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T1 Age 2 13 26-year-old T2 Sex 14 19 woman T3 Clinical_event 24 28 seen E1 Clinical_event:T3 T4 Nonbiological_location 36 56 emergency department T5 Nonbiological_location 58 60 ED R1 IDENTICAL Arg1:T5 Arg2:T4 R2 MODIFY Arg1:T4 Arg2:E1 T6 Sign_symptom 72 76 pain E2 Sign_symptom:T6 T7 Biological_structure 66 71 chest R3 MODIFY Arg1:T7 Arg2:E2 T8 Sign_symptom 81 93 hypertension E3 Sign_symptom:T8 T9 Disease_disorder 133 142 infection E4 Disease_disorder:T9 T10 Biological_structure 119 132 urinary tract R4 MODIFY Arg1:T10 Arg2:E4 T11 Medication 169 179 antibiotic E5 Medication:T11 T12 Medication 184 192 thiazide E6 Medication:T12 T13 Medication 193 201 diuretic E7 Medication:T13 R5 SUB_PROCEDURE Arg1:E6 Arg2:E7 T14 Date 203 217 Two days later E8 Date:T14 T15 Sign_symptom 248 252 pain E9 Sign_symptom:T15 T16 Biological_structure 237 247 epigastric R6 MODIFY Arg1:T16 Arg2:E9 T17 Sign_symptom 254 260 nausea E10 Sign_symptom:T17 T18 Sign_symptom 262 268 emesis E11 Sign_symptom:T18 T19 Sign_symptom 273 281 myalgias E12 Sign_symptom:T19 T20 History 299 329 no significant medical history T21 Sign_symptom 341 368 cardio-respiratory symptoms E13 Sign_symptom:T21 A1 POLARITY E13 NEG T22 Sign_symptom 399 421 low exercise tolerance E14 Sign_symptom:T22 T23 Duration 430 439 last year E15 Duration:T23 T24 Family_history 451 527 no family history of cardiac or pulmonary disease or of sudden cardiac death T25 Personal_background 537 552 born in the USA T26 History 561 613 neither travelled recently nor had any sick contacts T27 Sign_symptom 639 651 hypertensive E16 Sign_symptom:T27 T28 Sign_symptom 669 680 tachycardic E17 Sign_symptom:T28 T29 Sign_symptom 696 699 dry E18 Sign_symptom:T29 T30 Biological_structure 700 716 mucous membranes R7 MODIFY Arg1:T30 Arg2:E18 T31 Diagnostic_procedure 721 729 appeared E19 Diagnostic_procedure:T31 T32 Lab_value 730 733 ill E20 Lab_value:T32 R8 MODIFY Arg1:E20 Arg2:E19 T33 Lab_value 682 689 125 bpm E21 Lab_value:T33 T34 Lab_value 653 666 170/105 mm Hg E22 Lab_value:T34 R9 MODIFY Arg1:E22 Arg2:E16 R10 MODIFY Arg1:E21 Arg2:E17 T35 Diagnostic_procedure 777 793 serum creatinine E23 Diagnostic_procedure:T35 T36 Lab_value 768 776 elevated E24 Lab_value:T36 T37 Lab_value 797 807 160 μmol/l E25 Lab_value:T37 R11 MODIFY Arg1:E25 Arg2:E23 R12 MODIFY Arg1:E24 Arg2:E23 T38 Sign_symptom 940 955 short of breath E26 Sign_symptom:T38 T39 Sign_symptom 919 928 azotaemia E27 Sign_symptom:T39 T40 Detailed_description 910 918 prerenal R13 MODIFY Arg1:T40 Arg2:E27 T41 Disease_disorder 889 905 volume depletion E28 Disease_disorder:T41 T42 Medication 869 875 fluids E29 Medication:T42 T43 Administration 857 868 intravenous R14 MODIFY Arg1:T43 Arg2:E29 T44 Volume 848 852 1.5 R15 MODIFY Arg1:T44 Arg2:E29 T45 Sign_symptom 957 965 Crackles E30 Sign_symptom:T45 T46 Diagnostic_procedure 980 992 auscultation E31 Diagnostic_procedure:T46 T47 Biological_structure 1000 1005 chest R16 MODIFY Arg1:T47 Arg2:E31 T48 Sign_symptom 1123 1134 hypotension E32 Sign_symptom:T48 T49 Nonbiological_location 3074 3076 ED T50 Diagnostic_procedure 1140 1158 systolic pressures E33 Diagnostic_procedure:T50 T51 Lab_value 1166 1169 90s E34 Lab_value:T51 R17 MODIFY Arg1:E34 Arg2:E33 T52 Medication 1680 1687 sedated E35 Medication:T52 T53 Therapeutic_procedure 1666 1675 intubated E36 Therapeutic_procedure:T53 T54 Clinical_event 1561 1572 transferred E37 Clinical_event:T54 T55 Nonbiological_location 1580 1599 intensive care unit R18 MODIFY Arg1:T55 Arg2:E37 T56 Sign_symptom 1622 1629 anxious E38 Sign_symptom:T56 A2 TREND E38 INC T57 Sign_symptom 1634 1645 tachycardic E39 Sign_symptom:T57 T58 Lab_value 1649 1656 170 bpm E40 Lab_value:T58 R19 MODIFY Arg1:E40 Arg2:E39 T59 Diagnostic_procedure 1489 1523 left-ventricular ejection fraction E41 Diagnostic_procedure:T59 T60 Medication 1420 1430 furosemide E42 Medication:T60 T61 Administration 1408 1419 intravenous R20 MODIFY Arg1:T61 Arg2:E42 T62 Dosage 1399 1404 40 mg R21 MODIFY Arg1:T62 Arg2:E42 T63 Therapeutic_procedure 1722 1730 catheter E43 Therapeutic_procedure:T63 T64 Detailed_description 1716 1721 Foley R22 MODIFY Arg1:T64 Arg2:E43 T65 Medication 1770 1779 diuretics E44 Medication:T65 T66 Administration 1753 1769 intravenous loop R23 MODIFY Arg1:T66 Arg2:E44 T67 Sign_symptom 1794 1800 anuric E45 Sign_symptom:T67 T68 Duration 1809 1819 first 12 h E46 Duration:T68 T69 Clinical_event 1823 1838 hospitalisation E47 Clinical_event:T69 T70 Disease_disorder 1869 1882 kidney injury E48 Disease_disorder:T70 T71 Detailed_description 1863 1868 acute R24 MODIFY Arg1:T71 Arg2:E48 T72 Diagnostic_procedure 1890 1900 creatinine E49 Diagnostic_procedure:T72 T73 Lab_value 1906 1915 increased E50 Lab_value:T73 T74 Lab_value 1919 1929 350 μmol/l E51 Lab_value:T74 R25 MODIFY Arg1:E50 Arg2:E49 R26 MODIFY Arg1:E51 Arg2:E49 T75 Time 1930 1951 within the first 24 h E52 Time:T75 T76 Clinical_event 1955 1970 hospitalisation E53 Clinical_event:T76 T77 Medication 1985 1999 norepinephrine E54 Medication:T77 T78 Medication 2004 2013 milrinone E55 Medication:T78 T79 Diagnostic_procedure 2025 2039 cardiac output E56 Diagnostic_procedure:T79 T80 Lab_value 2017 2024 improve E57 Lab_value:T80 A3 POLARITY E57 UNCERTAIN R27 MODIFY Arg1:E57 Arg2:E56 #1 AnnotatorNotes E57 Not sure if cardiac output actually improved? T81 Date 2048 2058 second day E58 Date:T81 T82 Clinical_event 2062 2077 hospitalisation E59 Clinical_event:T82 T83 Diagnostic_procedure 2087 2096 evaluated E60 Diagnostic_procedure:T83 T84 Subject 2102 2114 cardiologist T85 Subject 2119 2141 cardiothoracic surgeon R28 MODIFY Arg1:T84 Arg2:E60 R29 MODIFY Arg1:T85 Arg2:E60 T86 Therapeutic_procedure 2155 2174 circulatory support E61 Therapeutic_procedure:T86 T87 Detailed_description 2146 2154 emergent R30 MODIFY Arg1:T87 Arg2:E61 T88 Sign_symptom 2234 2249 lactic acidosis E62 Sign_symptom:T88 T89 Sign_symptom 2205 2226 poor tissue perfusion E63 Sign_symptom:T89 T90 Lab_value 2251 2261 8.4 mmol/l E64 Lab_value:T90 R31 MODIFY Arg1:E64 Arg2:E62 T91 Sign_symptom 2287 2300 transaminitis E65 Sign_symptom:T91 T92 Diagnostic_procedure 2306 2353 aspartate aminotransferase/alanine transaminase E66 Diagnostic_procedure:T92 T93 Lab_value 2355 2364 >150 IU/l E67 Lab_value:T93 R32 MODIFY Arg1:E67 Arg2:E66 T94 Clinical_event 2391 2396 taken E68 Clinical_event:T94 T95 Nonbiological_location 2404 2438 cardiac catheterisation laboratory R33 MODIFY Arg1:T95 Arg2:E68 T96 Therapeutic_procedure 2458 2479 heart catheterisation E69 Therapeutic_procedure:T96 T97 Detailed_description 2452 2457 right R34 MODIFY Arg1:T97 Arg2:E69 T98 Detailed_description 2443 2451 emergent R35 MODIFY Arg1:T98 Arg2:E69 T99 Diagnostic_procedure 2484 2490 biopsy E70 Diagnostic_procedure:T99 T100 Disease_disorder 2508 2519 myocarditis E71 Disease_disorder:T100 A4 POLARITY E71 UNCERTAIN T101 Detailed_description 2502 2507 acute R36 MODIFY Arg1:T101 Arg2:E71 T102 Duration 2521 2543 Over the next few days E72 Duration:T102 T103 Therapeutic_procedure 2560 2578 fluid resuscitated E73 Therapeutic_procedure:T103 T104 Detailed_description 2553 2559 gently R37 MODIFY Arg1:T104 Arg2:E73 T105 Detailed_description 2580 2630 guided by bioreactance non-invasive cardiac output R38 MODIFY Arg1:T105 Arg2:E73 T106 Medication 2637 2645 pressors E74 Medication:T106 A5 TREND E74 DEC T107 Sign_symptom 2687 2699 non-oliguric E75 Sign_symptom:T107 T108 Diagnostic_procedure 2721 2735 renal function E76 Diagnostic_procedure:T108 T109 Lab_value 2705 2720 slowly regained E77 Lab_value:T109 R39 MODIFY Arg1:E77 Arg2:E76 T110 Clinical_event 3058 3066 returned E78 Clinical_event:T110 R40 MODIFY Arg1:T49 Arg2:E78 T111 Therapeutic_procedure 1202 1213 ventilation E79 Therapeutic_procedure:T111 T112 Detailed_description 1171 1183 Non-invasive T113 Detailed_description 1184 1201 positive pressure R41 MODIFY Arg1:T113 Arg2:E79 R42 MODIFY Arg1:T112 Arg2:E79 T114 Diagnostic_procedure 1232 1235 ECG E80 Diagnostic_procedure:T114 T115 Diagnostic_procedure 1027 1031 film E81 Diagnostic_procedure:T115 T116 Biological_structure 1021 1026 chest R43 MODIFY Arg1:T116 Arg2:E81 T117 Detailed_description 1012 1020 portable R44 MODIFY Arg1:T117 Arg2:E81 T118 Sign_symptom 1050 1061 infiltrates E82 Sign_symptom:T118 T119 Texture 1045 1049 hazy R45 MODIFY Arg1:T119 Arg2:E82 T120 Disease_disorder 1086 1102 pulmonary oedema E83 Disease_disorder:T120 A6 POLARITY E83 MAYBE_POS T121 Sign_symptom 1249 1266 sinus tachycardia E84 Sign_symptom:T121 T122 Diagnostic_procedure 1274 1278 rate E85 Diagnostic_procedure:T122 #2 AnnotatorNotes E85 heart rate T123 Lab_value 1282 1289 130 bpm E86 Lab_value:T123 R46 MODIFY Arg1:E86 Arg2:E85 T124 Sign_symptom 1302 1315 ST depression E87 Sign_symptom:T124 T125 Severity 1294 1301 minimal R47 MODIFY Arg1:T125 Arg2:E87 T126 Diagnostic_procedure 1323 1339 precordial leads E88 Diagnostic_procedure:T126 R48 SUB_PROCEDURE Arg1:E88 Arg2:E85 T127 Subject 1364 1376 cardiologist T128 Clinical_event 1344 1356 consultation E89 Clinical_event:T128 R49 MODIFY Arg1:T127 Arg2:E89 T129 Diagnostic_procedure 1435 1449 echocardiogram E90 Diagnostic_procedure:T129 T130 Sign_symptom 1470 1481 hypokinesis E91 Sign_symptom:T130 T131 Detailed_description 1463 1469 global R50 MODIFY Arg1:T131 Arg2:E91 T132 Lab_value 1524 1528 <10% E92 Lab_value:T132 R51 MODIFY Arg1:E92 Arg2:E41 T133 Diagnostic_procedure 2740 2755 organ perfusion E93 Diagnostic_procedure:T133 T134 Lab_value 2756 2764 improved E94 Lab_value:T134 R52 MODIFY Arg1:E94 Arg2:E93 T135 Sign_symptom 2788 2803 lactic acidosis E95 Sign_symptom:T135 T136 Diagnostic_procedure 2822 2841 liver transaminases E96 Diagnostic_procedure:T136 T137 Lab_value 2810 2818 decrease E97 Lab_value:T137 A7 POLARITY E95 NEG R53 MODIFY Arg1:E97 Arg2:E96 T138 Date 2855 2860 day 5 E98 Date:T138 T139 Clinical_event 2869 2880 transferred E99 Clinical_event:T139 T140 Nonbiological_location 2888 2900 medical ward R54 MODIFY Arg1:T140 Arg2:E99 T141 Clinical_event 2920 2930 discharged E100 Clinical_event:T141 T142 Nonbiological_location 2931 2935 home R55 MODIFY Arg1:T142 Arg2:E100 T143 Medication 2953 2963 β blockade E101 Medication:T143 T144 Detailed_description 2939 2952 non-selective R56 MODIFY Arg1:T144 Arg2:E101 T145 Medication 2968 2981 ACE inhibitor E102 Medication:T145 T146 Medication 2986 2993 nitrate E103 Medication:T146 T147 Clinical_event 3007 3016 follow-up E104 Clinical_event:T147 A8 POLARITY E104 UNCERTAIN #3 AnnotatorNotes E104 here, planned implicitly means "but something else happened" T148 Nonbiological_location 3024 3044 heart-failure clinic R57 MODIFY Arg1:T148 Arg2:E104 T149 Date 3077 3089 4 days later E105 Date:T149 T150 Disease_disorder 3190 3202 pancreatitis E106 Disease_disorder:T150 T151 Sign_symptom 3218 3222 mass E107 Sign_symptom:T151 T152 Biological_structure 3210 3217 adrenal R58 MODIFY Arg1:T152 Arg2:E107 T153 Diagnostic_procedure 3107 3121 blood pressure E108 Diagnostic_procedure:T153 T154 Lab_value 3098 3106 elevated E109 Lab_value:T154 R59 MODIFY Arg1:E109 Arg2:E108 T155 Sign_symptom 3123 3129 nausea E110 Sign_symptom:T155 T156 Sign_symptom 3144 3148 pain E111 Sign_symptom:T156 T157 Biological_structure 3134 3143 abdominal R60 MODIFY Arg1:T157 Arg2:E111 T158 Diagnostic_procedure 3152 3165 contrast scan E112 Diagnostic_procedure:T158 T159 Biological_structure 3173 3180 abdomen R61 MODIFY Arg1:T159 Arg2:E112 T160 Disease_disorder 3249 3261 pancreatitis E113 Disease_disorder:T160 T161 Therapeutic_procedure 3235 3244 treatment E114 Therapeutic_procedure:T161 T162 Sign_symptom 3280 3289 paroxysms E115 Sign_symptom:T162 T163 Sign_symptom 3293 3302 headaches E116 Sign_symptom:T163 T164 Sign_symptom 3304 3310 nausea E117 Sign_symptom:T164 T165 Sign_symptom 3312 3318 emesis E118 Sign_symptom:T165 T166 Sign_symptom 3333 3337 pain E119 Sign_symptom:T166 T167 Biological_structure 3323 3332 abdominal R62 MODIFY Arg1:T167 Arg2:E119 T168 Sign_symptom 3357 3369 hypertension E120 Sign_symptom:T168 T169 Lab_value 3377 3381 220s E121 Lab_value:T169 R63 MODIFY Arg1:E121 Arg2:E120 T170 Detailed_description 3382 3390 systolic R64 MODIFY Arg1:T170 Arg2:E120 T171 Sign_symptom 3395 3406 tachycardia E122 Sign_symptom:T171 T172 Lab_value 3410 3414 120s E123 Lab_value:T172 R65 MODIFY Arg1:E123 Arg2:E122 T173 Diagnostic_procedure 3431 3448 systolic pressure E124 Diagnostic_procedure:T173 T174 Lab_value 3452 3464 90–110 mm Hg E125 Lab_value:T174 R66 MODIFY Arg1:E125 Arg2:E124 T175 Diagnostic_procedure 3504 3518 catecholamines E126 Diagnostic_procedure:T175 T176 Lab_value 3524 3532 elevated E127 Lab_value:T176 T177 Detailed_description 3497 3503 plasma T178 Detailed_description 3485 3492 urinary R67 MODIFY Arg1:T177 Arg2:E126 R68 MODIFY Arg1:T178 Arg2:E126 R69 MODIFY Arg1:E127 Arg2:E126 T179 Therapeutic_procedure 3591 3608 fluid rehydration E128 Therapeutic_procedure:T179 T180 Detailed_description 3580 3590 aggressive R70 MODIFY Arg1:T180 Arg2:E128 T181 Medication 3613 3629 α and β blockade E129 Medication:T181 T182 Therapeutic_procedure 3644 3657 adrenalectomy E130 Therapeutic_procedure:T182 A9 POLARITY E130 UNCERTAIN T183 Coreference 3668 3675 surgery E131 Coreference:T183 R71 IDENTICAL Arg1:E131 Arg2:E130 T184 Diagnostic_procedure 3680 3714 left-ventricular ejection fraction E132 Diagnostic_procedure:T184 T185 Lab_value 3719 3727 improved E133 Lab_value:T185 T186 Lab_value 3731 3734 55% E134 Lab_value:T186 T187 Therapeutic_procedure 3738 3756 medical management E135 Therapeutic_procedure:T187 R72 MODIFY Arg1:E133 Arg2:E132 R73 MODIFY Arg1:E134 Arg2:E132 T188 Diagnostic_procedure 3773 3782 Pathology E136 Diagnostic_procedure:T188 T189 Biological_structure 3790 3803 adrenal gland R74 MODIFY Arg1:T189 Arg2:E136 T190 Disease_disorder 3840 3856 pheochromocytoma E137 Disease_disorder:T190 T191 Detailed_description 3826 3839 non-malignant R75 MODIFY Arg1:T191 Arg2:E137 * OVERLAP E1 E2 E3 E4 R76 BEFORE Arg1:E4 Arg2:E5 * OVERLAP E5 E7 R77 BEFORE Arg1:E7 Arg2:E8 * OVERLAP E8 E9 E10 E11 E12 E13 R78 AFTER Arg1:E13 Arg2:E14 * OVERLAP E14 E15 R79 BEFORE Arg1:E15 Arg2:E16 * OVERLAP E16 E17 E18 E19 E23 R80 BEFORE Arg1:E23 Arg2:E29 * OVERLAP E29 E28 E27 R81 BEFORE Arg1:E27 Arg2:E26 * OVERLAP E26 E30 E31 E81 E82 E83 R82 BEFORE Arg1:E83 Arg2:E32 * OVERLAP E32 E33 E79 E80 E84 E85 E87 R83 BEFORE Arg1:E87 Arg2:E89 * OVERLAP E89 E42 E90 E91 E41 R84 BEFORE Arg1:E41 Arg2:E37 * OVERLAP E37 E38 E39 E36 E35 E43 E44 R85 BEFORE Arg1:E44 Arg2:E45 * OVERLAP E45 E46 E47 R86 BEFORE Arg1:E47 Arg2:E48 * OVERLAP E48 E49 E52 E53 R87 BEFORE Arg1:E53 Arg2:E54 * OVERLAP E54 E55 E56 R88 BEFORE Arg1:E56 Arg2:E58 * OVERLAP E58 E59 E60 E61 E63 E62 E65 E66 R89 BEFORE Arg1:E66 Arg2:E68 * OVERLAP E68 E69 E70 E71 R90 BEFORE Arg1:E71 Arg2:E72 * OVERLAP E72 E73 E74 E75 R91 BEFORE Arg1:E75 Arg2:E76 * OVERLAP E76 E93 E95 E96 R92 BEFORE Arg1:E96 Arg2:E98 * OVERLAP E98 E99 R93 BEFORE Arg1:E99 Arg2:E100 * OVERLAP E100 E101 E102 E103 R94 BEFORE Arg1:E103 Arg2:E104 R95 BEFORE Arg1:E104 Arg2:E78 * OVERLAP E78 E105 E108 E110 E111 E112 E106 E107 E114 E113 E115 E116 E117 E118 E119 E120 E122 E124 E126 R96 BEFORE Arg1:E126 Arg2:E128 * OVERLAP E128 E129 E130 E131 E132 E135 E136 E137