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T1 Age 2 13 75–year–old T2 Sex 14 20 female T3 Nonbiological_location 38 105 Emergency Department of Ilfov Clinical Hospital, Bucharest, Romania T4 Sign_symptom 112 119 dyspnea E1 Sign_symptom:T4 T5 Sign_symptom 121 130 orthopnea E2 Sign_symptom:T5 T6 Sign_symptom 160 172 palpitations E3 Sign_symptom:T6 T7 Sign_symptom 150 158 swelling E4 Sign_symptom:T7 T8 Biological_structure 132 149 lower extremities R1 MODIFY Arg1:T8 Arg2:E4 T9 Duration 184 191 3 years E5 Duration:T9 T10 Sign_symptom 203 222 atrial fibrillation E6 Sign_symptom:T10 T11 Subject 240 253 family doctor T12 Duration 258 266 one-year E7 Duration:T12 T13 Disease_disorder 278 293 cardiac failure E8 Disease_disorder:T13 T14 Lab_value 294 335 NYHA (New York Heart Association) class Ⅱ R2 MODIFY Arg1:T14 Arg2:E8 R3 MODIFY Arg1:E7 Arg2:E8 R4 MODIFY Arg1:E5 Arg2:E6 T15 Diagnostic_procedure 337 357 Physical examination E9 Diagnostic_procedure:T15 T16 Lab_value 386 398 80 beats/min T17 Sign_symptom 370 385 irregular pulse E10 Sign_symptom:T17 T18 Diagnostic_procedure 400 414 blood pressure E11 Diagnostic_procedure:T18 T19 Lab_value 418 429 100/60 mmHg R5 MODIFY Arg1:T19 Arg2:E11 R6 MODIFY Arg1:T16 Arg2:E10 T20 Sign_symptom 431 448 bi–basal crackles E12 Sign_symptom:T20 T21 Diagnostic_procedure 458 470 auscultation E13 Diagnostic_procedure:T21 T22 Biological_structure 452 457 chest R7 MODIFY Arg1:T22 Arg2:E13 T23 Biological_structure 472 489 lower extremities T24 Coreference 490 498 swelling E14 Coreference:T24 R8 IDENTICAL Arg1:E14 Arg2:E4 R9 MODIFY Arg1:T23 Arg2:E14 T25 Diagnostic_procedure 500 524 Heart sounds examination E15 Diagnostic_procedure:T25 T26 Sign_symptom 548 566 pansystolic murmur E16 Sign_symptom:T26 T27 Lab_value 536 547 IVth degree R10 MODIFY Arg1:T27 Arg2:E16 T28 Biological_structure 574 598 left border of the stern R11 MODIFY Arg1:T28 Arg2:E16 T29 Sign_symptom 623 630 dilated E17 Sign_symptom:T29 T30 Biological_structure 604 617 jugular veins R12 MODIFY Arg1:T30 Arg2:E17 T31 Sign_symptom 658 662 pain E18 Sign_symptom:T31 T32 Biological_structure 670 698 upper right abdominal region R13 MODIFY Arg1:T32 Arg2:E18 T33 Detailed_description 700 721 enhanced by palpation R14 MODIFY Arg1:T33 Arg2:E18 T34 Diagnostic_procedure 848 851 EKG E19 Diagnostic_procedure:T34 T35 Sign_symptom 853 872 atrial fibrillation E20 Sign_symptom:T35 T36 Lab_value 876 882 80/min R15 MODIFY Arg1:T36 Arg2:E20 T37 Sign_symptom 884 909 right bundle branch block E21 Sign_symptom:T37 T38 Sign_symptom 926 934 ischemia E22 Sign_symptom:T38 T39 Biological_structure 911 925 infero-lateral R16 MODIFY Arg1:T39 Arg2:E22 T40 Diagnostic_procedure 951 961 ultrasound E23 Diagnostic_procedure:T40 T41 Biological_structure 936 950 Transabdominal R17 MODIFY Arg1:T41 Arg2:E23 T42 Sign_symptom 983 997 enlarged liver E24 Sign_symptom:T42 T43 Detailed_description 971 981 homogenous R18 MODIFY Arg1:T43 Arg2:E24 T44 Sign_symptom 1027 1034 dilated E25 Sign_symptom:T44 T45 Biological_structure 1003 1021 suprahepatic veins R19 MODIFY Arg1:T45 Arg2:E25 T46 Biological_structure 1051 1069 inferior vena cava R20 MODIFY Arg1:T46 Arg2:E25 T47 Lab_value 1071 1076 30 mm R21 MODIFY Arg1:T47 Arg2:T46 T48 Diagnostic_procedure 1111 1141 Transthoracic echocardiography E26 Diagnostic_procedure:T48 T49 Sign_symptom 1153 1160 dilated E27 Sign_symptom:T49 T50 Biological_structure 1161 1173 right atrium R22 MODIFY Arg1:T50 Arg2:E27 T51 Lab_value 1177 1184 74,2 mm T53 Diagnostic_procedure 727 739 liver margin E29 Diagnostic_procedure:T53 T52 Texture 744 750 tender R23 MODIFY Arg1:T52 Arg2:E29 T54 Shape 752 757 round R24 MODIFY Arg1:T54 Arg2:E29 T55 Distance 762 787 6 cm below the costal rib R25 MODIFY Arg1:T55 Arg2:E29 T56 Texture 796 802 smooth T57 Diagnostic_procedure 803 816 liver surface E28 Diagnostic_procedure:T57 R26 MODIFY Arg1:T56 Arg2:E28 R27 MODIFY Arg1:T51 Arg2:T50 T58 Sign_symptom 1197 1204 dilated E30 Sign_symptom:T58 T59 Biological_structure 1205 1216 left atrium T60 Lab_value 1220 1227 55,2 mm R28 MODIFY Arg1:T60 Arg2:T59 R29 MODIFY Arg1:T59 Arg2:E30 T61 Sign_symptom 1229 1236 dilated E31 Sign_symptom:T61 T62 Biological_structure 1237 1251 left ventricle T63 Lab_value 1255 1265 64/72,3 mm R30 MODIFY Arg1:T63 Arg2:T62 R31 MODIFY Arg1:T62 Arg2:E31 T64 Sign_symptom 1267 1274 dilated E32 Sign_symptom:T64 T65 Biological_structure 1275 1290 right ventricle T66 Lab_value 1294 1301 44,4 mm R32 MODIFY Arg1:T66 Arg2:T65 R33 MODIFY Arg1:T65 Arg2:E32 T67 Disease_disorder 1471 1491 mitral insufficiency E33 Disease_disorder:T67 T68 Disease_disorder 1399 1422 tricuspid insufficiency E34 Disease_disorder:T68 T69 Disease_disorder 1303 1323 Atrial septal defect E35 Disease_disorder:T69 T70 Detailed_description 1324 1344 ostium secundum type R34 MODIFY Arg1:T70 Arg2:E35 T71 Sign_symptom 1371 1390 left–to–right shunt E36 Sign_symptom:T71 R35 MODIFY Arg1:E36 Arg2:E35 T72 Distance 1349 1353 6 cm R36 MODIFY Arg1:T72 Arg2:E35 T73 Severity 1392 1398 Severe R37 MODIFY Arg1:T73 Arg2:E34 T74 Lab_value 1448 1458 55,4 mm Hg T75 Lab_value 1460 1470 4th degree R38 MODIFY Arg1:T75 Arg2:E33 T76 Sign_symptom 1510 1522 hypertension E37 Sign_symptom:T76 T77 Biological_structure 1500 1509 pulmonary R39 MODIFY Arg1:T77 Arg2:E37 T78 Severity 1493 1499 Severe R40 MODIFY Arg1:T78 Arg2:E37 T79 Lab_value 1526 1534 75 mm Hg R41 MODIFY Arg1:T79 Arg2:E37 T80 Diagnostic_procedure 1540 1557 ejection fraction E38 Diagnostic_procedure:T80 T81 Lab_value 1561 1564 29% R42 MODIFY Arg1:T81 Arg2:E38 T82 Sign_symptom 1566 1585 Atrial fibrillation E39 Sign_symptom:T82 R43 MODIFY Arg1:T74 Arg2:E34 T83 Sign_symptom 1634 1644 Flattening E40 Sign_symptom:T83 T84 Biological_structure 1652 1675 interventricular septum R44 MODIFY Arg1:T84 Arg2:E40 T85 Disease_disorder 1718 1739 chronic heart failure E41 Disease_disorder:T85 T86 Lab_value 1706 1717 IVth degree R45 MODIFY Arg1:T86 Arg2:E41 T87 Other_event 1746 1813;1814 1845;1846 1878;1879 1921;1922 1950;1951 1976 Atrial septal defect ostium secundum type with left–to–right shunt. Severe tricuspid insufficiency. 4th degree mitral insufficiency. Severe pulmonary hypertension of 75 mm Hg. Chronic atrial fibrillation. Right bundle branch block E42 Other_event:T87 #1 AnnotatorNotes E42 repeated earlier in the report verbatim T88 Sign_symptom 1614 1632 paradoxical motion E43 Sign_symptom:T88 T89 Biological_structure 1587 1608 Interventricular sept R46 MODIFY Arg1:T89 Arg2:E43 T90 Clinical_event 21 30 presented E44 Clinical_event:T90 R47 MODIFY Arg1:T3 Arg2:E44 * OVERLAP E44 E1 E2 E4 E3 R48 AFTER Arg1:E3 Arg2:E6 R49 BEFORE Arg1:E6 Arg2:E8 R50 BEFORE Arg1:E8 Arg2:E9 * OVERLAP E9 E10 E11 E12 E13 E14 E15 E16 E17 E18 E29 E28 E19 E20 E21 E22 E23 E24 E25 E26 E27 E30 E31 E32 E35 E34 E33 E37 E38 E39 E43 E40 E41