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+T1	Age 2 13	70–year–old
+T2	Sex 14 20	female
+T3	Nonbiological_location 38 58	Emergency Department
+T4	Sign_symptom 64 76	palpitations
+E1	Sign_symptom:T4 
+T5	Sign_symptom 78 85	dyspnea
+E2	Sign_symptom:T5 
+T6	Sign_symptom 99 108	epistaxis
+E3	Sign_symptom:T6 
+T7	Detailed_description 90 98	anterior
+R1	MODIFY Arg1:T7 Arg2:E3	
+T8	History 120 199	3 years history of atrial fibrillation and chronic heart failure NYHA class III
+T9	Duration 120 127	3 years
+E4	Duration:T9 
+T10	Disease_disorder 139 158	atrial fibrillation
+E5	Disease_disorder:T10 
+T11	Disease_disorder 171 184	heart failure
+E6	Disease_disorder:T11 
+T12	Detailed_description 163 170	chronic
+R2	MODIFY Arg1:T12 Arg2:E6	
+T13	Lab_value 185 199	NYHA class III
+R3	MODIFY Arg1:T13 Arg2:E6	
+T14	Medication 222 229	aspirin
+E7	Medication:T14 
+T15	Dosage 230 240	100 mg/day
+R4	MODIFY Arg1:T15 Arg2:E7	
+T16	Diagnostic_procedure 242 262	Physical examination
+E8	Diagnostic_procedure:T16 
+T17	Diagnostic_procedure 285 290	pulse
+E9	Diagnostic_procedure:T17 
+T18	Lab_value 275 284	irregular
+R5	MODIFY Arg1:T18 Arg2:E9	
+T19	Lab_value 294 307	148 beats/min
+R6	MODIFY Arg1:T19 Arg2:E9	
+T20	Diagnostic_procedure 309 323	blood pressure
+E10	Diagnostic_procedure:T20 
+T21	Lab_value 327 339	130/100 mmHg
+R7	MODIFY Arg1:T21 Arg2:E10	
+T22	Sign_symptom 360 366	murmur
+E11	Sign_symptom:T22 
+T23	Detailed_description 341 352	pansystolic
+T24	Biological_structure 353 359	mitral
+R8	MODIFY Arg1:T24 Arg2:E11	
+R9	MODIFY Arg1:T23 Arg2:E11	
+T25	Lab_value 370 379	2/6 grade
+R10	MODIFY Arg1:T25 Arg2:E11	
+#1	AnnotatorNotes T25	qualitative because this is a grading scale
+T26	Sign_symptom 381 387	murmur
+E12	Sign_symptom:T26 
+T27	Biological_structure 391 400	tricuspid
+T28	Detailed_description 401 414	regurgitation
+R11	MODIFY Arg1:T28 Arg2:E12	
+R12	MODIFY Arg1:T27 Arg2:E12	
+T29	Lab_value 418 427	3/6 grade
+R13	MODIFY Arg1:T29 Arg2:E12	
+T30	Sign_symptom 447 455	swelling
+E13	Sign_symptom:T30 
+T31	Biological_structure 429 446	lower extremities
+R14	MODIFY Arg1:T31 Arg2:E13	
+T32	Diagnostic_procedure 461 487	oto-rhino-laryngology exam
+E14	Diagnostic_procedure:T32 
+T33	Sign_symptom 515 524	epistaxis
+E15	Sign_symptom:T33 
+T34	Detailed_description 506 514	anterior
+R15	MODIFY Arg1:T34 Arg2:E15	
+T35	Diagnostic_procedure 538 555	electrocardiogram
+E16	Diagnostic_procedure:T35 
+T36	Detailed_description 530 537	12–lead
+R16	MODIFY Arg1:T36 Arg2:E16	
+T37	Diagnostic_procedure 609 639	International Normalized Ratio
+E17	Diagnostic_procedure:T37 
+T38	Diagnostic_procedure 641 644	INR
+E18	Diagnostic_procedure:T38 
+R17	IDENTICAL Arg1:E18 Arg2:E17	
+T39	Lab_value 653 657	1,24
+R18	MODIFY Arg1:T39 Arg2:E17	
+T40	Diagnostic_procedure 693 709	echocardiography
+E19	Diagnostic_procedure:T40 
+T41	Disease_disorder 565 584	atrial fibrillation
+E20	Disease_disorder:T41 
+T42	Sign_symptom 595 603	ischemia
+E21	Sign_symptom:T42 
+T43	Detailed_description 586 594	inferior
+R19	MODIFY Arg1:T43 Arg2:E21	
+T44	Biological_structure 679 692	transthoracic
+T45	Detailed_description 663 678	two–dimensional
+R20	MODIFY Arg1:T44 Arg2:E19	
+R21	MODIFY Arg1:T45 Arg2:E19	
+T46	Sign_symptom 721 752	thickening of the mitral valves
+E22	Sign_symptom:T46 
+T47	Sign_symptom 769 789	mitral insufficiency
+E23	Sign_symptom:T47 
+T48	Severity 760 768	moderate
+R22	MODIFY Arg1:T48 Arg2:E23	
+T49	Sign_symptom 809 813	mass
+E24	Sign_symptom:T49 
+T50	Shape 803 808	round
+T51	Detailed_description 796 802	mobile
+R23	MODIFY Arg1:T50 Arg2:E24	
+R24	MODIFY Arg1:T51 Arg2:E24	
+T52	Biological_structure 821 832	left atrium
+R25	MODIFY Arg1:T52 Arg2:E24	
+T53	Detailed_description 834 847	heterogeneous
+T54	Detailed_description 849 862	inhomogeneous
+R26	MODIFY Arg1:T53 Arg2:E24	
+R27	MODIFY Arg1:T54 Arg2:E24	
+T55	Distance 867 872	18 mm
+R28	MODIFY Arg1:T55 Arg2:E24	
+T56	Biological_structure 918 936	interatrial septum
+R29	MODIFY Arg1:T56 Arg2:E24	
+T57	Detailed_description 882 910	attached with a narrow stalk
+R30	MODIFY Arg1:T57 Arg2:T56	
+T58	Biological_structure 1005 1025	mitral annular plane
+T59	Coreference 938 940	It
+E25	Coreference:T59 
+R31	IDENTICAL Arg1:E25 Arg2:E24	
+T60	Detailed_description 950 990	tumor–like movement with a cardiac cycle
+R32	MODIFY Arg1:T60 Arg2:E25	
+R33	MODIFY Arg1:T58 Arg2:E25	
+T61	Diagnostic_procedure 1053 1069	echocardiography
+E26	Diagnostic_procedure:T61 
+T62	Sign_symptom 1077 1100	tricuspid insufficiency
+E27	Sign_symptom:T62 
+T63	Diagnostic_procedure 1108 1124	maximum gradient
+E28	Diagnostic_procedure:T63 
+T64	Lab_value 1128 1135	30 mmHg
+R34	MODIFY Arg1:T64 Arg2:E28	
+T65	Sign_symptom 1137 1162	intact interatrial septum
+E29	Sign_symptom:T65 
+T66	Sign_symptom 1164 1172	akinesia
+E30	Sign_symptom:T66 
+T67	Biological_structure 1176 1209	two thirds of basal inferior wall
+R35	MODIFY Arg1:T67 Arg2:E30	
+T68	Diagnostic_procedure 1211 1228	ejection fraction
+E31	Diagnostic_procedure:T68 
+T69	Lab_value 1232 1235	42%
+R36	MODIFY Arg1:T69 Arg2:E31	
+T70	Sign_symptom 1250 1254	mass
+E32	Sign_symptom:T70 
+A1	POLARITY E32 NEG
+T71	Biological_structure 1262 1283	left atrial appendage
+R37	MODIFY Arg1:T71 Arg2:E32	
+T72	Diagnostic_procedure 1321 1337	echocardiography
+E33	Diagnostic_procedure:T72 
+T73	Biological_structure 1305 1320	transesophageal
+T74	Detailed_description 1289 1304	two–dimensional
+R38	MODIFY Arg1:T73 Arg2:E33	
+R39	MODIFY Arg1:T74 Arg2:E33	
+T75	Sign_symptom 1380 1384	mass
+E34	Sign_symptom:T75 
+T76	Biological_structure 1368 1379	intraatrial
+R40	MODIFY Arg1:T76 Arg2:E34	
+T77	Disease_disorder 1424 1437	heart failure
+E35	Disease_disorder:T77 
+T78	Sign_symptom 1386 1395	Epistaxis
+E36	Sign_symptom:T78 
+R41	CAUSE Arg1:E35 Arg2:E36	
+T79	Sign_symptom 1456 1471	venous pressure
+E37	Sign_symptom:T79 
+T80	Lab_value 1446 1455	increased
+R42	MODIFY Arg1:T80 Arg2:E37	
+T81	Nonbiological_location 1505 1534	cardiovascular surgery clinic
+T82	Clinical_event 1489 1497	referred
+E38	Clinical_event:T82 
+R43	MODIFY Arg1:T81 Arg2:E38	
+T83	Therapeutic_procedure 1552 1559	surgery
+E39	Therapeutic_procedure:T83 
+A2	POLARITY E39 NEG
+T84	Therapeutic_procedure 1561 1576	Anticoagulation
+E40	Therapeutic_procedure:T84 
+T85	Medication 1582 1593	fraxiparine
+E41	Medication:T85 
+T86	Dosage 1597 1607	0,6 ml/day
+T87	Duration 1634 1645	for 3 weeks
+E42	Duration:T87 
+R44	SUB_PROCEDURE Arg1:E41 Arg2:E40	
+R45	MODIFY Arg1:T86 Arg2:E41	
+R46	MODIFY Arg1:E42 Arg2:E40	
+T88	Therapeutic_procedure 1679 1696	nasal tamponament
+E43	Therapeutic_procedure:T88 
+T89	Sign_symptom 1666 1675	epistaxis
+E44	Sign_symptom:T89 
+A3	POLARITY E44 NEG
+R47	CAUSE Arg1:E43 Arg2:E44	
+T90	Date 1698 1711	After 3 weeks
+E45	Date:T90 
+T91	Diagnostic_procedure 1716 1732	echocardiography
+E46	Diagnostic_procedure:T91 
+T92	Sign_symptom 1763 1767	mass
+E47	Sign_symptom:T92 
+A4	POLARITY E47 NEG
+T93	Sign_symptom 1838 1846	thrombus
+E48	Sign_symptom:T93 
+A5	POLARITY E48 UNCERTAIN
+T94	Clinical_event 21 30	presented
+E49	Clinical_event:T94 
+R48	MODIFY Arg1:T3 Arg2:E49	
+*	OVERLAP E49 E1 E2 E3
+R49	AFTER Arg1:E3 Arg2:E4	
+*	OVERLAP E4 E5 E6 E7
+R50	BEFORE Arg1:E7 Arg2:E8	
+*	OVERLAP E8 E9 E10 E11 E12 E13 E14 E15 E16 E20 E21 E17 E19 E22 E23 E24 E26 E27 E28 E29 E30 E31 E32 E33 E34 E36 E35 E37
+R51	BEFORE Arg1:E37 Arg2:E38	
+*	OVERLAP E38 E39
+R52	BEFORE Arg1:E39 Arg2:E40	
+*	OVERLAP E40 E42
+R53	AFTER Arg1:E42 Arg2:E44	
+R54	BEFORE Arg1:E44 Arg2:E45	
+*	OVERLAP E45 E46 E47
+R55	AFTER Arg1:E47 Arg2:E48