, no
records at [**Hospital1 18**] mention PE.
- Wedge fractures - Noted in lumbar region on CT scan
- prolonged hospitalization at [**Hospital1 18**] in [**8-30**] for epiglottitis
requiring cric/trach, with hospital course complicated by GI
bleeding and pseudonomas bacteremia


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage.
 Edema ..................



Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
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**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**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
Surgeon: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8583**], MD Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2146-12-7**]
1:15
Cardiologist:[**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2146-12-13**] 1:00

 Please call to schedule appointments with your
Primary Care Dr.[**Last Name (STitle) 84032**] [**Telephone/Fax (1) 28612**] in [**4-25**] weeks
Schedule a follow up appointmnet with your hematologist in 2
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**

INR goal 2.5
First draw on [**2146-11-19**]
Coumadin 2.5 mg on [**2146-11-18**]



Completed by:[**2146-11-18**]
{'Coronary atherosclerosis of native coronary artery,Chronic pulmonary embolism,Intermediate coronary syndrome,Hyposmolality and/or hyponatremia,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Fitting and adjustment of cardiac pacemaker,Peripheral vascular disease, unspecified,Other specified disorders of liver,Other and unspecified hyperlipidemia,Long-term (current) use of anticoagulants,Elevated prostate specific antigen [PSA],Osteoporosis, 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: Chest pain

PRESENT ILLNESS: Of note, pt is a poor historian. 68 y/o M with PMHx significant
for h/o atrial fibrillation, COPD, HTN, PVD, HLD, liver disease,
and ? h/o PE, who presented to the [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] with chest
pain and shortness of breath. Pt reports that he was initially
diagnosed with a PE approximately 2.5 months ago at [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **]. He had been on coumadin; however, he reports that his
coumadin had been stopped a few weeks ago for unclear reasons
(with plans to restart soon). Pt reports that when his visiting
nurse was at his house today, he reported some chest pain and
shortness of breath. Describes chest pain as pressure-like and
located in the left chest. It was associated with shortness of
breath and lightheadedness but no diaphoresis or nausea. It
lasted approximately 15 seconds. Pt reports similar episodes
over the past several months ever since he was diagnosed with
the PE. Each episode lasts anyhwere from 5 seconds to several
minutes. The visiting nurse [**First Name (Titles) 12690**] [**Last Name (Titles) **] and the patient was
brought to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] for further evaluation.
.
In the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) **], the patient underwent a CT chest which
showed a stable PE in the RLL. There was some concern regarding
anticoagulation in this patient because he had a previous
hospitalization at [**Hospital1 18**] in [**8-30**] that was complicated by GI
bleeding. Therefore, he was transferred to [**Hospital1 18**] for further
management of his anticoagulation. On arrival to the [**Hospital1 18**] ED,
the patient's VS were 96.8; 144/90; 106; 16; 99% on 4L. He was
guaiac negative. He was started on lovenox for anticoagulation
and received his first dose (90 mg SC) at 00:00 on [**2146-11-5**]. Lab
wokr in the ED was significant for a sodium of 132 and a
negative set of CEs. No further imaging was performed. ECG was
not significant changed from prior. He was admitted for further
evaluataion. VS prior to transfer: 126/83 99 19 96%2L.
.
On arrival to the floor, the patient's VS were T 97.9; BP
122/83; HR 100; RR 20; SaO2 100% on 2L. He denied any current
chest pain or shortness of breath. He denied any other
complaints at this time. Of note, pt did report some LLE pain
(calf and shin) recently that has since resolved.
.
.
Review of sytems:
(+) Per HPI. The patient also reported some chronic R-sided
weakness. He also complained of recent episodes of epistaxis.
(-) Denies fever, chills, night sweats, recent weight changes.
Denies rhinorrhea, or nasal congestion. Denies cough,
palpitations. Denies nausea, vomiting, diarrhea, constipation,
abdominal pain. Denies change in bladder habits, dysuria. Denies
arthralgias or myalgias.

MEDICAL HISTORY: - h/o atrial Fibrillation
- s/p Pacer ([**Company 1543**] DDD)
- COPD
- Hypertension
- PVD s/p Aortobifemoral bypass
- Hyperlipidemia
- Chronic liver disease [**2-22**] EtOH (sober now)
- Anemia: h/o maroon stools; colonoscopy in [**2146**] with
hemorrhoids, colon polyps, adenoma
- h/o epistaxis
- history of AAA that was repaired in 07
- h/o PE ~2-3 months ago per pt. Notes from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] mention
PE and imaging from today mentions stable PE. However, no
records at [**Hospital1 18**] mention PE.
- Wedge fractures - Noted in lumbar region on CT scan
- prolonged hospitalization at [**Hospital1 18**] in [**8-30**] for epiglottitis
requiring cric/trach, with hospital course complicated by GI
bleeding and pseudonomas bacteremia

MEDICATION ON ADMISSION: - Aspirin 325 mg daily
- Nicotine 7 mg patch
- Protonix 40 mg daily
- Revatio 10 mg [**Hospital1 **]
- Calcium + D 600/400 daily
- Venotlin 90 mcg QID
- Advair 250/50 [**Hospital1 **]
- Simvstatin 80 mg daily
- Metoprolol 12.5 mg [**Hospital1 **]
- MVI
- Folic Acid 1 mg daily
- Digoxin 125 mcg daily
- Famotidine 20 mg daily

ALLERGIES: Seroquel / Fentanyl / Flagyl

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
T 97.9; BP 122/83; HR 100; RR 20; SaO2 100% on 2L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: Supple, JVP ~6cm
Lungs: Diminished BS throughout, some scattered wheezes. No
rales or rhonchi.
CV: Distant HS. Regular rate and rhythm, normal S1 + S2, no
murmurs, rubs, gallops.
Abdomen: Soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly.
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema. No calf tenderness.
Neuro: Chronic weakness in the RUE and RLE. Otherwise grossly
non-focal.

FAMILY HISTORY: father and mother both died of CAD, dad died after age >50

SOCIAL HISTORY: - Unemployed. Used to work in the stockroom at the [**Location (un) **]
Corportation. Lives alone. Has a scooter at home.
- Health care proxy is his friend [**Name (NI) 892**] [**Name (NI) 16471**], (c) [**Telephone/Fax (1) 106834**],
(h) [**Telephone/Fax (1) 106835**].
- Tobacco: used to smoke 1.5 ppd x ~50 years. Quit 3 months ago. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Chronic pulmonary embolism,Intermediate coronary syndrome,Hyposmolality and/or hyponatremia,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Fitting and adjustment of cardiac pacemaker,Peripheral vascular disease, unspecified,Other specified disorders of liver,Other and unspecified hyperlipidemia,Long-term (current) use of anticoagulants,Elevated prostate specific antigen [PSA],Osteoporosis, unspecified'}
