CHIEF COMPLAINT: ascending aortic aneurysm (8.9cm)-incidental finding

PRESENT ILLNESS: The patient is an 85yo white male who was found to have an 8.9cm
ascending aortic aneurysm during a recent workup for prostate
cancer.  He does admit to dyspnea on exertion as well as
worsening fatigue.  He is admitted for surgical management.

MEDICAL HISTORY: ascending aortic aneurysm
prostate cancer, s/p external beam radiation [**2124**]
gastroesophageal reflux diseaase (h/o esophageal stricture)
atrial fibrillation/ atrial flutter- s/p cardioversion/ablations
diverticular disease
cholelithiasis
s/p appendectomy, hernia repair, decortication for empyema
(2yo), esophageal dilatation

MEDICATION ON ADMISSION: atenolol 25mg daily
spectravite multivitamin daily
advil pm prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
VS: 124/92, 74, 20
General: elderly white male in NAD
Skin: unremarkable
HEENT: unremarkable
Neck: supple, full ROM
Chest: lungs CTAB
Heart: irregular with murmur
Abdomen: soft, non-tender, non-distended, +BS
extremities: warm, well-perfused, gross edema bilaterally, no
varicosities
Neuro: grossly intact
pulses: 1+ throughout bilaterally
no carotid bruits

FAMILY HISTORY: denies family history of premature coronary artery disease

SOCIAL HISTORY: retired machinist, lives with wife, currently maintains two
family homes, denies tobacco, 1 alcoholic beverage per day
Thoracic aneurysm without mention of rupture,Defibrination syndrome,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Acute respiratory failure,Cardiac complications, not elsewhere classified,Cardiac arrest,Unspecified pleural effusion,Cardiac tamponade,Delirium due to conditions classified elsewhere,Aortic valve disorders,Personal history of malignant neoplasm of prostate,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Diverticulosis of colon (without mention of hemorrhage),Chronic kidney disease, unspecified,Gross hematuria,Other transfusion reaction
Thoracic aortic aneurysm,Defibrination syndrome,Ac posthemorrhag anemia,Hemorrhage complic proc,Acute respiratry failure,Surg compl-heart,Cardiac arrest,Pleural effusion NOS,Cardiac tamponade,Delirium d/t other cond,Aortic valve disorder,Hx-prostatic malignancy,Abn react-anastom/graft,Esophageal reflux,Dvrtclo colon w/o hmrhg,Chronic kidney dis NOS,Gross hematuria,Transfusion reaction NEC
Admission Date:  [**2141-2-22**]              Discharge Date:   [**2141-3-10**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
ascending aortic aneurysm (8.9cm)-incidental finding

Major Surgical or Invasive Procedure:
repair of ascending aortic aneurysm, aortic valve replacement
(21mm tissue [**Last Name (un) 3843**]/[**Doctor Last Name **]) under circulatory arrest [**2-22**],
chest closure [**2141-2-23**], permanent pacemaker [**2141-3-1**], evacuation
of tamponade [**2140-3-1**]

History of Present Illness:
The patient is an 85yo white male who was found to have an 8.9cm
ascending aortic aneurysm during a recent workup for prostate
cancer.  He does admit to dyspnea on exertion as well as
worsening fatigue.  He is admitted for surgical management.

Past Medical History:
ascending aortic aneurysm
prostate cancer, s/p external beam radiation [**2124**]
gastroesophageal reflux diseaase (h/o esophageal stricture)
atrial fibrillation/ atrial flutter- s/p cardioversion/ablations
diverticular disease
cholelithiasis
s/p appendectomy, hernia repair, decortication for empyema
(2yo), esophageal dilatation

Social History:
retired machinist, lives with wife, currently maintains two
family homes, denies tobacco, 1 alcoholic beverage per day

Family History:
denies family history of premature coronary artery disease

Physical Exam:
Admission:
VS: 124/92, 74, 20
General: elderly white male in NAD
Skin: unremarkable
HEENT: unremarkable
Neck: supple, full ROM
Chest: lungs CTAB
Heart: irregular with murmur
Abdomen: soft, non-tender, non-distended, +BS
extremities: warm, well-perfused, gross edema bilaterally, no
varicosities
Neuro: grossly intact
pulses: 1+ throughout bilaterally
no carotid bruits

Pertinent Results:
Hematology
  COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2141-3-10**] 04:47AM    11.6* 2.87* 9.3* 27.6* 96 32.5* 33.9
18.5* 268
Source: Line-picc
  BASIC COAGULATION (PT, PTT, PLT, INR) Plt Ct
[**2141-3-10**] 04:47AM    268
Source: Line-picc

Chemistry
  RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2141-3-10**] 04:47AM    95 38* 1.8* 142 3.9 108 28 10
Source: Line-picc

  ENZYMES & BILIRUBIN ALT AST LD(LDH) CK(CPK) AlkPhos Amylase
TotBili DirBili
[**2141-3-10**] 04:47AM    98* 140* 444*   216*   10.1*
Source: Line-picc
  CHEMISTRY TotProt Albumin Globuln Calcium Phos Mg UricAcd Iron

[**2141-3-10**] 04:47AM      2.4*
Source: Line-picc


Pathology Examination

Name Birthdate    Age     Sex Pathology #     [**Hospital1 18**] [**Known lastname 42131**],[**Known firstname **] J.       [**2055-2-6**]    86 Male      [**Numeric Identifier 42132**]
[**Numeric Identifier 42133**]
Report to:   DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]
Gross Description by:   DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/dif



SPECIMEN SUBMITTED: aortic valve leaflets, aortic tissue.

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2141-2-22**] [**2141-2-23**] [**2141-2-27**] DR. [**Last Name (STitle) **]. [**Doctor Last Name 1431**]/dsj??????

DIAGNOSIS:

1.  Heart valve, aortic (A):

With calcification and degenerative changes.



2.  Aortic tissue (B):

With atherosclerosis, medial degeneration and adventitial
chronic inflammation.

Clinical:   Coronary artery disease, AVR; ascending aorta; ?
coronary artery bypass.
Gross:



The specimen is received fresh labeled with the patient's name,
"[**Known lastname 34366**], [**Known firstname **]" and the medical record number.



Part 1 is additionally labeled "aortic valve leaflets." It
consists of three aortic valve leaflets.  They are arbitrarily
designated 1, 2, and 3.  Leaflet 1 measures 2.9 cm across the
base, 1.6 cm from apex to base and 0.5 cm in thickness. Leaflet
2 measures 2.8 cm across the base, 1.7 cm from apex to base, and
0.3 cm in thickness. Leaflet 3 measures 1.8 cm across the base
and 1.7 cm from apex to base and 0.4 cm in thickness. All three
leaflets are mildly calcified.  It is represented in A.



Part 2 is additionally labeled "aortic tissue." It consists of a
segment of aorta, measuring 10.1 cm in length and 7.5 cm in
greatest diameter. The adventitial surface is pink, red and
mottled.  The intimal surface is irregular and heterogeneously
yellow and tan. The aorta measures 0.4 cm in maximal thickness.
Additionally received are smaller fragments of aorta measuring
11.5 x 6.0 x 0.4 cm in aggregate.  These fragments are similar
to the large section of aorta.   It is represented in B.

By his/her signature above, the senior physician certifies that
he/she personally conducted a gross and/or microscopic
examination of the described specimens(s) and rendered or
confirmed the diagnosis(es) related thereto.

Immunohistochemistry test(s), if applicable, were developed and
their performance characteristics were determined by The
Department of Pathology at [**Hospital1 69**],
[**Location (un) 86**], MA. They have not been cleared or approved by the U.S.
Food and Drug Administration. The FDA has determined that such
clearance or approval is not necessary. These tests are used for
clinical purposes. They should not be regarded as
investigational or for research. This laboratory is certified
under the Clinical Laboratory Improvement Amendments of [**2120**]
(CLIA - 88) as qualified to perform high complexity clinical
laboratory testing.

    [**Known lastname **],[**Known firstname **] J. [**Medical Record Number 42134**] M  86  [**2055-2-6**]

Radiology Report ABDOMEN U.S. (PORTABLE) Study Date of [**2141-3-4**]
8:35 PM


[**Last Name (LF) **],[**First Name7 (NamePattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] CSRU [**2141-3-4**] 8:35 PM
ABDOMEN U.S. (PORTABLE)   Clip # [**Clip Number (Radiology) 42135**]
Reason: RUQ US to r/o biliary obstruction



[**Hospital 93**] MEDICAL CONDITION:
   86 year old man with elevated bilirubin
REASON FOR THIS EXAMINATION:
   RUQ US to r/o biliary obstruction



Final Report
INDICATION: 86-year-old male with elevated bilirubin. Evaluate
for biliary
obstruction.

COMPARISON: None.

FINDINGS: Ultrasound of the right upper quadrant performed. Exam
is limited
by poor acoustic windows secondary to overlying bandage. The
liver shows
normal echogenicity without focal lesion. The gallbladder is
normal without
evidence of stone. There is no intra- or extra-hepatic biliary
dilatation.
The common duct measures 3 mm. The portal vein is patent with
hepatopetal
flow. The right kidney shows no hydronephrosis.

IMPRESSION: Limited exam secondary to poor acoustic windows from
overlying
bandage. The liver and gallbladder are normal. No intra- or
extra-hepatic
biliary dilatation.

The study and the report were reviewed by the staff radiologist.


DR. [**First Name8 (NamePattern2) **] [**Name (STitle) 7410**]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 7832**]
Approved: SUN [**2141-3-5**] 4:45 PM

  Imaging Lab



[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 42136**] (Complete)
Done [**2141-2-22**] at 4:44:21 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2055-2-6**]
Age (years): 86 M  Hgt (in): 63
BP (mm Hg): /  Wgt (lb): 128
HR (bpm):  BSA (m2): 1.60 m2
Indication: ascending aorta and hemiarch replacement with AVR
ICD-9 Codes: 440.0, 424.1, 424.0
Test Information
Date/Time: [**2141-2-22**] at 16:44    Interpret MD: [**Known firstname **] [**Last Name (NamePattern1) **], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2009AW2-: Machine: 2
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  55%  >= 55%
Aorta - Annulus:  1.9 cm  <= 3.0 cm
Aorta - Ascending:  *8.0 cm  <= 3.4 cm
Aorta - Arch:  *8.3 cm  <= 3.0 cm

Findings
RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV.

LEFT VENTRICLE: Normal LV wall thickness and cavity size.
Overall normal LVEF (>55%).

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

AORTA: Markedly dilated ascending aorta.

AORTIC VALVE: Severely thickened/deformed aortic valve leaflets.
Moderate to severe (3+) AR.

MITRAL VALVE: Mild mitral annular calcification. The MR vena
contracta is <0.3cm. Mild (1+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. No TEE related complications. Results were
Conclusions
PREBYPASS
* patient has a histroy of esophageal strictures which have been
dilated ~ 20 times over the past 25 years. He has had successful
TEE (without transgastric view) without problems in the past.
Only midesophageal views obtained.

1. Left ventricular wall thicknesses and cavity size are normal.
Overall left ventricular systolic function is normal (LVEF>55%).


2. Right ventricular chamber size and free wall motion are
normal.

3. The ascending aorta is markedly dilated The aortic valve
leaflets are severely thickened/deformed. Moderate to severe
(3+) aortic regurgitation is seen.

4. Mild (1+) mitral regurgitation is seen.

5. There is no pericardial effusion.

6. Dr. [**Last Name (STitle) 914**] was notified in person of the results during the
surgery.

POSTBYPASS
1. Patient on norepinephrine, epinephrine, phenylephrine, and
vasopressin

2. Left ventricular function remains good with an EF 55%

3. A well seated, well functioning prostetic valve is seen in
the aortic position. No transgastric views were obtained.

4. As volume transfusion progresses, the RV function began to
decline. Epinephrine started with moderate return of function.

5. Dr [**Last Name (STitle) 914**] aware
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Known firstname **] [**Last Name (NamePattern1) **], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2141-2-24**] 09:26


?????? [**2135**] CareGroup IS. All rights reserved.


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier **]Portable TTE
(Complete) Done [**2141-3-2**] at 11:24:30 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2055-2-6**]
Age (years): 86 M  Hgt (in): 63
BP (mm Hg): 105/67  Wgt (lb): 128
HR (bpm): 96  BSA (m2): 1.60 m2
Indication: Evaluate for Tamponade.
ICD-9 Codes: 423.9
Test Information
Date/Time: [**2141-3-2**] at 11:24    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 171**], MD
Test Type: Portable TTE (Complete) Son[**Name (NI) 930**]: [**First Name8 (NamePattern2) 2270**] [**Last Name (NamePattern1) **]
Doppler: Limited Doppler and no color Doppler Test Location:
West SICU/CTIC/VICU
Contrast: None Tech Quality: Adequate
Tape #: 2009W005-0:00 Machine: Vivid [**8-8**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  >= 55%  >= 55%
Pericardium - Effusion Size:  2.7 cm

Findings
This study was compared to the prior study of [**2141-2-27**].
LEFT VENTRICLE: Suboptimal technical quality, a focal LV wall
motion abnormality cannot be fully excluded. Overall normal LVEF
(>55%).

PERICARDIUM: Large pericardial effusion. Effusion echo dense,
c/w blood, inflammation or other cellular elements. RV diastolic
collapse, c/w impaired fillling/tamponade physiology.

GENERAL COMMENTS: Echocardiographic results were reviewed by
Conclusions
Due to suboptimal technical quality, a focal wall motion
abnormality cannot be fully excluded. Overall left ventricular
systolic function is normal (LVEF>55%). There is a large
pericardial effusion anterior to the right ventricle. The
effusion is echo dense, most consistent with blood. There is
right ventricular diastolic collapse, consistent with impaired
fillling/tamponade physiology.

IMPRESSION: Large anterior intrapericardial hematoma with right
ventricular compression and tamponade physiology.

Compared with the prior study (images reviewed) of [**2141-2-27**],
anterior pericardial effusion has expanded, compressing the
right ventricle.
  Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 171**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2141-3-2**] 11:38


?????? [**2135**] CareGroup IS. All rights reserved.


Brief Hospital Course:
The patient was brought to the operating room on [**2141-2-22**] where
he underwent aortic valve replacement and replacement of the
ascending aorta and hemi-arch with a 28mm gelweave graft.
Please see full operative report for details.  The patient had
significant bleeding and multiple blood products were used.
Satisfactory hemostasis could not be achieved, so the patient's
chest was left open.  He returned to the operating room the
following day, [**2141-2-23**] for mediastinal exploration and chest
closure.  The patient tolerated this procedure well and left the
operating room on levophed.  On POD 2 the patient developed
rapid atrial fibrillation, which he did not tolerate
hemodynamically.  He was started on amiodarone and cardioverted
to an underlying rhythm of asystole.  He was A-paced and
remained pacer dependent.  Electrophysiology was consulted and
placed a temporary pacing wire at the bedside under fluoro.  The
patient received a St. [**Male First Name (un) 923**] permanent pacemaker on [**2141-3-1**].  The
patient had a prolonged intubation, and tube feeds were started
for nutrition.  Chest tubes were discontinued on POD 3.  The
patient was extubated on [**2141-2-28**].  He became confused and
agitated and attempted to remove his lines, therefore was placed
in restraints.  Coumadin was initiated for atrial fibrillation.
On [**2141-3-2**], the patient was found to be slightly hypotensive
with a rising PT/INR.  Echo demonstrated tamponade physiology
with RV collapse, and the patient returned to the operating room
for evacuation of pericardial clot and left pleural effusion.
Following this, the patient returned to [**Location 42137**] on epi and neo.
The patient was found to have hematuria, and GU consult was
obtained.  Given his history of prostate cancer and radiation
treatment, and anticoagulation- hematuria is not an unusual
finding.  The patient is instructed to follow up with GU [**7-10**]
weeks post-op.
He developed a leukocytosis and infectious disease was
consulted.  He was found to grow pseudomonas from sputum and
urine, and zosyn therapy was initiated.  The patient was again
extubated on [**2141-3-4**].  He developed jaundice, and was found to
have elevated LFTs, including a Tbili of 15.  GI was consulted.
Likely explanation is hemolysis from multiple blood products
received.  The patient made progress and was transferred to the
telemetry floor on [**2141-3-7**]. he continue to do well w/ WBC, LFT's,
BUN/CREAT trending downward. He is diuresisng slowly. Remains on
zosyn until [**2141-3-13**]. He was screened by PT and rehab was
recommended.
2/4/9

Medications on Admission:
atenolol 25mg daily
spectravite multivitamin daily
advil pm prn


Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day.
5. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
6. Lidocaine HCl 2 % Gel Sig: One (1) Appl Mucous membrane PRN
(as needed).
7. Furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day
for 2 weeks: until edema resloves.
8. Piperacillin-Tazobactam 2.25 gram Recon Soln Sig: 2.25 gms
Intravenous Q6H (every 6 hours) for 3 days.
9. picc line care
pic line care and flushes per protocol
non-heparin dependent line.
10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 2
weeks.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
9cm ascending aortic aneurysm, prostate cancer (s/p external
radiation [**2124**]), GERD (h/o esophageal stricture), h/o
afib/flutter-s/p ablations, diverticular dz, cholelithiasis, s/p
appy, herniorraphy, empyema s/p R decortication @2yo, esophageal
dilatation
hematuria- blood clots- keep foley until urology appointment.


Discharge Condition:
deconditioned.


Discharge Instructions:
no driving for 4 weeks and off all narcotics
no lifting more than 10 pounds for 10 weeks
shower daily, no baths or swimming for 6 weeks
no lotions, creams or powders to incisions
report any redness of, or drainage from incisions
report any weight gain greater than 2 pounds a day or 5 pounds a
week
report any fever greater than 100.5
take all medications as directed
zosyn will be completed last dose [**2141-3-13**]
Keep foley until urology follow up [**2141-3-23**]- irrigant as needed.

Followup Instructions:
Dr. [**Last Name (STitle) 770**] (urology) [**Telephone/Fax (1) 5727**], [**3-23**] 4pm, [**Hospital1 18**], [**Hospital Ward Name 23**] [**Location (un) **]
Follow up with Dr. [**Last Name (STitle) 914**] in 4 weeks
Follow up with PCP and cardiologist when d/c'd from rehab



Completed by:[**2141-3-10**]
{'Thoracic aneurysm without mention of rupture,Defibrination syndrome,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Acute respiratory failure,Cardiac complications, not elsewhere classified,Cardiac arrest,Unspecified pleural effusion,Cardiac tamponade,Delirium due to conditions classified elsewhere,Aortic valve disorders,Personal history of malignant neoplasm of prostate,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Diverticulosis of colon (without mention of hemorrhage),Chronic kidney disease, unspecified,Gross hematuria,Other transfusion reaction'}


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: ascending aortic aneurysm (8.9cm)-incidental finding

PRESENT ILLNESS: The patient is an 85yo white male who was found to have an 8.9cm
ascending aortic aneurysm during a recent workup for prostate
cancer.  He does admit to dyspnea on exertion as well as
worsening fatigue.  He is admitted for surgical management.

MEDICAL HISTORY: ascending aortic aneurysm
prostate cancer, s/p external beam radiation [**2124**]
gastroesophageal reflux diseaase (h/o esophageal stricture)
atrial fibrillation/ atrial flutter- s/p cardioversion/ablations
diverticular disease
cholelithiasis
s/p appendectomy, hernia repair, decortication for empyema
(2yo), esophageal dilatation

MEDICATION ON ADMISSION: atenolol 25mg daily
spectravite multivitamin daily
advil pm prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
VS: 124/92, 74, 20
General: elderly white male in NAD
Skin: unremarkable
HEENT: unremarkable
Neck: supple, full ROM
Chest: lungs CTAB
Heart: irregular with murmur
Abdomen: soft, non-tender, non-distended, +BS
extremities: warm, well-perfused, gross edema bilaterally, no
varicosities
Neuro: grossly intact
pulses: 1+ throughout bilaterally
no carotid bruits

FAMILY HISTORY: denies family history of premature coronary artery disease

SOCIAL HISTORY: retired machinist, lives with wife, currently maintains two
family homes, denies tobacco, 1 alcoholic beverage per day 

### Response:
{'Thoracic aneurysm without mention of rupture,Defibrination syndrome,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Acute respiratory failure,Cardiac complications, not elsewhere classified,Cardiac arrest,Unspecified pleural effusion,Cardiac tamponade,Delirium due to conditions classified elsewhere,Aortic valve disorders,Personal history of malignant neoplasm of prostate,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Diverticulosis of colon (without mention of hemorrhage),Chronic kidney disease, unspecified,Gross hematuria,Other transfusion reaction'}
