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T1 Date 3 15 January 2009 E1 Date:T1 T2 Age 19 30 57-year-old T3 Sex 31 36 woman T4 Clinical_event 48 57 presented E2 Clinical_event:T4 T5 Sign_symptom 69 88 shortness of breath E3 Sign_symptom:T5 T6 Duration 100 107 1-month E4 Duration:T6 T7 Sign_symptom 131 150 shortness of breath E5 Sign_symptom:T7 T8 Detailed_description 119 130 progressive T9 Diagnostic_procedure 177 194 exercise capacity E6 Diagnostic_procedure:T9 T10 Lab_value 157 173 gradual decrease R1 MODIFY Arg1:T10 Arg2:E6 T11 Sign_symptom 213 220 dyspnea E7 Sign_symptom:T11 T12 Severity 208 212 mild R2 MODIFY Arg1:T12 Arg2:E7 T13 Sign_symptom 238 257 additional symptoms E8 Sign_symptom:T13 A1 POLARITY E8 NEG R3 MODIFY Arg1:T8 Arg2:E5 T14 Date 262 268 age 40 E9 Date:T14 T15 Clinical_event 283 292 diagnosed E10 Clinical_event:T15 T19 Disease_disorder 329 342 breast cancer E11 Disease_disorder:T19 T20 Detailed_description 318 328 left-sided R4 MODIFY Arg1:T20 Arg2:E11 T21 Lab_value 311 316 T1bN1 R5 MODIFY Arg1:T21 Arg2:E11 T22 Lab_value 300 309 stage IIA R6 MODIFY Arg1:T22 Arg2:E11 T23 History 300 342 stage IIA, T1bN1, left-sided breast cancer T24 Therapeutic_procedure 377 387 lumpectomy E12 Therapeutic_procedure:T24 T25 Therapeutic_procedure 401 416 node dissection E13 Therapeutic_procedure:T25 T26 Biological_structure 392 400 axillary R7 MODIFY Arg1:T26 Arg2:E13 T27 Medication 457 468 DOX therapy E14 Medication:T27 T28 Dosage 470 478 75 mg/m2 R8 MODIFY Arg1:T28 Arg2:E14 T29 Dosage 445 453 4 cycles R9 MODIFY Arg1:T29 Arg2:E14 T30 Dosage 493 501 8 cycles T31 Medication 505 521 cyclophosphamide E15 Medication:T31 T32 Medication 523 535 methotrexate E16 Medication:T32 T33 Medication 541 555 5-fluorouracil E17 Medication:T33 T34 Diagnostic_procedure 557 585 Multigated acquisition scans E18 Diagnostic_procedure:T34 T35 Medication 603 615 chemotherapy E19 Medication:T35 T36 Diagnostic_procedure 630 646 cardiac function E20 Diagnostic_procedure:T36 T37 Lab_value 623 629 normal R10 MODIFY Arg1:T37 Arg2:E20 T38 Medication 654 666 chemotherapy E21 Medication:T38 T39 Therapeutic_procedure 700 709 radiation E22 Therapeutic_procedure:T39 T40 Biological_structure 682 699 left whole-breast R11 MODIFY Arg1:T40 Arg2:E22 T41 Detailed_description 718 732 axillary boost R12 MODIFY Arg1:T41 Arg2:E22 T42 Sign_symptom 746 751 tumor E23 Sign_symptom:T42 T43 Detailed_description 761 787 estrogen receptor-positive R13 MODIFY Arg1:T43 Arg2:E23 T44 Medication 838 859 anti-estrogen therapy E24 Medication:T44 T45 Medication 870 879 tamoxifen E25 Medication:T45 T16 Duration 884 891 5 years E26 Duration:T16 T17 Medication 934 943 letrozole E27 Medication:T17 T18 Duration 952 966 17 years after E28 Duration:T18 T46 Sign_symptom 994 1000 active E29 Sign_symptom:T46 T47 Diagnostic_procedure 1024 1030 health E30 Diagnostic_procedure:T47 T48 Lab_value 1008 1023 relatively good R14 MODIFY Arg1:T48 Arg2:E30 T49 Sign_symptom 1090 1101 tachycardia E31 Sign_symptom:T49 T50 Sign_symptom 1103 1112 tachypnea E32 Sign_symptom:T50 T51 Sign_symptom 1118 1130 hypertension E33 Sign_symptom:T51 T52 Sign_symptom 1162 1172 distention E34 Sign_symptom:T52 T53 Biological_structure 1147 1161 jugular venous T54 Sign_symptom 1177 1179 S3 E35 Sign_symptom:T54 #1 AnnotatorNotes E35 specifically, S3 heart sound T55 Sign_symptom 1181 1196 pulmonary rales E36 Sign_symptom:T55 T56 Sign_symptom 1219 1224 edema E37 Sign_symptom:T56 T57 Detailed_description 1208 1218 peripheral T58 Severity 1202 1207 trace R15 MODIFY Arg1:T57 Arg2:E37 R16 MODIFY Arg1:T58 Arg2:E37 T59 Diagnostic_procedure 1234 1251 laboratory values E38 Diagnostic_procedure:T59 R17 MODIFY Arg1:T53 Arg2:E34 T60 Lab_value 1257 1277 within normal limits R18 MODIFY Arg1:T60 Arg2:E38 T61 Diagnostic_procedure 1310 1350 N-terminal pro-brain natriuretic peptide E39 Diagnostic_procedure:T61 T62 Lab_value 1352 1364 >2,000 pg/mL R19 MODIFY Arg1:T62 Arg2:E39 T63 Lab_value 1292 1300 elevated R20 MODIFY Arg1:T63 Arg2:E39 T64 Disease_disorder 1411 1425 cardiomyopathy E40 Disease_disorder:T64 T65 Diagnostic_procedure 1442 1456 cardiac enzyme E41 Diagnostic_procedure:T65 T66 Lab_value 1435 1441 normal R21 MODIFY Arg1:T66 Arg2:E41 T67 Diagnostic_procedure 1468 1485 electrocardiogram E42 Diagnostic_procedure:T67 T68 Diagnostic_procedure 1487 1490 ECG E43 Diagnostic_procedure:T68 R22 IDENTICAL Arg1:E43 Arg2:E42 T69 Sign_symptom 1509 1525 ischemic changes E44 Sign_symptom:T69 A2 POLARITY E44 NEG T70 Diagnostic_procedure 1542 1551 angiogram E45 Diagnostic_procedure:T70 T71 Biological_structure 1533 1541 coronary R23 MODIFY Arg1:T71 Arg2:E45 T72 Lab_value 1555 1561 normal R24 MODIFY Arg1:T72 Arg2:E45 T73 Diagnostic_procedure 1578 1581 ECG E46 Diagnostic_procedure:T73 T74 Sign_symptom 1595 1606 tachycardia E47 Sign_symptom:T74 T75 Detailed_description 1589 1594 sinus R25 MODIFY Arg1:T75 Arg2:E47 T76 Sign_symptom 1654 1673 left-axis deviation E48 Sign_symptom:T76 T77 Sign_symptom 1621 1652 premature ventricular complexes E49 Sign_symptom:T77 T78 Frequency 1612 1620 frequent R26 MODIFY Arg1:T78 Arg2:E49 T79 Sign_symptom 1687 1698 enlargement E50 Sign_symptom:T79 T80 Biological_structure 1675 1686 left atrial R27 MODIFY Arg1:T80 Arg2:E50 T81 Sign_symptom 1716 1729 QRS complexes E51 Sign_symptom:T81 T82 Detailed_description 1704 1715 low-voltage R28 MODIFY Arg1:T82 Arg2:E51 T83 Sign_symptom 1747 1757 ST changes E52 Sign_symptom:T83 T84 Detailed_description 1735 1746 nonspecific R29 MODIFY Arg1:T84 Arg2:E52 T85 Diagnostic_procedure 1783 1797 echocardiogram E53 Diagnostic_procedure:T85 T86 Detailed_description 1769 1782 2-dimensional R30 MODIFY Arg1:T86 Arg2:E53 T87 Diagnostic_procedure 1809 1843 left ventricular ejection fraction E54 Diagnostic_procedure:T87 T88 Diagnostic_procedure 1845 1849 LVEF E55 Diagnostic_procedure:T88 R31 IDENTICAL Arg1:E55 Arg2:E54 T89 Lab_value 1854 1858 0.20 R32 MODIFY Arg1:T89 Arg2:E54 T90 Sign_symptom 1897 1908 hypokinesis E56 Sign_symptom:T90 T91 Sign_symptom 1923 1930 dilated E57 Sign_symptom:T91 T92 Severity 1860 1866 severe T93 Biological_structure 1875 1891 left ventricular T94 Detailed_description 1867 1874 diffuse T95 Biological_structure 1893 1895 LV R33 IDENTICAL Arg1:T95 Arg2:T93 R34 MODIFY Arg1:T93 Arg2:E56 R35 MODIFY Arg1:T94 Arg2:E56 R36 MODIFY Arg1:T92 Arg2:E56 T96 Severity 1916 1922 mildly R37 MODIFY Arg1:T96 Arg2:E57 T97 Biological_structure 1931 1942 left atrium R38 MODIFY Arg1:T97 Arg2:E57 T98 Diagnostic_procedure 2003 2036 cardiovascular magnetic resonance E58 Diagnostic_procedure:T98 T99 Diagnostic_procedure 2038 2041 CMR E59 Diagnostic_procedure:T99 R39 IDENTICAL Arg1:E59 Arg2:E58 T100 Diagnostic_procedure 2075 2079 LVEF E60 Diagnostic_procedure:T100 T101 Lab_value 2083 2087 0.20 R40 MODIFY Arg1:T101 Arg2:E60 T103 Diagnostic_procedure 2093 2113 T2-weighted sequence E62 Diagnostic_procedure:T103 R41 SUB_PROCEDURE Arg1:E62 Arg2:E58 T102 Disease_disorder 2147 2158 dysfunction E61 Disease_disorder:T102 T104 Diagnostic_procedure 2126 2130 flow E63 Diagnostic_procedure:T104 T105 Lab_value 2121 2125 slow R42 MODIFY Arg1:T105 Arg2:E63 T106 Biological_structure 2144 2146 LV R43 MODIFY Arg1:T106 Arg2:E61 T107 Sign_symptom 2178 2183 edema E64 Sign_symptom:T107 A3 POLARITY E64 NEG T108 Biological_structure 2167 2177 myocardial R44 MODIFY Arg1:T108 Arg2:E64 T109 Diagnostic_procedure 2199 2221 gadolinium enhancement E65 Diagnostic_procedure:T109 R45 SUB_PROCEDURE Arg1:E65 Arg2:E58 T110 Detailed_description 2194 2198 Late R46 MODIFY Arg1:T110 Arg2:E65 T111 Sign_symptom 2251 2259 thinning E66 Sign_symptom:T111 T112 Biological_structure 2240 2250 myocardial R47 MODIFY Arg1:T112 Arg2:E66 T113 Detailed_description 2232 2239 diffuse R48 MODIFY Arg1:T113 Arg2:E66 T114 Therapeutic_procedure 2302 2319 treated medically E67 Therapeutic_procedure:T114 T115 Sign_symptom 2325 2333 symptoms E68 Sign_symptom:T115 A4 TREND E68 DEC T116 Lab_value 2348 2356 improved R49 MODIFY Arg1:T116 Arg2:E68 T117 Therapeutic_procedure 2364 2371 therapy E69 Therapeutic_procedure:T117 T118 Medication 2394 2403 β-blocker E70 Medication:T118 T119 Medication 2408 2447 angiotensin-converting enzyme inhibitor E71 Medication:T119 T120 Medication 2449 2456 digoxin E72 Medication:T120 T121 Medication 2464 2472 diuretic E73 Medication:T121 T122 Coreference 2478 2485 therapy E74 Coreference:T122 A5 TREND E74 DEC R50 IDENTICAL Arg1:E74 Arg2:E69 T123 Lab_value 2497 2504 tapered R51 MODIFY Arg1:T123 Arg2:E74 T124 Diagnostic_procedure 2514 2518 LVEF E75 Diagnostic_procedure:T124 T125 Lab_value 2519 2528 increased R52 MODIFY Arg1:T125 Arg2:E75 T126 Lab_value 2534 2538 0.20 T127 Lab_value 2542 2546 0.55 T128 Duration 2557 2571 8-month period E76 Duration:T128 R53 MODIFY Arg1:T126 Arg2:E75 R54 MODIFY Arg1:T127 Arg2:E75 T129 Medication 2577 2588 medications E77 Medication:T129 A6 POLARITY E77 NEG T130 Lab_value 2625 2637 discontinued R55 MODIFY Arg1:T130 Arg2:E77 T131 Medication 2609 2619 metoprolol E78 Medication:T131 T132 Dosage 2600 2608 low-dose R56 MODIFY Arg1:T132 Arg2:E78 T133 Date 2638 2650 after 1 year E79 Date:T133 T134 Sign_symptom 2669 2681 asymptomatic E80 Sign_symptom:T134 T135 Detailed_description 63 68 acute R57 MODIFY Arg1:T135 Arg2:E3 * OVERLAP E2 E3 E1 R58 AFTER Arg1:E3 Arg2:E4 * OVERLAP E4 E5 E6 E7 E8 R59 AFTER Arg1:E8 Arg2:E9 * OVERLAP E9 E10 E11 R60 BEFORE Arg1:E11 Arg2:E12 * OVERLAP E12 E13 R61 BEFORE Arg1:E13 Arg2:E14 R62 MODIFY Arg1:T30 Arg2:E15 R63 MODIFY Arg1:T30 Arg2:E16 R64 MODIFY Arg1:T30 Arg2:E17 * OVERLAP E14 E15 E16 E17 R65 BEFORE Arg1:E17 Arg2:E18 * OVERLAP E18 E19 E20 R66 BEFORE Arg1:E20 Arg2:E21 * OVERLAP E21 E22 E23 R67 BEFORE Arg1:E23 Arg2:E24 R68 BEFORE Arg1:E24 Arg2:E25 * OVERLAP E25 E26 R69 BEFORE Arg1:E26 Arg2:E27 R70 BEFORE Arg1:E27 Arg2:E28 * OVERLAP E28 E29 E30 R71 BEFORE Arg1:E30 Arg2:E31 * OVERLAP E31 E32 E33 E34 E35 E36 E37 E38 E39 E40 E41 E42 E44 E45 E46 E47 E49 E48 E50 E51 E52 E53 E54 E56 E57 E58 E60 E63 E61 E64 E66 E81 T136 Sign_symptom 2267 2275 scarring E81 Sign_symptom:T136 A7 POLARITY E81 NEG R72 BEFORE Arg1:E81 Arg2:E67 * OVERLAP E67 E68 E69 R73 SUB_PROCEDURE Arg1:E70 Arg2:E69 R74 SUB_PROCEDURE Arg1:E71 Arg2:E69 R75 SUB_PROCEDURE Arg1:E72 Arg2:E69 R76 SUB_PROCEDURE Arg1:E73 Arg2:E69 R77 BEFORE Arg1:E69 Arg2:E74 * OVERLAP E74 E75 E76 R78 BEFORE Arg1:E76 Arg2:E77 * OVERLAP E77 E78 E79 E80