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T1 Age 2 13 60-year-old T2 Personal_background 14 23 Caucasian T3 Sex 24 29 woman T4 History 35 65 no significant medical history T5 Sign_symptom 76 96 exercise intolerance E1 Sign_symptom:T5 T6 Sign_symptom 98 105 fatigue E2 Sign_symptom:T6 T7 Sign_symptom 110 129 shortness of breath E3 Sign_symptom:T7 T8 Detailed_description 133 141 exertion R1 MODIFY Arg1:T8 Arg2:E3 T9 Duration 151 171 several months prior E4 Duration:T9 T10 Clinical_event 179 191 presentation E5 Clinical_event:T10 T11 Nonbiological_location 199 216 outpatient clinic R2 MODIFY Arg1:T11 Arg2:E5 T12 Sign_symptom 272 277 cough E6 Sign_symptom:T12 T13 Detailed_description 268 271 dry R3 MODIFY Arg1:T13 Arg2:E6 T14 Sign_symptom 279 288 orthopnea E7 Sign_symptom:T14 T15 Sign_symptom 311 319 dyspnoea E8 Sign_symptom:T15 T16 Detailed_description 301 310 nocturnal T17 Detailed_description 290 300 paroxysmal R4 MODIFY Arg1:T16 Arg2:E8 R5 MODIFY Arg1:T17 Arg2:E8 T18 Sign_symptom 333 341 weakness E9 Sign_symptom:T18 T19 Detailed_description 321 332 generalised R6 MODIFY Arg1:T19 Arg2:E9 T20 Sign_symptom 359 367 numbness E10 Sign_symptom:T20 T21 Biological_structure 375 380 hands T22 Biological_structure 385 389 feet R7 MODIFY Arg1:T21 Arg2:E10 R8 MODIFY Arg1:T22 Arg2:E10 T23 Detailed_description 346 358 intermittent R9 MODIFY Arg1:T23 Arg2:E10 T24 Activity 423 430 smoking E11 Activity:T24 A1 POLARITY E11 NEG T25 Activity 432 439 alcohol E12 Activity:T25 A2 POLARITY E12 NEG T26 Activity 443 456 illicit drugs E13 Activity:T26 A3 POLARITY E13 NEG T27 Diagnostic_procedure 458 478 Physical examination E14 Diagnostic_procedure:T27 T28 Lab_value 483 495 unremarkable R10 MODIFY Arg1:T28 Arg2:E14 T29 Sign_symptom 523 533 distension E15 Sign_symptom:T29 T30 Outcome 2470 2479 succumbed E16 Outcome:T30 T31 Disease_disorder 2483 2503 sudden cardiac death E17 Disease_disorder:T31 T32 Biological_structure 508 522 jugular venous R11 MODIFY Arg1:T32 Arg2:E15 T33 Sign_symptom 543 559 S1 and S2 sounds E18 Sign_symptom:T33 T34 Sign_symptom 571 579 crackles E19 Sign_symptom:T34 T35 Detailed_description 561 570 bilateral R12 MODIFY Arg1:T35 Arg2:E19 T36 Diagnostic_procedure 583 600 lung auscultation E20 Diagnostic_procedure:T36 T37 Sign_symptom 623 629 oedema E21 Sign_symptom:T37 T38 Detailed_description 615 622 pitting T39 Detailed_description 605 614 bilateral R13 MODIFY Arg1:T39 Arg2:E21 R14 MODIFY Arg1:T38 Arg2:E21 T40 Diagnostic_procedure 637 642 X-ray E22 Diagnostic_procedure:T40 T41 Biological_structure 631 636 Chest R15 MODIFY Arg1:T41 Arg2:E22 T42 Sign_symptom 650 662 cardiomegaly E23 Sign_symptom:T42 T43 Sign_symptom 664 680 pulmonary oedema E24 Sign_symptom:T43 T44 Sign_symptom 707 724 pleural effusions E25 Sign_symptom:T44 T45 Severity 685 696 small-sized T46 Detailed_description 697 706 bilateral R16 MODIFY Arg1:T46 Arg2:E25 R17 MODIFY Arg1:T45 Arg2:E25 T47 Diagnostic_procedure 736 739 ECG E26 Diagnostic_procedure:T47 T48 Detailed_description 728 735 12-lead R18 MODIFY Arg1:T48 Arg2:E26 T49 Diagnostic_procedure 760 772 sinus rhythm E27 Diagnostic_procedure:T49 T50 Lab_value 753 759 normal R19 MODIFY Arg1:T50 Arg2:E27 T51 Sign_symptom 774 795 low-voltage complexes E28 Sign_symptom:T51 T52 Sign_symptom 808 828 right-axis deviation E29 Sign_symptom:T52 T53 Severity 800 807 extreme R20 MODIFY Arg1:T53 Arg2:E29 T54 Diagnostic_procedure 841 869 Transthoracic echocardiogram E30 Diagnostic_procedure:T54 T55 Diagnostic_procedure 871 874 TTE E31 Diagnostic_procedure:T55 R21 IDENTICAL Arg1:E31 Arg2:E30 R22 CAUSE Arg1:E17 Arg2:E16 T56 Sign_symptom 914 925 hypertrophy E32 Sign_symptom:T56 T57 Biological_structure 900 913 biventricular T58 Detailed_description 889 899 asymmetric R23 MODIFY Arg1:T57 Arg2:E32 R24 MODIFY Arg1:T58 Arg2:E32 T59 Diagnostic_procedure 941 958 ejection fraction E33 Diagnostic_procedure:T59 T60 Lab_value 931 940 preserved R25 MODIFY Arg1:T60 Arg2:E33 T61 Lab_value 962 965 60% R26 MODIFY Arg1:T61 Arg2:E33 T62 Diagnostic_procedure 994 1011 systolic pressure E34 Diagnostic_procedure:T62 T63 Lab_value 967 975 elevated T64 Biological_structure 976 993 right-ventricular R27 MODIFY Arg1:T64 Arg2:E34 R28 MODIFY Arg1:T63 Arg2:E34 T65 Lab_value 1015 1023 36 mm Hg R29 MODIFY Arg1:T65 Arg2:E34 T66 Diagnostic_procedure 1037 1055 myocardial texture E35 Diagnostic_procedure:T66 T67 Lab_value 1028 1036 abnormal R30 MODIFY Arg1:T67 Arg2:E35 T68 Texture 1071 1089 granular sparkling R31 MODIFY Arg1:T68 Arg2:E35 T69 Diagnostic_procedure 1112 1124 CT angiogram E36 Diagnostic_procedure:T69 T70 Biological_structure 1103 1111 Coronary R32 MODIFY Arg1:T70 Arg2:E36 T71 Lab_value 1138 1144 normal R33 MODIFY Arg1:T71 Arg2:E36 T72 Biological_structure 1145 1162 coronary arteries R34 MODIFY Arg1:T72 Arg2:T71 T73 Diagnostic_procedure 1186 1189 MRI E37 Diagnostic_procedure:T73 T74 Biological_structure 1178 1185 cardiac R35 MODIFY Arg1:T74 Arg2:E37 T75 Sign_symptom 1236 1255 delayed enhancement E38 Sign_symptom:T75 T76 Biological_structure 1221 1235 subendocardial T77 Detailed_description 1213 1220 diffuse T78 Detailed_description 1203 1208 early R36 MODIFY Arg1:T76 Arg2:E38 R37 MODIFY Arg1:T77 Arg2:E38 R38 MODIFY Arg1:T78 Arg2:E38 T79 Disease_disorder 1272 1303 infiltrative myocardial disease E39 Disease_disorder:T79 A4 POLARITY E39 UNCERTAIN T80 Sign_symptom 1334 1345 hypertrophy E40 Sign_symptom:T80 T81 Detailed_description 1312 1319 diffuse T82 Biological_structure 1320 1333 biventricular R39 MODIFY Arg1:T82 Arg2:E40 R40 MODIFY Arg1:T81 Arg2:E40 T83 Diagnostic_procedure 1359 1376 ejection fraction E41 Diagnostic_procedure:T83 T84 Lab_value 1352 1358 normal R41 MODIFY Arg1:T84 Arg2:E41 T85 Therapeutic_procedure 1417 1438 heart catheterisation E42 Therapeutic_procedure:T85 T86 Detailed_description 1411 1416 right R42 MODIFY Arg1:T86 Arg2:E42 T87 Diagnostic_procedure 1459 1465 biopsy E43 Diagnostic_procedure:T87 T88 Biological_structure 1444 1458 endomyocardial R43 MODIFY Arg1:T88 Arg2:E43 T89 Disease_disorder 1485 1496 amyloidosis E44 Disease_disorder:T89 T90 Detailed_description 1477 1484 diffuse R44 MODIFY Arg1:T90 Arg2:E44 T91 Sign_symptom 1512 1534 proteinaceous material E45 Sign_symptom:T91 T92 Detailed_description 1502 1511 amorphous R45 MODIFY Arg1:T92 Arg2:E45 T93 Biological_structure 1542 1558 cardiac myocytes R46 MODIFY Arg1:T93 Arg2:E45 T94 Biological_structure 1570 1583 blood vessels R47 MODIFY Arg1:T94 Arg2:E45 T95 Diagnostic_procedure 1608 1623 Congo red stain E46 Diagnostic_procedure:T95 T96 Lab_value 1595 1603 positive R48 MODIFY Arg1:E45 Arg2:E46 R49 MODIFY Arg1:T96 Arg2:E46 T97 Diagnostic_procedure 1647 1668 laboratory evaluation E47 Diagnostic_procedure:T97 T98 Diagnostic_procedure 1690 1709 free λ light chains E48 Diagnostic_procedure:T98 T99 Lab_value 1680 1688 elevated R50 MODIFY Arg1:T99 Arg2:E48 T100 Lab_value 1711 1720 86.3 mg/L R51 MODIFY Arg1:T100 Arg2:E48 T101 Diagnostic_procedure 1759 1778 Bence-Jones protein E49 Diagnostic_procedure:T101 T102 Lab_value 1750 1758 positive R52 MODIFY Arg1:T102 Arg2:E49 T103 Detailed_description 1800 1805 urine R53 MODIFY Arg1:T103 Arg2:E49 T104 Lab_value 1780 1791 0.37 g/24 h R54 MODIFY Arg1:T104 Arg2:E49 T105 Diagnostic_procedure 1819 1825 biopsy E50 Diagnostic_procedure:T105 T106 Biological_structure 1807 1818 Bone marrow R55 MODIFY Arg1:T106 Arg2:E50 T107 Disease_disorder 1971 1973 MM E51 Disease_disorder:T107 #1 AnnotatorNotes E51 multiple myeloma T108 Disease_disorder 2029 2040 amyloidosis E52 Disease_disorder:T108 T109 Detailed_description 2026 2028 AL #2 AnnotatorNotes T109 immunoglobulin light chain amyloidosis R56 MODIFY Arg1:T109 Arg2:E52 T110 Detailed_description 2017 2025 systemic R57 MODIFY Arg1:T110 Arg2:E52 T111 Disease_disorder 2075 2086 amyloidosis E53 Disease_disorder:T111 T112 Biological_structure 2067 2074 cardiac T113 Detailed_description 2056 2065 stage III T114 Severity 2046 2054 advanced R58 MODIFY Arg1:T112 Arg2:E53 R59 MODIFY Arg1:T113 Arg2:E53 R60 MODIFY Arg1:T114 Arg2:E53 T115 Disease_disorder 2105 2107 MM E54 Disease_disorder:T115 R61 CAUSE Arg1:E54 Arg2:E53 T116 Diagnostic_procedure 1852 1864 infiltration E55 Diagnostic_procedure:T116 T117 Lab_value 1835 1851 greater than 10% R62 MODIFY Arg1:T117 Arg2:E55 T118 Detailed_description 1868 1899 CD19− CD56+ CD138+ plasma cells R63 MODIFY Arg1:T118 Arg2:E55 T119 Lab_value 1905 1913 reversal T120 Diagnostic_procedure 1917 1933 marrow κ/λ ratio E56 Diagnostic_procedure:T120 R64 MODIFY Arg1:T119 Arg2:E56 T121 Lab_value 1935 1939 <1:2 R65 MODIFY Arg1:T121 Arg2:E56 T122 Disease_disorder 2136 2147 amyloidosis E57 Disease_disorder:T122 T123 Biological_structure 2128 2135 cardiac T124 Severity 2119 2127 advanced R66 MODIFY Arg1:T123 Arg2:E57 R67 MODIFY Arg1:T124 Arg2:E57 T125 Therapeutic_procedure 2193 2229 autologous stem-cell transplantation E58 Therapeutic_procedure:T125 A5 POLARITY E58 NEG T126 Medication 2267 2279 chemotherapy E59 Medication:T126 T127 Detailed_description 2258 2266 systemic R68 MODIFY Arg1:T127 Arg2:E59 T128 Medication 2285 2294 melphalan E60 Medication:T128 T129 Medication 2299 2312 dexamethasone E61 Medication:T129 R69 SUB_PROCEDURE Arg1:E60 Arg2:E59 R70 SUB_PROCEDURE Arg1:E61 Arg2:E59 T130 Medication 2377 2386 diuretics E62 Medication:T130 T131 Medication 2388 2398 β-blockers E63 Medication:T131 T132 Medication 2403 2417 ACE inhibitors E64 Medication:T132 T133 Diagnostic_procedure 2432 2441 condition E65 Diagnostic_procedure:T133 T134 Lab_value 2455 2461 worsen R71 MODIFY Arg1:T134 Arg2:E65 * OVERLAP E1 E2 E3 E4 R72 BEFORE Arg1:E4 Arg2:E5 * OVERLAP E5 E6 E7 E8 E9 E10 R73 AFTER Arg1:E10 Arg2:E11 * OVERLAP E11 E12 E13 T135 History 391 456 Social history was negative for smoking, alcohol or illicit drugs R74 BEFORE Arg1:E13 Arg2:E14 * OVERLAP E14 E15 E18 E19 E20 E21 E22 E23 E24 E25 E26 E27 E28 E29 E30 E32 E33 E34 E35 E36 R75 BEFORE Arg1:E36 Arg2:E37 * OVERLAP E37 E38 E39 E40 E41 R76 BEFORE Arg1:E41 Arg2:E42 * OVERLAP E42 E43 E44 E45 E46 R77 BEFORE Arg1:E46 Arg2:E47 R78 SUB_PROCEDURE Arg1:E48 Arg2:E47 R79 SUB_PROCEDURE Arg1:E49 Arg2:E47 * OVERLAP E47 E50 E55 E56 E51 R80 BEFORE Arg1:E51 Arg2:E52 * OVERLAP E52 E53 E54 E57 E58 R81 BEFORE Arg1:E58 Arg2:E59 R82 BEFORE Arg1:E59 Arg2:E62 * OVERLAP E62 E63 E64 R83 BEFORE Arg1:E64 Arg2:E65 R84 BEFORE Arg1:E65 Arg2:E16