Upload 513 files

Finished/Acute Coronary Syndrome/NSTEMI/11535902-DS-14.json

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+{
+    "NSTEMI$Intermedia_5": {
+        "hs-cTn is a strong value for ACS$Cause_1": {
+            "Trop-T:0.55$Input2": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "cTropnT-0.55*\ncTropnT-0.66*\ncTropnT-0.38*\ncTropnT-0.38*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "HTN, hypothyroidism are risk factors of ACS$Cause_1": {
+                "F presents with history of HTN, hypothyroidism,$Input2": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "symptom of ACS.$Cause_1": {
+                "Patient endorses right sided chest pain for the last 2 days which worsened today, at which point she started having nausea and vomiting.$Input2": {}
+            },
+            "risk factors of ACS$Cause_1": {
+                "+ \"Irregular heart rhythm, for a long time\" per pt for which she takes Toprol XL\n+ Hyperlipidemia$Input3": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "HTN, hypothyroidism are risk factors of ACS$Cause_1": {
+                    "F presents with history of HTN, hypothyroidism,$Input2": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": {
+                "ST depressions in V2-V4$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "HTN, hypothyroidism are risk factors of ACS$Cause_1": {
+                    "F presents with history of HTN, hypothyroidism,$Input2": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "symptom of ACS.$Cause_1": {
+                    "Patient endorses right sided chest pain for the last 2 days which worsened today, at which point she started having nausea and vomiting.$Input2": {}
+                },
+                "risk factors of ACS$Cause_1": {
+                    "+ \"Irregular heart rhythm, for a long time\" per pt for which she takes Toprol XL\n+ Hyperlipidemia$Input3": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "Chest pain$Input1": {}
+                    },
+                    "HTN, hypothyroidism are risk factors of ACS$Cause_1": {
+                        "F presents with history of HTN, hypothyroidism,$Input2": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "F presents with history of HTN, hypothyroidism, no priorcardiac hx who presented to ED with chest pain.\n\nPatient endorses right sided chest pain for the last 2 days which worsened today, at which point she started having nausea and vomiting. Chest pain both at rest and on exertion. At baseline she walks with a walker throughout her house. No shortness of breath or leg swelling. Denies any anginal symptoms, pre-syncope, or syncope. \n\nShe had 2 falls and was treated at outside hospitals. Per patient, injured her pelvis and R leg but unsure of specifics. Hospital course c/b aspiration PNA. Otherwise no recent falls or hospitalizations. \n\nNo family history of cardiac disease known to patient. Her granddaughter passed away yesterday from breast cancer.\n\nIn the ED initial vitals were: 96.7 70 163/78 18 97% RA weight: 88lb height: 5ft   \nEKG: ST depressions in V2-V4  \nLabs/studies notable for: Trop-T: 0.55, lactate 2.9, K 6.0, WC 11.5   \nPatient was given: ASA 300, metop tartrate 12.5, nitro SL, atorva 80, Lasix 20, insulin 10u+ 25 gm dextrose 50%, hep gtt   \nVitals on transfer:  65 120/61 21 99% RA \n  \nOn the floor, denies any current CP, dyspnea, N/V. Feels at her baseline overall.\n\nREVIEW OF SYSTEMS:  \n10 point ROS otherwise negative.\n",
+    "input3": "+ \"Irregular heart rhythm, for a long time\" per pt for which she takes Toprol XL\n+ Hyperlipidemia\n+ H/o Cdiff per recent OMR notes\n+ Esophageal strictures s/p several dilations in the past\n+ Temporal arteritis --> she states she's been taking Prednisone \n+ Hypothyroidism\n+ History of lower GI bleed\n+ DJD\n+ Lumbar stenosis, lumbar radiculopathy, hip pain\n+ Osteoporosis\n\n+ Admitted with n/v/d/rectal bleeding, found to have a portal vein thrombosis, which was felt to be likely due to ascending thrombophlebitis from a UTI. Abdominal pelvic CT scan with contrast which shows a persistent thrombosis in her superior right portal vein with evidence of partial degradation of clot; there is no longer filling defect with the right main portal vein as was seen on prior study. \n+ Large hiatal hernia\n+ She denies any AMI's/CABG/caths, CVA's, DM, HTN, or other heart/lung/kidney/liver/GI major diseases\n+admission for pan sensitive Ecoli urosepsis treated with IV Ceftriaxone, d/c'd home with 2wk course of PO Cipro. Bladder defects again seen on CT scan, but repeat bladder u/s normal.\n",
+    "input4": "None\n",
+    "input5": "Admission Physical Exam:\n\nVS: 97.5PO 127 / 70 56 18 99 ra  \nGENERAL: NAD Oriented x3. Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor\nor cyanosis of the oral mucosa. No xanthelasma.  \nNECK: Supple with JVP 12\nCARDIAC: PMI located in intercostal space, midclavicularline. RRR, normal S1, S2. soft systolic cresc/decresc murmur. No thrills, lifts.  \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi.  \nABDOMEN: Soft, NTND. No HSM or tenderness.  \nEXTREMITIES: No c/c/e\nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.  \nPULSES: Distal pulses palpable and symmetric\n",
+    "input6": "Admission Labs:\n\n___ 03:30PM BLOOD WBC-11.5* RBC-3.91 Hgb-11.6 Hct-36.2 MCV-93 MCH-29.7 MCHC-32.0 RDW-15.2 RDWSD-51.2* Plt ___\n___ 03:30PM BLOOD Neuts-66.3 ___ Monos-10.1 Eos-1.4 Baso-0.7 Im ___ AbsNeut-7.62* AbsLymp-2.41 AbsMono-1.16* AbsEos-0.16 AbsBaso-0.08\n___ 03:30PM BLOOD ___ PTT-22.3* ___\n___ 03:30PM BLOOD Glucose-124* UreaN-14 Creat-0.5 Na-137 K-6.0* Cl-99 HCO3-17* AnGap-21*\n___ 03:30PM BLOOD ALT-15 AST-40 AlkPhos-39 TotBili-0.8\n___ 03:30PM BLOOD cTropnT-0.09*\n___ 09:55PM BLOOD CK-MB-25* cTropnT-0.55*\n___ 07:25AM BLOOD CK-MB-19* cTropnT-0.66*\n___ 02:20AM BLOOD CK-MB-8 cTropnT-0.38*\n___ 06:20AM BLOOD cTropnT-0.38*\n___ 03:38PM BLOOD Lactate-2.9*\n\nImaging:\nChest Xray ___\nIMPRESSION:  \nModerate to large hiatal hernia with mild bibasilar atelectasis. No subdiaphragmatic free air or cardiomegaly. \n\nECHO ___\nIMPRESSION: Normal left ventricular cavity size with mild regional systolic dysfunction. Mild-moderate mitral regurgitation. Moderate tricuspoid regurgitation. Increased PCWP. Compared with the prior study (images reviewed), very mild regional LV dysfunction is now seen and the severity of mitral regurgitation is increased.\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/11859083-DS-17.json

@@ -0,0 +1,108 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "BLOOD cTropnT-0.60*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "Chest Pain is a symptom of ACS..$Cause_1": {
+                "Patient reports that she began having chest pain yesterday at rest. Previous chest pain is a sharp pain but this was a dull ache that started in her back and chest. Never had this type of pain before or pain that has lasted this long before. No radiation aside from into her back.$Input2": {}
+            },
+            "Coronary artery disease  \nHypercholesterolemia  are big risk factors$Cause_1": {
+                "Coronary artery disease  \nHypercholesterolemia  \n+DM + TYPE 2 UNCNTRLD$Input3": {}
+            },
+            "Hypertension  is a risk factor$Cause_1": {
+                "Fatty liver  \nHypertension goal BP (blood pressure) < 130/80  \n+Chronic pain$Input3": {}
+            },
+            "Morbid obesity is a risk factor$Cause_1": {
+                "Morbid obesity with BMI of 40.0-44.9, adult  \n+Type 2 diabetes, uncontrolled, with renal manifestation$Input3": {}
+            },
+            "Family history is a big risk factor$Cause_1": {
+                "Father with MI$Input4": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "Chest Pain is a symptom of ACS..$Cause_1": {
+                    "Patient reports that she began having chest pain yesterday at rest. Previous chest pain is a sharp pain but this was a dull ache that started in her back and chest. Never had this type of pain before or pain that has lasted this long before. No radiation aside from into her back.$Input2": {}
+                },
+                "Coronary artery disease  \nHypercholesterolemia  are big risk factors$Cause_1": {
+                    "Coronary artery disease  \nHypercholesterolemia  \n+DM + TYPE 2 UNCNTRLD$Input3": {}
+                },
+                "Hypertension  is a risk factor$Cause_1": {
+                    "Fatty liver  \nHypertension goal BP (blood pressure) < 130/80  \n+Chronic pain$Input3": {}
+                },
+                "Morbid obesity is a risk factor$Cause_1": {
+                    "Morbid obesity with BMI of 40.0-44.9, adult  \n+Type 2 diabetes, uncontrolled, with renal manifestation$Input3": {}
+                },
+                "Family history is a big risk factor$Cause_1": {
+                    "Father with MI$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation$Cause_1": {
+                "EKG: Sinus, rate 62, QTC 456, no new ischemic changes  \nExam notable for: Distant heart sounds, RRR no R/M/G, CTAB, soft, obese, non distended, no abdominal pain  non-ST-elevation$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "Chest Pain is a symptom of ACS..$Cause_1": {
+                    "Patient reports that she began having chest pain yesterday at rest. Previous chest pain is a sharp pain but this was a dull ache that started in her back and chest. Never had this type of pain before or pain that has lasted this long before. No radiation aside from into her back.$Input2": {}
+                },
+                "Coronary artery disease  \nHypercholesterolemia  are big risk factors$Cause_1": {
+                    "Coronary artery disease  \nHypercholesterolemia  \n+DM + TYPE 2 UNCNTRLD$Input3": {}
+                },
+                "Hypertension  is a risk factor$Cause_1": {
+                    "Fatty liver  \nHypertension goal BP (blood pressure) < 130/80  \n+Chronic pain$Input3": {}
+                },
+                "Morbid obesity is a risk factor$Cause_1": {
+                    "Morbid obesity with BMI of 40.0-44.9, adult  \n+Type 2 diabetes, uncontrolled, with renal manifestation$Input3": {}
+                },
+                "Family history is a big risk factor$Cause_1": {
+                    "Father with MI$Input4": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "Chest pain$Input1": {}
+                    },
+                    "Chest Pain is a symptom of ACS..$Cause_1": {
+                        "Patient reports that she began having chest pain yesterday at rest. Previous chest pain is a sharp pain but this was a dull ache that started in her back and chest. Never had this type of pain before or pain that has lasted this long before. No radiation aside from into her back.$Input2": {}
+                    },
+                    "Coronary artery disease  \nHypercholesterolemia  are big risk factors$Cause_1": {
+                        "Coronary artery disease  \nHypercholesterolemia  \n+DM + TYPE 2 UNCNTRLD$Input3": {}
+                    },
+                    "Hypertension  is a risk factor$Cause_1": {
+                        "Fatty liver  \nHypertension goal BP (blood pressure) < 130/80  \n+Chronic pain$Input3": {}
+                    },
+                    "Morbid obesity is a risk factor$Cause_1": {
+                        "Morbid obesity with BMI of 40.0-44.9, adult  \n+Type 2 diabetes, uncontrolled, with renal manifestation$Input3": {}
+                    },
+                    "Family history is a big risk factor$Cause_1": {
+                        "Father with MI$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "Patient reports that she began having chest pain yesterday at rest. Previous chest pain is a sharp pain but this was a dull ache that started in her back and chest. Never had this type of pain before or pain that has lasted this long before. No radiation aside from into her back. Some associated SOB that has been ongoing for several weeks. Chest pain not relieved with multiple SL nitro at home (but patient thinks these may have been expired). No fever, chills, nausea or vomiting. Her friend encouraged her to come to ED.  \n \nIn the ED initial vitals were: 98, 88, 186/71, 18, 98% RA  \nEKG: Sinus, rate 62, QTC 456, no new ischemic changes  \nExam notable for: Distant heart sounds, RRR no R/M/G, CTAB, soft, obese, non distended, no abdominal pain  non-ST-elevation\r\nLabs/studies notable for:  \n - CBC: 9.3/13.7/41.6/228  \n - CHem&: ___  \n - Trp 0.04  \n - Ddimer 251  \n CXR: No acute cardiopulmonary process  \n \nPatient was given:  \n ___ 00:48 IV Morphine Sulfate 2 mg  \n ___ 01:26 IV Morphine Sulfate 2 mg  \n ___ 01:29 IV Ondansetron 4 mg  \n ___ 02:20 IV Morphine Sulfate 4 mg  \n ___ 02:20 IV Heparin Started 800  \n \nVitals on transfer: 98.3, 63, 138/63, 16, 96% RA  \n \nOn the floor: patient reports feeling the best she has felt in 24 hours. Chest pain is resolved. feels small dull ache but nothing compared with past 24 hours per her report. she recently went to her cardiologist and was suppose to start Lasix 20mg for increased lower extremity edema but she has not filled this medication yet.\n",
+    "input3": "+Nephrolithiasis  \n+Hypothyroidism  \n+Asthma  \n+Low back pain  \n+Rhinitis, allergic  \n+Coronary artery disease  \n+Hypercholesterolemia  \n+DM + TYPE 2 UNCNTRLD  \n+Hemorrhoids  \n+Lichen sclerosus et atrophicus  \n+OSTEOARTHRITIS, LOCALIZED PRIMARY + KNEE  \n+History of total knee replacement  \n+Sleep apnea  \n+Fatty liver  \n+Hypertension goal BP (blood pressure) < 130/80  \n+Chronic pain  \n+Colonic adenoma  \n+Cervical high risk human papillomavirus (HPV) DNA test positive \n+S/P total knee arthroplasty  \n+Pain due to total right knee replacement  \n+Morbid obesity with BMI of 40.0-44.9, adult  \n+Type 2 diabetes, uncontrolled, with renal manifestation\n",
+    "input4": "Father with MI\n",
+    "input5": "Admission Physical\n\nVS:97.6, 124/62, 57, 18, 98% RA  \nFinger stick: 227  \nWeight: 107.3kg  \nGENERAL: NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa.  \nNECK: Supple with no elevated JVD  \nCARDIAC: RRR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts.  \nLUNGS: CTAB. No crackles, wheezes or rhonchi.  \nABDOMEN: Soft, NTND. No HSM or tenderness.  \nEXTREMITIES: 1+ pitting edema bilaterally, warm  \nNEURO: grossly non focal, moving all extremities.\n",
+    "input6": "Admission Labs\n===============\n___ 12:45AM BLOOD WBC-9.3 RBC-4.96 Hgb-13.7 Hct-41.6 MCV-84 MCH-27.6 MCHC-32.9 RDW-13.4 RDWSD-40.8 Plt ___\n___ 12:45AM BLOOD Neuts-56.6 ___ Monos-5.6 Eos-2.7 Baso-0.5 AbsNeut-5.25 AbsLymp-3.18 AbsMono-0.52 AbsEos-0.25 AbsBaso-0.05\n___ 12:45AM BLOOD PTT-33.0\n___ 12:45AM BLOOD Glucose-339* UreaN-15 Creat-0.7 Na-135 K-4.0 Cl-100 HCO3-24 AnGap-15\n___ 12:45AM BLOOD cTropnT-0.60*\n___ 06:55AM BLOOD Calcium-9.2 Phos-3.8 Mg-1.8\n\nImaging & Studies\n\nTTE ___\nThe left atrium and right atrium are normal in cavity size. There is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (LVEF>55%). Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion.\n\nIMPRESSION: Suboptimal image quality. Mild symmetric left ventricular hypertrophy with preserved global biventricular systolic function. No valvular pathology or pathologic flow identified. \n\nCXR ___\nFINDINGS: \n \nThe lungs are well-expanded and clear.  The cardiomediastinal and hilar contours are unremarkable.  There is no pneumothorax, pleural \neffusion, or consolidation.\n \nIMPRESSION: \nNo acute cardiopulmonary process.\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/11990712-DS-12.json

@@ -0,0 +1,90 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "He was noted to have ECG with known LBBB with troponin 0.59 --> 1.45.$Input2": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest Pain is a symptom of ACS$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "A history of heart disease is an important risk factor$Cause_1": {
+                "77 year old male with very significant past coronary history with multiple PCIs, CABG with LIMA-LAD, SVG-OM, SVG-DM with patient report of \"two of those grafts being down,\" HTN, and LBBB who presented to OSH.$Input2": {}
+            },
+            "Hypertension and else are risk factors$Cause_1": {
+                "+ Hypertension  \n+ CABG\n-LAD, SVG-OM, SVG-Diag\n+ PERCUTANEOUS CORONARY INTERVENTIONS: Multiple\n+ Vitamin D deficiency$Input3": {}
+            },
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "Patient reports that around 830PM he began experiencing substernal chest pain that radiated to his right shoulder and neck. Of note, he had just completed a large meal and was doing some housework with his upper body and exerting himself. He has known stable angina and took his SLN x3 without significant relief of his symptoms.$Input2": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": {
+                "CONCLUSION:\nThe left atrium is elongated. The right atrium is mildly enlarged. There \nis mild symmetric left ventricular hypertrophy with a normal cavity size. There is egional left ventricular systolic dysfunction with very mild hypokinesis of the mid anteroseptum (see schematic) and preserved/normal contractility of the remaining segments. The visually estimated left ventricular ejection fraction is 55-60%. There is no resting left ventricular outflow tract gradient. Normal right ventricular cavity size with normal free wall motion. The aortic sinus diameter is normal for gender with normal ascending aorta diameter for gender. The aortic valve leaflets (?#) are mildly thickened. There is no aortic valve stenosis. There is trace aortic regurgitation. The mitral valve leaflets are mildly thickened with no mitral valve prolapse. There is trivial mitral regurgitation. The tricuspidvalve leaflets appear structurally normal. There is physiologic tricuspid regurgitation. The pulmonary artery systolic pressure could not be estimated. There is no pericardial effusion.\nIMPRESSION: Mild symmetric left ventricular hypertrophy with mild regional systolic dysfunction.$Input6": {}
+            },
+            "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": {
+                "CARDIAC: RRR, normal S1, S2. II/VI systolic ejection murmur appreciated best at RUSB without radiation to carotids.$Input5": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "A history of heart disease is an important risk factor$Cause_1": {
+                    "77 year old male with very significant past coronary history with multiple PCIs, CABG with LIMA-LAD, SVG-OM, SVG-DM with patient report of \"two of those grafts being down,\" HTN, and LBBB who presented to OSH.$Input2": {}
+                },
+                "Hypertension and else are risk factors$Cause_1": {
+                    "+ Hypertension  \n+ CABG\n-LAD, SVG-OM, SVG-Diag\n+ PERCUTANEOUS CORONARY INTERVENTIONS: Multiple\n+ Vitamin D deficiency$Input3": {}
+                },
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Patient reports that around 830PM he began experiencing substernal chest pain that radiated to his right shoulder and neck. Of note, he had just completed a large meal and was doing some housework with his upper body and exerting himself. He has known stable angina and took his SLN x3 without significant relief of his symptoms.$Input2": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation\r is  a sign of NSTE-ACS$Cause_1": {
+                ".non-ST-elevation$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "A history of heart disease is an important risk factor$Cause_1": {
+                    "77 year old male with very significant past coronary history with multiple PCIs, CABG with LIMA-LAD, SVG-OM, SVG-DM with patient report of \"two of those grafts being down,\" HTN, and LBBB who presented to OSH.$Input2": {}
+                },
+                "Hypertension and else are risk factors$Cause_1": {
+                    "+ Hypertension  \n+ CABG\n-LAD, SVG-OM, SVG-Diag\n+ PERCUTANEOUS CORONARY INTERVENTIONS: Multiple\n+ Vitamin D deficiency$Input3": {}
+                },
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Patient reports that around 830PM he began experiencing substernal chest pain that radiated to his right shoulder and neck. Of note, he had just completed a large meal and was doing some housework with his upper body and exerting himself. He has known stable angina and took his SLN x3 without significant relief of his symptoms.$Input2": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": {
+                    "CONCLUSION:\nThe left atrium is elongated. The right atrium is mildly enlarged. There \nis mild symmetric left ventricular hypertrophy with a normal cavity size. There is egional left ventricular systolic dysfunction with very mild hypokinesis of the mid anteroseptum (see schematic) and preserved/normal contractility of the remaining segments. The visually estimated left ventricular ejection fraction is 55-60%. There is no resting left ventricular outflow tract gradient. Normal right ventricular cavity size with normal free wall motion. The aortic sinus diameter is normal for gender with normal ascending aorta diameter for gender. The aortic valve leaflets (?#) are mildly thickened. There is no aortic valve stenosis. There is trace aortic regurgitation. The mitral valve leaflets are mildly thickened with no mitral valve prolapse. There is trivial mitral regurgitation. The tricuspidvalve leaflets appear structurally normal. There is physiologic tricuspid regurgitation. The pulmonary artery systolic pressure could not be estimated. There is no pericardial effusion.\nIMPRESSION: Mild symmetric left ventricular hypertrophy with mild regional systolic dysfunction.$Input6": {}
+                },
+                "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": {
+                    "CARDIAC: RRR, normal S1, S2. II/VI systolic ejection murmur appreciated best at RUSB without radiation to carotids.$Input5": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS$Cause_1": {
+                        "Chest pain$Input1": {}
+                    },
+                    "A history of heart disease is an important risk factor$Cause_1": {
+                        "77 year old male with very significant past coronary history with multiple PCIs, CABG with LIMA-LAD, SVG-OM, SVG-DM with patient report of \"two of those grafts being down,\" HTN, and LBBB who presented to OSH.$Input2": {}
+                    },
+                    "Hypertension and else are risk factors$Cause_1": {
+                        "+ Hypertension  \n+ CABG\n-LAD, SVG-OM, SVG-Diag\n+ PERCUTANEOUS CORONARY INTERVENTIONS: Multiple\n+ Vitamin D deficiency$Input3": {}
+                    },
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "Patient reports that around 830PM he began experiencing substernal chest pain that radiated to his right shoulder and neck. Of note, he had just completed a large meal and was doing some housework with his upper body and exerting himself. He has known stable angina and took his SLN x3 without significant relief of his symptoms.$Input2": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "77 year old male with very significant past coronary history with multiple PCIs, CABG with LIMA-LAD, SVG-OM, SVG-DM with patient report of \"two of those grafts being down,\" HTN, and LBBB who presented to OSH.\n\nPatient reports that around 830PM he began experiencing substernal chest pain that radiated to his right shoulder and neck. Of note, he had just completed a large meal and was doing some housework with his upper body and exerting himself. He has known stable angina and took his SLN x3 without significant relief of his symptoms.\n\nHe was noted to have ECG with known LBBB with troponin 0.59 --> 1.45. He was given aspirin, Plavix, and lovenoxand transferred for further management and likely cath. Of note, his chest pain resolved sometime though patient could not specify exactly when.\n\nHis initial vitals were notable for BPs 170s/80-90s. An ECG confirmed known LBBB but was negative for Sgarbossa criteria. Labs notable for trop 0.06 --> 0.1 with MB 15. He received metoprolol succinate 50mg and Lisinopril 5mg. Heparin gtt was deferred as he had received Lovenox at around 2300 the night prior.non-ST-elevation\r\n\nOn the floor, the patient confirms the above. He is chest pain free and denies shortness of breath, nausea, vomiting, lightheadedness, and dizziness.\n",
+    "input3": "+ Hypertension  \n+ CABG\n-LAD, SVG-OM, SVG-Diag\n+ PERCUTANEOUS CORONARY INTERVENTIONS: Multiple\n+ Vitamin D deficiency\n",
+    "input4": "Father died of LM disease. Mother had breast cancer. Siblings and children do not have any known history of CAD, sudden death, or MIs.\n",
+    "input5": "ADMISSION PHYSICAL EXAMINATION:  \n================================  \nVITALS:  97.4  169/97  74  16  95%RA\nGENERAL: Well-developed, well-nourished. NAD. Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva pink, no pallor or cyanosis of the oral mucosa. No xanthelasma.  \nNECK: Supple with no JVD\nCARDIAC: RRR, normal S1, S2. II/VI systolic ejection murmur appreciated best at RUSB without radiation to carotids. \nLUNGS: Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi.  \nABDOMEN: Soft, NTND. No HSM or tenderness.  \nEXTREMITIES: No c/c/e. No femoral bruits.  \nPULSES: Distal pulses palpable and symmetric\n",
+    "input6": "ADMISSION LABS\n==============\n___ 05:30AM BLOOD WBC-5.4 RBC-5.28 Hgb-15.5 Hct-47.1 MCV-89 MCH-29.4 MCHC-32.9 RDW-12.5 RDWSD-41.0 Plt ___\n___ 05:30AM BLOOD Neuts-56.1 ___ Monos-8.9 Eos-5.2 Baso-0.9 Im ___ AbsNeut-3.01 AbsLymp-1.53 AbsMono-0.48 AbsEos-0.28 AbsBaso-0.05\n___ 05:30AM BLOOD ___ PTT-41.6* ___\n___ 05:30AM BLOOD Glucose-129* UreaN-11 Creat-0.8 Na-138 K-4.2 Cl-101 HCO3-23 AnGap-14\n___ 05:30AM BLOOD CK(CPK)-174\n___ 05:30AM BLOOD CK-MB-15* MB Indx-8.6*\n___ 05:30AM BLOOD cTropnT-0.06*\n___ 05:30AM BLOOD Calcium-9.2 Phos-3.4 Mg-2.1\n\nSTUDIES\n=======\nTTE ___\nCONCLUSION:\nThe left atrium is elongated. The right atrium is mildly enlarged. There \nis mild symmetric left ventricular hypertrophy with a normal cavity size. There is egional left ventricular systolic dysfunction with very mild hypokinesis of the mid anteroseptum (see schematic) and preserved/normal contractility of the remaining segments. The visually estimated left ventricular ejection fraction is 55-60%. There is no resting left ventricular outflow tract gradient. Normal right ventricular cavity size with normal free wall motion. The aortic sinus diameter is normal for gender with normal ascending aorta diameter for gender. The aortic valve leaflets (?#) are mildly thickened. There is no aortic valve stenosis. There is trace aortic regurgitation. The mitral valve leaflets are mildly thickened with no mitral valve prolapse. There is trivial mitral regurgitation. The tricuspidvalve leaflets appear structurally normal. There is physiologic tricuspid regurgitation. The pulmonary artery systolic pressure could not be estimated. There is no pericardial effusion.\nIMPRESSION: Mild symmetric left ventricular hypertrophy with mild regional systolic dysfunction.\n\nCardiac Cath ___\nFindings\nThe left main is normal\nThe LAD has severe proximal and mid disease with mid occlusion. The distal vessel fills via the LIMA graft with diffuse iorregularities. The LCX has proximal occlusion; The distal OM fills via a patent SVG and has severe diffuse disease\nThe RCA has widely patent proximal and mid stents. The distal RCA, PDA and PL branches have severe diffuse disease\nThe LIMA-LAD is normal\nThe SVG-OM has diffuse mild disease with severe disease in distal native OM unchanged\nThe SVG-diagonal has diffuse severe disease with slow flow into very small diseased distal vessels\nLVEDEP is normal\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/11992836-DS-23.json

@@ -0,0 +1,72 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "cTropnT-0.14*\ncTropnT-0.21*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest Pain is a symptom of ACS$Cause_1": {
+                "chest pain$Input1": {}
+            },
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "presents 1 day history of chest pain. She was in her USOH until yesterday, noted sudden onset left sided chest pressure w/ nausea, diaphoresis, vomiting, radiation of pain down L arm.$Input2": {}
+            },
+            "Dyslipidemia  \n Rheumatoid Arthritis are Risk factors$Cause_1": {
+                "Dyslipidemia  \n Rheumatoid Arthritis$Input3": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": {
+                "Mild symmetric left ventricular hypertrophy with subtle hypokinesis of the midinferoseptum. No clinically significant valvular regurgitation or stenosis. Indeterminate pulmonary pressure\n\nCATH ___:\nSuccessful PCI of the mid RCA with 3.0 DES(Mild disease in the other coronaries) Re load with clopidgrel 600 mg tonite and continue DAPT with ASA.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS$Cause_1": {
+                    "chest pain$Input1": {}
+                },
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "presents 1 day history of chest pain. She was in her USOH until yesterday, noted sudden onset left sided chest pressure w/ nausea, diaphoresis, vomiting, radiation of pain down L arm.$Input2": {}
+                },
+                "Dyslipidemia  \n Rheumatoid Arthritis are Risk factors$Cause_1": {
+                    "Dyslipidemia  \n Rheumatoid Arthritis$Input3": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation\r is  a sign of NSTE-ACS$Cause_1": {
+                "ECG\uff1a\nnon-ST-elevation$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS$Cause_1": {
+                    "chest pain$Input1": {}
+                },
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "presents 1 day history of chest pain. She was in her USOH until yesterday, noted sudden onset left sided chest pressure w/ nausea, diaphoresis, vomiting, radiation of pain down L arm.$Input2": {}
+                },
+                "Dyslipidemia  \n Rheumatoid Arthritis are Risk factors$Cause_1": {
+                    "Dyslipidemia  \n Rheumatoid Arthritis$Input3": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": {
+                    "Mild symmetric left ventricular hypertrophy with subtle hypokinesis of the midinferoseptum. No clinically significant valvular regurgitation or stenosis. Indeterminate pulmonary pressure\n\nCATH ___:\nSuccessful PCI of the mid RCA with 3.0 DES(Mild disease in the other coronaries) Re load with clopidgrel 600 mg tonite and continue DAPT with ASA.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS$Cause_1": {
+                        "chest pain$Input1": {}
+                    },
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "presents 1 day history of chest pain. She was in her USOH until yesterday, noted sudden onset left sided chest pressure w/ nausea, diaphoresis, vomiting, radiation of pain down L arm.$Input2": {}
+                    },
+                    "Dyslipidemia  \n Rheumatoid Arthritis are Risk factors$Cause_1": {
+                        "Dyslipidemia  \n Rheumatoid Arthritis$Input3": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "chest pain\n",
+    "input2": "Female with PMH of rheumatoid arthritis on prednisone, current smoker,  who presents 1 day history of chest pain. She was in her USOH until yesterday, noted sudden onset left sided chest pressure w/ nausea, diaphoresis, vomiting, radiation of pain down L arm. Went to OSH  and received ASA 325. Currently CP free, BPs 110s/74 HR 58, on RA. EKG notable initial submilimeter elevation AVL, no other elevations; resolved on repeat EKGs; noted TWI in AVF and VIII. Her troponins were elevated at 0.14, 0.21, and she was sent for PCI for NSTEMI. She was found to have a 99% occlusion of the RCA s/p DES and minimial residual disease in other vessels. Given full dose ASA and loaded with Plavix.\n\nCurrently she is chest pain free. She states that she has had small episodes of chest pressure and DOE recently that have always resolved quickly when she sits down. She denies headache, chest pain, fevers, chills, SOB, nausea, vomiting, or diarrhea.\n\nREVIEW OF SYSTEMS:  \nPositive per HPI.  \nCardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope, or presyncope.  On further review of systems, denies fevers or chills. Denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. Denies exertional buttock or calf pain. All of the other review of systems were negative.\n",
+    "input3": "+ Dyslipidemia  \n+ Rheumatoid Arthritis\n+ Osteopenia\n+ Vitamin D Deficiency\n+ Coronaries: Unknown\n+ Pump: Unknown\n+ Rhythm: NSR\n",
+    "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death. Sister had a hear murmur as a child.\n",
+    "input5": "ADMISSION PHYSICAL EXAM\n=======================\nBP: 104/75 HR: 53 O2 sat: 98%\nGENERAL: Well developed, well nourished female in NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: Normocephalic atraumatic. Sclera anicteric. PERRL. EOMI. Conjunctiva were pink. No pallor or cyanosis of the oral mucosa. No xanthelasma.    \nCARDIAC: PMI located in intercostal space, midclavicular line. bradycardic, regular. Normal S1, S2. No murmurs, rubs, or gallops. No thrills or lifts.  \nLUNGS: No chest wall deformities or tenderness. Respiration is unlabored with no accessory muscle use. No crackles, wheezes or rhonchi.  \nABDOMEN: Soft, non-tender, non-distended. No hepatomegaly. No splenomegaly.  \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or peripheral edema. R wrist non-tender with pulses intact, TR band in place with no evidence of hematoma. Sensation intact. \nSKIN: No significant skin lesions or rashes.  \nPULSES: Distal pulses palpable and symmetric.\n",
+    "input6": "ADMISSION LABS\n==============\n___ 06:00AM BLOOD WBC-9.0 RBC-3.98 Hgb-12.1 Hct-36.5 MCV-92 MCH-30.4 MCHC-33.2 RDW-15.1 RDWSD-50.6* Plt ___\n___ 06:00AM BLOOD Neuts-51.1 ___ Monos-7.3 Eos-1.4 Baso-0.6 Im ___ AbsNeut-4.59 AbsLymp-3.50 AbsMono-0.66 AbsEos-0.13 AbsBaso-0.05\n___ 09:33AM BLOOD ___ PTT-69.2* ___\n___ 06:00AM BLOOD Glucose-106* UreaN-14 Creat-0.9 Na-148* K-4.3 Cl-111* HCO3-23 AnGap-14\n___ 06:00AM BLOOD cTropnT-0.14*\n___ 09:33AM BLOOD cTropnT-0.21*\n___ 08:10AM BLOOD Calcium-9.3 Phos-4.0 Mg-2.0\n\nIMAGING\n=======\nTTE ___: Mild symmetric left ventricular hypertrophy with subtle hypokinesis of the midinferoseptum. No clinically significant valvular regurgitation or stenosis. Indeterminate pulmonary pressure\n\nCATH ___:\nSuccessful PCI of the mid RCA with 3.0 DES(Mild disease in the other coronaries) Re load with clopidgrel 600 mg tonite and continue DAPT with ASA.\n\nECG\uff1a\nnon-ST-elevation\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/12054012-DS-14.json

@@ -0,0 +1,84 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "cTropnT-0.11*\n cTropnT-0.24*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Weakness, diaphoresis are symptoms of ACS$Cause_1": {
+                "Weakness, diaphoresis$Input1": {}
+            },
+            "weakness, hypotension and diaphoresis.\n are symptom of ACS.$Cause_1": {
+                "presented with the chief complaint of urinary retention. He had a Foley placed and then developed profound weakness, hypotension and diaphoresis.$Input2": {}
+            },
+            "chronic back pain is a risk factor$Cause_1": {
+                "+PMHx: No medical care for the past decade\n+chronic back pain$Input3": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": {
+                "ECHOCARDIOGRAM\nThe left atrium is elongated. Left ventricular wall thicknesses are normal. The left ventricular cavity is mildly dilated. There is severe regional left ventricular systolic dysfunction with akinesis of the mid anterior, lateral, and inferior walls and entire distal apex. hypokinesis of . There is severe hypokinesis of the remaining segments, with worse hypokinesis in the mid-level compared with the basal walls (LVEF = 15 %). The estimated cardiac index is normal (>=2.5L/min/m2). No masses or thrombi are seen in the left ventricle. Diastolic function could not be assessed. Right ventricular chamber size is normal with borderline normal free wall function. The aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\nIMPRESSION: Dilated left ventricle with severe regional and global dysfunction c/w CAD (3VD). Borderline right ventricular systolic function.IMPRESSION: Dilated left ventricle with severe regional and global dysfunction c/w CAD (3VD). Borderline right ventricular systolic function.\n\n___ CARDIAC CATHETERIZATION\nMultiple attempts were required for right radial arterial access. The Magic Torque wire could not be delivered into the proximalright subclavian artery past the right vertebral artery due toextreme tortuousity (most likely a 360 degree turn). Rightfemoral artery access was then obtained using ultrasound imagingguidance and a MicroPuncture kit on the attempt. The RIMA waspatent.\n\nThe heart appeared dilated with splayed coronary arteries widely separated. There was dense posterior mitral annular calcification.\n\nCoronary angiography: CO-dominant\n  LMCA: The LMCA was short with distal funneling to 25%.\n  LAD: The proximal LAD was heavily calcified. The mid LAD was occluded after small D1, D2 and D3 branches. There was faint reconstitution of the mid-distal LAD via left-to-left collaterals.\n  LCX: The AV groove CX was large in caliber with mild plaquing throughout. There were 2 short OM1 and OM2 branches with no obvious perfusion of the high lateral wall (raising the possibility of an occluded ramus intermedius branch). The major OM3/LPL1 had an origin tubular 70% stenosis. LPL2 was subtotally occluded proximally and reconstituted via left-to-left collaterals with distal moderate disease at a bifurcation and TIM1 flow. The distal CX supplied collaterals to the diseased RPDA and RCA with retrograde filling up to the mid RCA. The LPDA was somewhat tortuous.\n  RCA: The RCA was occluded proximally past the conus and SA nodal branches. There was no reconstitution of the native RCA beyond.\n\n___ CXR \nThere is mild-to-moderate cardiomegaly with left ventricular configuration. The aorta is unfolded.  There is possible minimal upper zone re-distribution, but no other evidence of CHF.  No focal infiltrate or effusion.  No pneumothorax detected. Increased opacity adjacent to the left cardiac apex/left costophrenic angle most likely is related to a cardiac fat pad and/or overlying soft tissues. \n  \nIMPRESSION:  Cardiomegaly.  No acute pulmonary process identified.$Input6": {}
+            },
+            "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": {
+                "An EKG then was significant for T wave inversions in the inferolateral leads.$Input2": {}
+            },
+            "Abnormal electrocardiogram can be a strongly sign of acs$Cause_1": {
+                "A repeat ECG had <1mm ST elevations in I and aVL with Qs anteriorly and inferiorly. TTE showed LVEF of 15% globally with akinetic apex.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Weakness, diaphoresis are symptoms of ACS$Cause_1": {
+                    "Weakness, diaphoresis$Input1": {}
+                },
+                "weakness, hypotension and diaphoresis.\n are symptom of ACS.$Cause_1": {
+                    "presented with the chief complaint of urinary retention. He had a Foley placed and then developed profound weakness, hypotension and diaphoresis.$Input2": {}
+                },
+                "chronic back pain is a risk factor$Cause_1": {
+                    "+PMHx: No medical care for the past decade\n+chronic back pain$Input3": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation\r is  a sign of NSTE-ACS$Cause_1": {
+                "non-ST-elevation$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Weakness, diaphoresis are symptoms of ACS$Cause_1": {
+                    "Weakness, diaphoresis$Input1": {}
+                },
+                "weakness, hypotension and diaphoresis.\n are symptom of ACS.$Cause_1": {
+                    "presented with the chief complaint of urinary retention. He had a Foley placed and then developed profound weakness, hypotension and diaphoresis.$Input2": {}
+                },
+                "chronic back pain is a risk factor$Cause_1": {
+                    "+PMHx: No medical care for the past decade\n+chronic back pain$Input3": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": {
+                    "ECHOCARDIOGRAM\nThe left atrium is elongated. Left ventricular wall thicknesses are normal. The left ventricular cavity is mildly dilated. There is severe regional left ventricular systolic dysfunction with akinesis of the mid anterior, lateral, and inferior walls and entire distal apex. hypokinesis of . There is severe hypokinesis of the remaining segments, with worse hypokinesis in the mid-level compared with the basal walls (LVEF = 15 %). The estimated cardiac index is normal (>=2.5L/min/m2). No masses or thrombi are seen in the left ventricle. Diastolic function could not be assessed. Right ventricular chamber size is normal with borderline normal free wall function. The aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\nIMPRESSION: Dilated left ventricle with severe regional and global dysfunction c/w CAD (3VD). Borderline right ventricular systolic function.IMPRESSION: Dilated left ventricle with severe regional and global dysfunction c/w CAD (3VD). Borderline right ventricular systolic function.\n\n___ CARDIAC CATHETERIZATION\nMultiple attempts were required for right radial arterial access. The Magic Torque wire could not be delivered into the proximalright subclavian artery past the right vertebral artery due toextreme tortuousity (most likely a 360 degree turn). Rightfemoral artery access was then obtained using ultrasound imagingguidance and a MicroPuncture kit on the attempt. The RIMA waspatent.\n\nThe heart appeared dilated with splayed coronary arteries widely separated. There was dense posterior mitral annular calcification.\n\nCoronary angiography: CO-dominant\n  LMCA: The LMCA was short with distal funneling to 25%.\n  LAD: The proximal LAD was heavily calcified. The mid LAD was occluded after small D1, D2 and D3 branches. There was faint reconstitution of the mid-distal LAD via left-to-left collaterals.\n  LCX: The AV groove CX was large in caliber with mild plaquing throughout. There were 2 short OM1 and OM2 branches with no obvious perfusion of the high lateral wall (raising the possibility of an occluded ramus intermedius branch). The major OM3/LPL1 had an origin tubular 70% stenosis. LPL2 was subtotally occluded proximally and reconstituted via left-to-left collaterals with distal moderate disease at a bifurcation and TIM1 flow. The distal CX supplied collaterals to the diseased RPDA and RCA with retrograde filling up to the mid RCA. The LPDA was somewhat tortuous.\n  RCA: The RCA was occluded proximally past the conus and SA nodal branches. There was no reconstitution of the native RCA beyond.\n\n___ CXR \nThere is mild-to-moderate cardiomegaly with left ventricular configuration. The aorta is unfolded.  There is possible minimal upper zone re-distribution, but no other evidence of CHF.  No focal infiltrate or effusion.  No pneumothorax detected. Increased opacity adjacent to the left cardiac apex/left costophrenic angle most likely is related to a cardiac fat pad and/or overlying soft tissues. \n  \nIMPRESSION:  Cardiomegaly.  No acute pulmonary process identified.$Input6": {}
+                },
+                "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": {
+                    "An EKG then was significant for T wave inversions in the inferolateral leads.$Input2": {}
+                },
+                "Abnormal electrocardiogram can be a strongly sign of acs$Cause_1": {
+                    "A repeat ECG had <1mm ST elevations in I and aVL with Qs anteriorly and inferiorly. TTE showed LVEF of 15% globally with akinetic apex.$Input2": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Weakness, diaphoresis are symptoms of ACS$Cause_1": {
+                        "Weakness, diaphoresis$Input1": {}
+                    },
+                    "weakness, hypotension and diaphoresis.\n are symptom of ACS.$Cause_1": {
+                        "presented with the chief complaint of urinary retention. He had a Foley placed and then developed profound weakness, hypotension and diaphoresis.$Input2": {}
+                    },
+                    "chronic back pain is a risk factor$Cause_1": {
+                        "+PMHx: No medical care for the past decade\n+chronic back pain$Input3": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "symptom of ACS\n",
+    "input2": "He is a 66 year old male who presented with the chief complaint of urinary retention. He had a Foley placed and then developed profound weakness, hypotension and diaphoresis. An EKG then was significant for T wave inversions in the inferolateral leads. His troponin was elevated to .34. He received ASA 325 and heparin gtt at 10 AM. Of note, he endorsed having intermittent episodes of weakness over the past month as well as syncopal episodes. Per wife, husband has had decreased ability to perform daily tasks and becomes short of breath + experiences CP with even brief bursts of acitivity; no longer mows the lawn. With this episode at the ED, he denies experiencing chest pain, arm pain, scapular pain, or nausea. \n\nAt the ED, his vitals were Temp: 98.4 HR: 98 BP: 157/85 Resp: 16 O(2)Sat: 98 Normal\n\nHis cardiac catheterization is significant for 3 VD with fully occluded RCA and LAD / Cx with diffuse disease. \n\nA repeat ECG had <1mm ST elevations in I and aVL with Qs anteriorly and inferiorly. TTE showed LVEF of 15% globally with akinetic apex and non-ST-elevation\n",
+    "input3": "+PMHx: No medical care for the past decade\n+chronic back pain\n",
+    "input4": "Noncontributory\n",
+    "input5": "Admit PE: \nTemp: 98.4 HR: 98 BP: 157/85 Resp: 16 O(2)Sat: 98 Normal\nConstitutional: Comfortable\nChest: Clear to auscultation\nCardiovascular: Regular Rate and Rhythm\nAbdominal: Soft\nGU/Flank: No costovertebral angle tenderness\nExtr/Back: No cyanosis, clubbing or edema\nSkin: Warm and dry, No rash\nNeuro: Speech fluent\nPsych: Normal mood, Normal mentation\n",
+    "input6": "ADMISSION LABS\n___ 12:42PM BLOOD WBC-10.8 RBC-5.43 Hgb-15.4 Hct-47.1 MCV-87 MCH-28.5 MCHC-32.8 RDW-14.7 Plt ___\n___ 12:42PM BLOOD Neuts-91.9* Lymphs-5.0* Monos-2.4 Eos-0.6 Baso-0.2\n___ 12:42PM BLOOD ___ PTT-83.6* ___\n___ 12:42PM BLOOD Glucose-127* UreaN-20 Creat-1.1 Na-141 K-3.9 Cl-105 HCO3-24 AnGap-16\n___ 12:42PM BLOOD ALT-21 AST-28 CK(CPK)-96 AlkPhos-61 TotBili-0.4\n___ 12:42PM BLOOD cTropnT-0.11*\n___ 06:20AM BLOOD cTropnT-0.24*\n___ 12:42PM BLOOD Albumin-4.2 Calcium-8.6 Phos-2.7 Mg-1.9\n___ 07:30PM BLOOD %HbA1c-5.5 eAG-111\n___ 12:52PM BLOOD Lactate-1.6\n\nOTHER STUDIES\n___ ECHOCARDIOGRAM\nThe left atrium is elongated. Left ventricular wall thicknesses are normal. The left ventricular cavity is mildly dilated. There is severe regional left ventricular systolic dysfunction with akinesis of the mid anterior, lateral, and inferior walls and entire distal apex. hypokinesis of . There is severe hypokinesis of the remaining segments, with worse hypokinesis in the mid-level compared with the basal walls (LVEF = 15 %). The estimated cardiac index is normal (>=2.5L/min/m2). No masses or thrombi are seen in the left ventricle. Diastolic function could not be assessed. Right ventricular chamber size is normal with borderline normal free wall function. The aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\nIMPRESSION: Dilated left ventricle with severe regional and global dysfunction c/w CAD (3VD). Borderline right ventricular systolic function.\n\n___ CARDIAC CATHETERIZATION\nMultiple attempts were required for right radial arterial access. The Magic Torque wire could not be delivered into the proximalright subclavian artery past the right vertebral artery due toextreme tortuousity (most likely a 360 degree turn). Rightfemoral artery access was then obtained using ultrasound imagingguidance and a MicroPuncture kit on the attempt. The RIMA waspatent.\n\nThe heart appeared dilated with splayed coronary arteries widely separated. There was dense posterior mitral annular calcification.\n\nCoronary angiography: CO-dominant\n  LMCA: The LMCA was short with distal funneling to 25%.\n  LAD: The proximal LAD was heavily calcified. The mid LAD was occluded after small D1, D2 and D3 branches. There was faint reconstitution of the mid-distal LAD via left-to-left collaterals.\n  LCX: The AV groove CX was large in caliber with mild plaquing throughout. There were 2 short OM1 and OM2 branches with no obvious perfusion of the high lateral wall (raising the possibility of an occluded ramus intermedius branch). The major OM3/LPL1 had an origin tubular 70% stenosis. LPL2 was subtotally occluded proximally and reconstituted via left-to-left collaterals with distal moderate disease at a bifurcation and TIM1 flow. The distal CX supplied collaterals to the diseased RPDA and RCA with retrograde filling up to the mid RCA. The LPDA was somewhat tortuous.\n  RCA: The RCA was occluded proximally past the conus and SA nodal branches. There was no reconstitution of the native RCA beyond.\n\n___ CXR \nThere is mild-to-moderate cardiomegaly with left ventricular configuration. The aorta is unfolded.  There is possible minimal upper zone re-distribution, but no other evidence of CHF.  No focal infiltrate or effusion.  No pneumothorax detected. Increased opacity adjacent to the left cardiac apex/left costophrenic angle most likely is related to a cardiac fat pad and/or overlying soft tissues. \n  \nIMPRESSION:  Cardiomegaly.  No acute pulmonary process identified.\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/12137011-DS-27.json

@@ -0,0 +1,96 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "TnT 0.12$Input2": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "chest Pain after exercisec is a symptom of ACS.$Cause_1": {
+                "He went up and down stairs twice outside in the heat, and developed acute chest pressure/pain after exertion. the chest pain was midsternal, non-radiating, and associated with extreme flushing/diaphoresis, no N/V.$Input2": {}
+            },
+            "Status post aortic valve replacement and mitral valve is Risk factors$Cause_1": {
+                "+Status post aortic valve replacement and mitral valve\n+Prosthetic valve endocarditis (Staphylococcus epidermidis)\n+Myocardial infarction secondary to endocarditis, septic embolus\n+History of atrial fibrillation.\n+History of Crohn's disease\n-Hypertension.\n+Hypercholesterolemia.$Input3": {}
+            },
+            "Family history is a big risk factor$Cause_1": {
+                "Father -diabetes, chronic obstructive pulmonary disease, and a history of cerebrovascular accidents;Brother with lupus.$Input4": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": {
+                "Normal functioning bileaflet AVR and MVR. Symmetric left ventricular hypertrophy with regional systolic dysfunction most c/w CAD. Mildly dilated ascending aorta.$Input6": {}
+            },
+            "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": {
+                "EKG: Regular sinus rhythm, RBBB, diffuse ST elevation in II, III, aVF, V2 through V6, Q wave in I, II, and aVL, unchanged from prior$Input2": {}
+            },
+            "Abnormal electrocardiogram is a diagnostic criteria of ACS.$Cause_1": {
+                "Right bundle-branch block. Left anterior fascicular block. Anterior wall myocardial infarction of indeterminate age. Prolonged Q-T interval. Compared to the previous tracing P-R interval is now prolonged.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "chest Pain after exercisec is a symptom of ACS.$Cause_1": {
+                    "He went up and down stairs twice outside in the heat, and developed acute chest pressure/pain after exertion. the chest pain was midsternal, non-radiating, and associated with extreme flushing/diaphoresis, no N/V.$Input2": {}
+                },
+                "Status post aortic valve replacement and mitral valve is Risk factors$Cause_1": {
+                    "+Status post aortic valve replacement and mitral valve\n+Prosthetic valve endocarditis (Staphylococcus epidermidis)\n+Myocardial infarction secondary to endocarditis, septic embolus\n+History of atrial fibrillation.\n+History of Crohn's disease\n-Hypertension.\n+Hypercholesterolemia.$Input3": {}
+                },
+                "Family history is a big risk factor$Cause_1": {
+                    "Father -diabetes, chronic obstructive pulmonary disease, and a history of cerebrovascular accidents;Brother with lupus.$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation\r is  a sign of NSTE-ACS$Cause_1": {
+                "non-ST-elevation$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "chest Pain after exercisec is a symptom of ACS.$Cause_1": {
+                    "He went up and down stairs twice outside in the heat, and developed acute chest pressure/pain after exertion. the chest pain was midsternal, non-radiating, and associated with extreme flushing/diaphoresis, no N/V.$Input2": {}
+                },
+                "Status post aortic valve replacement and mitral valve is Risk factors$Cause_1": {
+                    "+Status post aortic valve replacement and mitral valve\n+Prosthetic valve endocarditis (Staphylococcus epidermidis)\n+Myocardial infarction secondary to endocarditis, septic embolus\n+History of atrial fibrillation.\n+History of Crohn's disease\n-Hypertension.\n+Hypercholesterolemia.$Input3": {}
+                },
+                "Family history is a big risk factor$Cause_1": {
+                    "Father -diabetes, chronic obstructive pulmonary disease, and a history of cerebrovascular accidents;Brother with lupus.$Input4": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": {
+                    "Normal functioning bileaflet AVR and MVR. Symmetric left ventricular hypertrophy with regional systolic dysfunction most c/w CAD. Mildly dilated ascending aorta.$Input6": {}
+                },
+                "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": {
+                    "EKG: Regular sinus rhythm, RBBB, diffuse ST elevation in II, III, aVF, V2 through V6, Q wave in I, II, and aVL, unchanged from prior$Input2": {}
+                },
+                "Abnormal electrocardiogram is a diagnostic criteria of ACS.$Cause_1": {
+                    "Right bundle-branch block. Left anterior fascicular block. Anterior wall myocardial infarction of indeterminate age. Prolonged Q-T interval. Compared to the previous tracing P-R interval is now prolonged.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "Chest pain$Input1": {}
+                    },
+                    "chest Pain after exercisec is a symptom of ACS.$Cause_1": {
+                        "He went up and down stairs twice outside in the heat, and developed acute chest pressure/pain after exertion. the chest pain was midsternal, non-radiating, and associated with extreme flushing/diaphoresis, no N/V.$Input2": {}
+                    },
+                    "Status post aortic valve replacement and mitral valve is Risk factors$Cause_1": {
+                        "+Status post aortic valve replacement and mitral valve\n+Prosthetic valve endocarditis (Staphylococcus epidermidis)\n+Myocardial infarction secondary to endocarditis, septic embolus\n+History of atrial fibrillation.\n+History of Crohn's disease\n-Hypertension.\n+Hypercholesterolemia.$Input3": {}
+                    },
+                    "Family history is a big risk factor$Cause_1": {
+                        "Father -diabetes, chronic obstructive pulmonary disease, and a history of cerebrovascular accidents;Brother with lupus.$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "He is with history of bicuspid aortic valve status post prosthetic aortic valve, staphylococcus epidermidis endocarditis requiring a repeat aortic valve surgery, thromboembolic myocardial infarction s/p balloon angioplasty of the left circumflex artery, HLD, CKD (baseline creatinine 1.4), gout, Crohn's disease, who presented with chest pain.  \n\nPatient reported that he was in his usual state of health until the day of presentation. He went up and down stairs twice outside in the heat, and developed acute chest pressure/pain after exertion. the chest pain was midsternal, non-radiating, and associated with extreme flushing/diaphoresis, no N/V. Feeling much improved. Also w/+SOB and DOE, no orthopnea. He has a history of MI but doesn't know if this is a similar pain. He also reported bad taste in his mouth with this episode. Wife noted that his ankles appear more swollen b/l.  \n\nHe denies fever, chills, headache, dizziness, dysuria, calf tenderness. He has cough at baseline.  \n\nIn the ED, initial vitals were: 98.3 63 121/71 17 96% RA  \nExam notable for:  rrr, s1/s2, ___ murmurs  ctabl no w/c/r  soft, +bs, nd/nt  no edema, no tenderness b/l, wwp  \n\nLabs notable for:  \nWBC 8.0 N:75.4 H/H 13.3/41.6 Platelets: 163  \nNa 137 K 3.9 creatinine 1.5  \nPTT: 54.1 INR: 3.8  \nALT: 47 AP: 94 Tbili: 0.8 Alb: 4.0 AST: 61  \n2100 Trop-T: 0.12 CK: 135 MB: 4  \n0300 Trop-T: 0.12 CK: 112 MB: 4  \nUA within normal limits  \nImaging notable for: CXR with no acute cardiopulmonary process.  \n\nEKG: Regular sinus rhythm, RBBB, diffuse ST elevation in II, III, aVF, V2 through V6, Q wave in I, II, and aVL, unchanged from prior \n non-ST-elevation \n \nPatient was given:  \nNitroglycerin SL .4 mg  PO/NG Atorvastatin 80 mg Metoprolol Tartrate 25 mg  \n\nCardiology consulted and recommended: Hx of nonobstructive CAD. P/w several ours of chest pain at rest. resolved after arriving to ED (NTG). TnT 0.12, second set pending. ECG essentially unchanged from baseline. RBBB j point elevations V4-6. New isolated concordant STD in V1. on VKA, INR supratheraputic, hold UFH, give ASA and high potency statin.\n",
+    "input3": "+Status post aortic valve replacement and mitral valve\n+Prosthetic valve endocarditis (Staphylococcus epidermidis)\n+Myocardial infarction secondary to endocarditis, septic embolus\n+History of atrial fibrillation.\n+History of Crohn's disease\n-Hypertension.\n+Hypercholesterolemia.\n",
+    "input4": "Father -diabetes, chronic obstructive pulmonary disease, and a history of cerebrovascular accidents;Brother with lupus.\n",
+    "input5": "ADMISSION PHYSICAL EXAM:  \n=========================\nVital Signs: 97.8 | 155/91 | 54 | 18 | 96%RA  \nGeneral: Alert, oriented, no acute distress  \nHEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL, neck supple, JVP not elevated, no LAD  \nCV: Regular mechanical heart sounds, no murmurs, rubs, gallops  \nLungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi  \nAbdomen: Soft, non-tender, non-distended, bowel sounds present, no organomegaly, no rebound or guarding  \nGU: No foley  \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema  \nNeuro: Grossly non-focal\n",
+    "input6": "IMAGING & STUDIES:  \n\n___ Imaging CHEST (PA & LAT) \nMidline sternotomy wires again noted.  Cardiomediastinal silhouette is unchanged with mild cardiac enlargement.  Aortic and mitral valve replacements are noted.  Lungs are clear without overt signs of edema or pneumonia.  Mild hilar congestion is suspected.  No large effusion or pneumothorax.  Bony  structures are intact.  Degenerative changes of the left shoulder partially imaged \n\n___ Cardiovascular ECG \nSinus rhythm with A-V conduction delay. Right bundle-branch block. Left anterior fascicular block. Anterior wall myocardial infarction of indeterminate age. Prolonged Q-T interval. Compared to the previous tracing P-R interval is now prolonged.  \nTRACING #1 \n\n___ Cardiovascular ECG \nSinus rhythm. Right bundle-branch block. Left anterior fascicular block.  A-V conduction delay. Anterior wall myocardial infarction of indeterminate age. Compared to tracing #1 findings are similar. \nTRACING #2 \n\n___ Cardiovascular ECG \nSinus bradycardia. A-V conduction delay. Right bundle-branch block. Left anterior fascicular block. Anterior wall myocardial infarction of indeterminate age. Compared to tracing #2 the heart rate has slowed. \nTRACING #3 \n\n___: ECHO: (LVEF = 41%)\nThe left atrial volume index is moderately increased. There is moderate symmetric left ventricular hypertrophy with normal cavity size. There is mild regional left ventricular systolic dysfunction with thinning/akinesis of the distal half of the inferolateral and distal inferior wall. The remaining segments contract normally (LVEF = 41%). No masses or thrombi are seen in the left ventricle. The ascending aorta is mildly dilated. A bileaflet aortic valve prosthesis is present. The aortic valve prosthesis appears well seated, with normal disc motion and transvalvular gradients. No aortic regurgitation is seen. A bileaflet mitral valve prosthesis is present. The mitral prosthesis appears well seated, with normal disc motion and transvalvular gradients. No mitral regurgitation is seen. Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\nIMPRESSION: Suboptimal image quality. Normal functioning bileaflet AVR and MVR. Symmetric left ventricular hypertrophy with regional systolic dysfunction most c/w CAD. Mildly dilated ascending aorta.\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/12275216-DS-11.json

@@ -0,0 +1,90 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "Troponins initially .06, repeat troponin at 8:20AM day of transfer, 0.25.$Input2": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "Chest Pain$Input1": {}
+            },
+            "+Hypertension  \n+Hyperlipidemia\nis a risk factor of ACS$Cause_1": {
+                "+Hypertension  \n+Hyperlipidemia$Input3": {}
+            },
+            "Chest Pain is a symptom of ACS$Cause_1": {
+                "At the time of presentation, patient's pain was in severity.$Input2": {}
+            },
+            "Family history is a big risk factor$Cause_1": {
+                "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family. Thinks his family members have hypercholesterolemia, diabetes, hypertension. + early cardiac death.$Input4": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "Cardiac structural abnormalities is a diagnostic criteria of ACS$Cause_1": {
+                "He is a gentleman with CAD (known occluded RCA with collaterals s/p PCI's (PTCA and stenting of ostial LCx and PTCA ostial RI c/b instent restenosis at ostium of LCx and restenosis of ramus branch s/p PTCA of LCx ostium and ramus ostium, HTN, HL, chronic low back pain and anxiety who presented to OSH with chest pain.$Input2": {}
+            },
+            "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": {
+                "CV: RR, normal S1, S2. No m/r/g. No S3 or S4. Distant heart \nsounds.$Input5": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "+Hypertension  \n+Hyperlipidemia\nis a risk factor of ACS$Cause_1": {
+                    "+Hypertension  \n+Hyperlipidemia$Input3": {}
+                },
+                "Chest Pain is a symptom of ACS$Cause_1": {
+                    "At the time of presentation, patient's pain was in severity.$Input2": {}
+                },
+                "Family history is a big risk factor$Cause_1": {
+                    "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family. Thinks his family members have hypercholesterolemia, diabetes, hypertension. + early cardiac death.$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation\r is  a sign of NSTE-ACS$Cause_1": {
+                "ECG\uff1a\nnon-ST-elevation$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "+Hypertension  \n+Hyperlipidemia\nis a risk factor of ACS$Cause_1": {
+                    "+Hypertension  \n+Hyperlipidemia$Input3": {}
+                },
+                "Chest Pain is a symptom of ACS$Cause_1": {
+                    "At the time of presentation, patient's pain was in severity.$Input2": {}
+                },
+                "Family history is a big risk factor$Cause_1": {
+                    "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family. Thinks his family members have hypercholesterolemia, diabetes, hypertension. + early cardiac death.$Input4": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "Cardiac structural abnormalities is a diagnostic criteria of ACS$Cause_1": {
+                    "He is a gentleman with CAD (known occluded RCA with collaterals s/p PCI's (PTCA and stenting of ostial LCx and PTCA ostial RI c/b instent restenosis at ostium of LCx and restenosis of ramus branch s/p PTCA of LCx ostium and ramus ostium, HTN, HL, chronic low back pain and anxiety who presented to OSH with chest pain.$Input2": {}
+                },
+                "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": {
+                    "CV: RR, normal S1, S2. No m/r/g. No S3 or S4. Distant heart \nsounds.$Input5": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "Chest Pain$Input1": {}
+                    },
+                    "+Hypertension  \n+Hyperlipidemia\nis a risk factor of ACS$Cause_1": {
+                        "+Hypertension  \n+Hyperlipidemia$Input3": {}
+                    },
+                    "Chest Pain is a symptom of ACS$Cause_1": {
+                        "At the time of presentation, patient's pain was in severity.$Input2": {}
+                    },
+                    "Family history is a big risk factor$Cause_1": {
+                        "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family. Thinks his family members have hypercholesterolemia, diabetes, hypertension. + early cardiac death.$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest Pain\n",
+    "input2": "He is a gentleman with CAD (known occluded RCA with collaterals s/p PCI's (PTCA and stenting of ostial LCx and PTCA ostial RI c/b instent restenosis at ostium of LCx and restenosis of ramus branch s/p PTCA of LCx ostium and ramus ostium, HTN, HL, chronic low back pain and anxiety who presented to OSH with chest pain. He was found to have an NSTEMI and was transferred to for catheterization.\n  \nAt the time of presentation, patient's pain was in severity. Troponins initially .06, repeat troponin at 8:20AM day of transfer, 0.25. VS on transfer: 136/59, HR 69 SR, 16, 97% 2 liters, afebrile.  Patient arrived and underwent uncomplicated cardiac cath with right femoral access. During procedure DES was placed in the ostial LCx with residual 40-50% distal left main to LAD. Plan per interventional is ASA, plavix, IVF overnight with plan for TTE, consult in the AM. Of note patient received ample versed and Fentanyl  \n\nOn arrival to the floor, patient without complaint. Denies chest pain, shortness of breath, palpitations. Tolerating PO without nausea, vomiting. Chronic back pain is at its baseline. Last BM yesterday.\n",
+    "input3": "+CAD s/p MI and multiple PCI's  \n+Hypertension  \n+Hyperlipidemia  \n+Chronic low back pain\n+s/p cholecystectomy  \n+h/o osteomyelitis  \n+Depression  \n+Anxiety  \n+Umbilical hernia\n",
+    "input4": "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family. Thinks his family members have hypercholesterolemia, diabetes, hypertension. + early cardiac death.\n",
+    "input5": "ADMISSION EXAM\nVS T 97.8 102/60 72 14 96%RA  \nGen: Obese M in NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.  \nNeck: Supple with no JVD noted (difficult to assess).  \nCV: RR, normal S1, S2. No m/r/g. No S3 or S4. Distant heart \nsounds.  \nChest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi.  \nAbd: NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. Morphine pump can be felt on the RLQ under the skin.  \nExt: no c/c/e. Right femoral cath site c/d/i under tegaderm.  \nSkin: No stasis dermatitis, ulcers, scars, xanthomas. + tattoos noted  \nRight: 2+ DPs  \nLeft: 2+ DP and radial\n",
+    "input6": "ADMISSION LABS\n--------------------\n___ 02:34AM BLOOD Plt ___\n___ 02:34AM BLOOD UreaN-15 Creat-1.1 Na-140 K-4.8 Cl-104\n___ 02:34AM BLOOD CK(CPK)-78\n___ 02:34AM BLOOD CK-MB-3 cTropnT-0.10*\n\nECG\uff1a\nnon-ST-elevation\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/12364675-DS-12.json

@@ -0,0 +1,96 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "Peak troponin greater than 8.$Input2": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Dyspnea is a symptom of ACS$Cause_1": {
+                "Dyspnea$Input1": {}
+            },
+            "DM is a risk factor of ACS$Cause_1": {
+                "w/ DM2, h/o prostate ca, h/o thyroid ca, stage IV SCC tongue, s/p dissection and chemorad , G-tube, presents as a transfer for I/s/o CAD.$Input2": {}
+            },
+            "HTN is is a risk factor of ACS$Cause_1": {
+                "+HTN$Input3": {}
+            },
+            "DM is is a risk factor of ACS.$Cause_1": {
+                "+DM managed with metformin$Input3": {}
+            },
+            "CAD is a risk factor of ACS.$Cause_1": {
+                "+CAD s/p stenting$Input3": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "s1, s2 present, systolic murmur on LSB w/radiation to carotid is a sign of ACS$Cause_1": {
+                "CARDIAC: RRR, s1, s2 present, systolic murmur on LSB w/radiation to carotid$Input5": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Dyspnea is a symptom of ACS$Cause_1": {
+                    "Dyspnea$Input1": {}
+                },
+                "DM is a risk factor of ACS$Cause_1": {
+                    "w/ DM2, h/o prostate ca, h/o thyroid ca, stage IV SCC tongue, s/p dissection and chemorad , G-tube, presents as a transfer for I/s/o CAD.$Input2": {}
+                },
+                "HTN is is a risk factor of ACS$Cause_1": {
+                    "+HTN$Input3": {}
+                },
+                "DM is is a risk factor of ACS.$Cause_1": {
+                    "+DM managed with metformin$Input3": {}
+                },
+                "CAD is a risk factor of ACS.$Cause_1": {
+                    "+CAD s/p stenting$Input3": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation\r is  a sign of NSTE-ACS$Cause_1": {
+                "ECG\uff1a\nnon-ST-elevation$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Dyspnea is a symptom of ACS$Cause_1": {
+                    "Dyspnea$Input1": {}
+                },
+                "DM is a risk factor of ACS$Cause_1": {
+                    "w/ DM2, h/o prostate ca, h/o thyroid ca, stage IV SCC tongue, s/p dissection and chemorad , G-tube, presents as a transfer for I/s/o CAD.$Input2": {}
+                },
+                "HTN is is a risk factor of ACS$Cause_1": {
+                    "+HTN$Input3": {}
+                },
+                "DM is is a risk factor of ACS.$Cause_1": {
+                    "+DM managed with metformin$Input3": {}
+                },
+                "CAD is a risk factor of ACS.$Cause_1": {
+                    "+CAD s/p stenting$Input3": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "s1, s2 present, systolic murmur on LSB w/radiation to carotid is a sign of ACS$Cause_1": {
+                    "CARDIAC: RRR, s1, s2 present, systolic murmur on LSB w/radiation to carotid$Input5": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Dyspnea is a symptom of ACS$Cause_1": {
+                        "Dyspnea$Input1": {}
+                    },
+                    "DM is a risk factor of ACS$Cause_1": {
+                        "w/ DM2, h/o prostate ca, h/o thyroid ca, stage IV SCC tongue, s/p dissection and chemorad , G-tube, presents as a transfer for I/s/o CAD.$Input2": {}
+                    },
+                    "HTN is is a risk factor of ACS$Cause_1": {
+                        "+HTN$Input3": {}
+                    },
+                    "DM is is a risk factor of ACS.$Cause_1": {
+                        "+DM managed with metformin$Input3": {}
+                    },
+                    "CAD is a risk factor of ACS.$Cause_1": {
+                        "+CAD s/p stenting$Input3": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Dyspnea\n",
+    "input2": "w/ DM2, h/o prostate ca, h/o thyroid ca, stage IV SCC tongue, s/p dissection and chemorad , G-tube, presents as a transfer for I/s/o CAD.\n\nHad acute onset of SOB after receiving daily hydration at theinfusion clinic. And 5 days ago, went into acute pulmonary edema while at the infusion clinic.  BNP was greater.  Peak troponin greater than 8. Treated ICU with BiPAP and diuresis and is now compensated. Echo revealed an EF with aortic stenosis with a mean gradient of 12 mmHg and a valve area of 0.9cm2. Right heart cath today: Mean Wedge 20mmHG, pulmonary artery pressure 46/21.  Mean aortic gradient 9 mmHg.  Valve area calculated at 2.93.  Left ventriculogram: EF 25%.  Coronary angiography revealed a patent LAD stent with an 80% stenosis immediately after.  Ostial circumflex with a 90% stenosis.  RCA 70% proximal with a chronically occluded right PDA.  A large ramus had a 60% proximal stenosis.  Patient was stable in the ICU and no longer required ICU care. \n\nOf note, there is a report of him having some intermittent confusion and combativeness at home.  PCP had started him on Keppra for ? concern for seizures. His G tube got clogged and was pulled out this admission. Is able to eat applesauce, protein shakes. Has lost significant weight. They have not been able to put the tube back in due to his current cardiac status. Takes all pills whole in applesauce. Of note, right radial access today: TR band is still in place but depressurized.  No bleeding or hematoma. \n\nVitals prior to transfer: 127/48, 89, 16, afebrile, 96% on 4 liters\n\nOn the floor VSS, on 4L O2, pt is stable. Reporting improvement of SOB, and denies CP now and in the past. Only had CP when he had PCI.  had his last chemo for tongue SCC lastweek.\n",
+    "input3": "+CAD s/p stenting\n+Osteoarthritis with severe arthritis of the left hip (? cane at baseline)\n+HTN\n+HLD\n+DM managed with metformin\n+Hypothyroidism\n+Sporadic Medullary Thyroid Carcinoma s/p thyroidectomy and \ncentral compartment lymph node dissection\n+Migraine headache\n+Esophageal diverticulum and perforation s/p esophageal stent/repair via right thoracotomy with subsequent removal complicated by intrathoracic abscess weeks post op from esophageal repair as mentioned above)\n+Glaucoma\n+Oral leukoplakia\n+Pulmonary nodule right lower lobe (unchanged over years)\n",
+    "input4": "Per record, brother with hx of colon problems.  Mother hx. of DM.\n",
+    "input5": "ADMISSION PHYSICAL EXAM\n=======================\nGENERAL: NAD Oriented x3. Mood, affect appropriate.  \nNECK: Supple. JVP of 15 cm.  \nCARDIAC: RRR, s1, s2 present, systolic murmur on LSB w/radiation to carotid\nLUNGS: Bilateral crackles from mid to base\nABDOMEN: Soft, non-tender, non-distended. No hepatomegaly. No\nsplenomegaly.  \nEXTREMITIES: traces of edema\n\nGeneral: NAD\nLungs: Quiet bilaterally, poor air movement \nCV: RRR, S1, S2 present with ___ systolic murmur radiating to\ncarotid, heard at ___\nAbdomen: BS+, ND, NT, soft\nExt: no edema\n",
+    "input6": "ADMISSION LABS\n===========================\n___ 08:04PM BLOOD WBC-4.8 RBC-2.84* Hgb-8.6* Hct-27.5* MCV-97 MCH-30.3 MCHC-31.3* RDW-20.2* RDWSD-69.8* Plt ___\n___ 08:04PM BLOOD ___ PTT-25.9 ___\n___ 08:04PM BLOOD Glucose-166* UreaN-15 Creat-0.7 Na-134* K-4.4 Cl-95* HCO3-28 AnGap-11\n___ 08:04PM BLOOD ___\n___ 08:04PM BLOOD Calcium-6.8* Phos-3.6 Mg-1.8\n___ 08:04PM BLOOD TSH-1.9\n\nDISCHARGE LABS\n===========================\n___ 04:49AM BLOOD WBC-4.8 RBC-2.74* Hgb-8.2* Hct-26.4* MCV-96 MCH-29.9 MCHC-31.1* RDW-19.9* RDWSD-68.8* Plt ___\n___ 04:49AM BLOOD ___ PTT-38.4* ___\n___ 04:49AM BLOOD Glucose-117* UreaN-13 Creat-0.7 Na-138 K-3.7 Cl-95* HCO3-29 AnGap-14\n\nIMAGING\n============================\nCXR ___ IMPRESSION:  \nThere is a left chest wall Port-A-Cath with the tip terminating in the \nsuperior vena cava. There are small bilateral pleural effusions (right greater than left) with bibasilar atelectasis. Underlying consolidation cannot be excluded. There is no pneumothorax. The cardiomediastinal silhouette is within normal limits. There is no pulmonary edema. No acute osseous abnormalities are identified. \n\n\nFindings\nSuccessful PCI with drug-eluting stent of the circumflex coronary artery.\n\nECG\uff1a\nnon-ST-elevation\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/12806822-DS-18.json

@@ -0,0 +1,72 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": {
+            "cTropnT-0.55$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "diaphoresis, and clammy feeling is a symptom of ACS.$Cause_1": {
+                "he was walking pt abruptly started having a dull CP at this chest in severity. He also had some diaphoresis, and clammy feeling but denies any jaw or neck pain, radiating pain to the arm.$Input2": {}
+            },
+            "hemmoroids is a risk fact$Cause_1": {
+                "hemmoroids$Input3": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n are strongly signs of acs$Cause_1": {
+                "Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "diaphoresis, and clammy feeling is a symptom of ACS.$Cause_1": {
+                    "he was walking pt abruptly started having a dull CP at this chest in severity. He also had some diaphoresis, and clammy feeling but denies any jaw or neck pain, radiating pain to the arm.$Input2": {}
+                },
+                "hemmoroids is a risk fact$Cause_1": {
+                    "hemmoroids$Input3": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation\r is  a sign of NSTE-ACS$Cause_1": {
+                "ECG\uff1a\nnon-ST-elevation$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "diaphoresis, and clammy feeling is a symptom of ACS.$Cause_1": {
+                    "he was walking pt abruptly started having a dull CP at this chest in severity. He also had some diaphoresis, and clammy feeling but denies any jaw or neck pain, radiating pain to the arm.$Input2": {}
+                },
+                "hemmoroids is a risk fact$Cause_1": {
+                    "hemmoroids$Input3": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n are strongly signs of acs$Cause_1": {
+                    "Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.$Input2": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "Chest pain$Input1": {}
+                    },
+                    "diaphoresis, and clammy feeling is a symptom of ACS.$Cause_1": {
+                        "he was walking pt abruptly started having a dull CP at this chest in severity. He also had some diaphoresis, and clammy feeling but denies any jaw or neck pain, radiating pain to the arm.$Input2": {}
+                    },
+                    "hemmoroids is a risk fact$Cause_1": {
+                        "hemmoroids$Input3": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "69 yo M w/o any signicant PMH presents with CP. Each morning he walks 1.5mi and this morning when he was walking pt abruptly started having a dull CP at this chest in severity. He also had some diaphoresis, and clammy feeling but denies any jaw or neck pain, radiating pain to the arm.  Once the pain occured he sat down, and the pain lasted a total of 10 minutes and completely went away. Pt did admit that he had some R hand numbness. Pt did not take an asprin or any other med, and when he got back home did take one prilosec. The pain was different from indigestion he has been having over the last couple months which is lower on his chest and a feeling offullness and some acid reflux feeling. Pt said he also had similar CP on (4d ago) when doing yard work and shoveling, and also later that night with the same pattern of pain/length and resolution when resting.\n \nOn review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. Only (+) for blurry vision - for a couple minutes at a time over the last couple weeks pt would have a small area of his visual field that would be blurry and go away. \n\nCardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n",
+    "input3": "+hemmoroids\n-no other medical hx\n",
+    "input4": "There is no family history of premature coronary artery disease or sudden death.\n",
+    "input5": "VS - 97.3, 143/89, 61, 18, 100%RA\nGen: WDWN middle aged male in NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma.  \nNeck: Supple with JVP of *** cm.  \nCV: PMI located in ___ intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.  \nChest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi.  \nAbd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits.  \nExt: No c/c/e. No femoral bruits.  \nSkin: No stasis dermatitis, ulcers, scars, or xanthomas.  \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+\n",
+    "input6": "___ 09:08PM   CK(CPK)-107\n___ 09:08PM   CK-MB-4\n___ 09:08PM   PLT COUNT-179\n___ 09:28AM   GLUCOSE-116* UREA N-26* CREAT-1.0 SODIUM-144 POTASSIUM-4.6 CHLORIDE-108 TOTAL CO2-29 ANION GAP-12\n___ 09:28AM   estGFR-Using this\n___ 09:28AM   CK(CPK)-148\n___ 09:28AM   cTropnT-0.55\n___ 09:28AM   CK-MB-5\n___ 09:28AM   WBC-5.1 RBC-4.68 HGB-14.4 HCT-42.1 MCV-90 MCH-30.7 MCHC-34.1 RDW-13.6\n___ 09:28AM   NEUTS-73.6* ___ MONOS-3.9 EOS-1.7 BASOS-0.5\n___ 09:28AM   PLT COUNT-191\n___ 09:28AM   ___ PTT-23.5 ___\n\nECG\uff1a\nnon-ST-elevation\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/12808249-DS-8.json

@@ -0,0 +1,114 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "The peak hs-cTn exceeded the 99th percentile of the normal control value$Cause_1": {
+            "cTropnT-1.77*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Possible mitral regurgitation$Cause_1": {
+                "Trivial mitral regurgitation is seen.$Input6": {}
+            },
+            "Chest pain is the mainly clinical presentation$Cause_1": {
+                "patient reported epigastric pressure while at rest which was non-radiating. Pain started while sitting, then lasted until he fell$Input2": {}
+            },
+            "Chest pain is a clinical presentation$Cause_1": {
+                "Chest Pain$Input1": {}
+            },
+            "DM, AFib and HTN etc are the risk factors of ACS$Cause_1": {
+                "He is a Male w/ DM, AFib and HTN who presented to ED w/ one day of epigastric pain, EKG changes, and a troponin leak$Input2": {}
+            },
+            "DM, AFib and HTN etc are the risk factors.$Cause_1": {
+                "+ Diabetes mellitus type II: oral agents & insulin\n+ Atrial Fibrillation\n+ Hypertension$Input3": {}
+            },
+            "may be a family history$Cause_1": {
+                "Father MI in late, Mother DM$Input4": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "transient ST-segment elevation, persistent or transient ST-segment depression, and T wave abnormalities, including hyperacute T waves, T wave inversion, biphasic T waves, flat T waves.$Cause_1": {
+                "Sinus rhythm. ST segment elevation in leads III and possibly lead aVF. T wave inversions in leads V4-V6. ST segment depressions in leads I and V6 consistent with acute ischemia or an infarction. No previous tracing available for comparison.$Input6": {}
+            },
+            "transient ST-segment elevation, persistent or transient ST-segment depression, and T wave abnormalities, including hyperacute T waves, T wave inversion, biphasic T waves, flat T waves, and pseudonormalization of T waves.$Cause_1": {
+                "Sinus Rhythm at 75 ant/septal and lateral ST-T changes, ST elevation in III, and + TWI.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Possible mitral regurgitation$Cause_1": {
+                    "Trivial mitral regurgitation is seen.$Input6": {}
+                },
+                "Chest pain is the mainly clinical presentation$Cause_1": {
+                    "patient reported epigastric pressure while at rest which was non-radiating. Pain started while sitting, then lasted until he fell$Input2": {}
+                },
+                "Chest pain is a clinical presentation$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "DM, AFib and HTN etc are the risk factors of ACS$Cause_1": {
+                    "He is a Male w/ DM, AFib and HTN who presented to ED w/ one day of epigastric pain, EKG changes, and a troponin leak$Input2": {}
+                },
+                "DM, AFib and HTN etc are the risk factors.$Cause_1": {
+                    "+ Diabetes mellitus type II: oral agents & insulin\n+ Atrial Fibrillation\n+ Hypertension$Input3": {}
+                },
+                "may be a family history$Cause_1": {
+                    "Father MI in late, Mother DM$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation\r is  a sign of NSTE-ACS$Cause_1": {
+                "ECG\uff1anon-ST-elevation$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Possible mitral regurgitation$Cause_1": {
+                    "Trivial mitral regurgitation is seen.$Input6": {}
+                },
+                "Chest pain is the mainly clinical presentation$Cause_1": {
+                    "patient reported epigastric pressure while at rest which was non-radiating. Pain started while sitting, then lasted until he fell$Input2": {}
+                },
+                "Chest pain is a clinical presentation$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "DM, AFib and HTN etc are the risk factors of ACS$Cause_1": {
+                    "He is a Male w/ DM, AFib and HTN who presented to ED w/ one day of epigastric pain, EKG changes, and a troponin leak$Input2": {}
+                },
+                "DM, AFib and HTN etc are the risk factors.$Cause_1": {
+                    "+ Diabetes mellitus type II: oral agents & insulin\n+ Atrial Fibrillation\n+ Hypertension$Input3": {}
+                },
+                "may be a family history$Cause_1": {
+                    "Father MI in late, Mother DM$Input4": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "transient ST-segment elevation, persistent or transient ST-segment depression, and T wave abnormalities, including hyperacute T waves, T wave inversion, biphasic T waves, flat T waves.$Cause_1": {
+                    "Sinus rhythm. ST segment elevation in leads III and possibly lead aVF. T wave inversions in leads V4-V6. ST segment depressions in leads I and V6 consistent with acute ischemia or an infarction. No previous tracing available for comparison.$Input6": {}
+                },
+                "transient ST-segment elevation, persistent or transient ST-segment depression, and T wave abnormalities, including hyperacute T waves, T wave inversion, biphasic T waves, flat T waves, and pseudonormalization of T waves.$Cause_1": {
+                    "Sinus Rhythm at 75 ant/septal and lateral ST-T changes, ST elevation in III, and + TWI.$Input2": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Possible mitral regurgitation$Cause_1": {
+                        "Trivial mitral regurgitation is seen.$Input6": {}
+                    },
+                    "Chest pain is the mainly clinical presentation$Cause_1": {
+                        "patient reported epigastric pressure while at rest which was non-radiating. Pain started while sitting, then lasted until he fell$Input2": {}
+                    },
+                    "Chest pain is a clinical presentation$Cause_1": {
+                        "Chest Pain$Input1": {}
+                    },
+                    "DM, AFib and HTN etc are the risk factors of ACS$Cause_1": {
+                        "He is a Male w/ DM, AFib and HTN who presented to ED w/ one day of epigastric pain, EKG changes, and a troponin leak$Input2": {}
+                    },
+                    "DM, AFib and HTN etc are the risk factors.$Cause_1": {
+                        "+ Diabetes mellitus type II: oral agents & insulin\n+ Atrial Fibrillation\n+ Hypertension$Input3": {}
+                    },
+                    "may be a family history$Cause_1": {
+                        "Father MI in late, Mother DM$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest Pain\n",
+    "input2": "He is a Male w/ DM, AFib and HTN who presented to ED w/ one day of epigastric pain, EKG changes, and a troponin leak most consistent with Acute coronary syndrome.\n\nIn ED, patient reported epigastric pressure while at rest which was non-radiating. Pain started while sitting, then lasted until he fell). Patient noted similar pain the morning of admission after taking daily medications. He took ASA 325 mg at home with complete relief of symptoms. Denied pain on exertion, SOB, N/V, or diaphoresis. \n\nED Course: \nInitial Vitals: pain HR 74  140/82  15  94%. \nTrop: 0.27, INR of 1.0 and hemeoccult neg, will start heparin. \nEKG: Sinus Rhythm at 75 ant/septal and lateral ST-T changes, ST elevation in III, and + TWI. Cards consult: dx NSTEMI vs missed STEMI, admit, cath in AM. Heparin gtt initiated; guaiac neg At time of transfer to floor vitals were: 98.4  HR 57  122/67 21 95% RA \n\nOn arrival to floor, patient denies any chest pain, abdominal pain, or dyspnea. Overall, feels well.\n\nROS: + diarrhea x1 month with some normal BM's usually after takes meds; Otherwise full 10 pt review of systems negative except for above. Of note, no denies any abdominal pain, dyspnea, fever, nausea or vomiting.\n",
+    "input3": "+ Diabetes mellitus type II: oral agents & insulin\n+ Atrial Fibrillation\n+ Hypertension\n",
+    "input4": "Father MI in late, Mother DM\n",
+    "input5": "Admission Physical Exam:\nVS:  98.0  122/80  HR 70  sat 98% on RA;  weight 92 kg\nGen: NAD\nHEENT: clear OP\nCV: NR, RR, no murmur\nPulm: CTAB, nonlabored\nAbd: soft, NT, ND\nGU: no Foley\nExt: no edema\nSkin: no lesions noted\nNeuro: no gross deficits, A&Ox3\nPsych: appropriate\n",
+    "input6": "Admission Labs:\n___ 03:23PM   ___ PTT-30.3 ___\n___ 03:23PM   PLT COUNT-260\n___ 03:23PM   NEUTS-77.3* LYMPHS-16.7* MONOS-4.7 EOS-0.3 BASOS-1.0\n___ 03:23PM   WBC-9.5 RBC-4.66 HGB-15.0 HCT-43.6 MCV-94 MCH-32.2* MCHC-34.4 RDW-12.9\n___ 03:23PM   cTropnT-0.27*\n___ 03:23PM   estGFR-Using this\n___ 03:23PM   GLUCOSE-286* UREA N-16 CREAT-0.8 SODIUM-138 POTASSIUM-4.4 CHLORIDE-102 TOTAL CO2-26 ANION GAP-14\n___ 09:45PM   cTropnT-1.77*\n___:37PM   PTT-52.7*\n\nImaging/Studies:\n# CXR: IMPRESSION: No evidence of an acute cardiopulmonary process.\n# ECG: Sinus rhythm. ST segment elevation in leads III and possibly lead aVF. T wave inversions in leads V4-V6. ST segment depressions in leads I and V6 consistent with acute ischemia or an infarction. No previous tracing available for comparison. \n# ECG: Sinus rhythm. Similar to tracing #1.\n# ECG: Sinus rhythm with partial resolution of the ST-T wave abnormalities in the anterolateral wall. \n# ECG: Sinus rhythm. Similar to tracing #3.\nECG\uff1anon-ST-elevation\n\nFindings\nESTIMATED blood loss: < 50 cc\nHemodynamics (see above): Coronary angiography:  right dominant\nLMCA:  Mild diffuse\nLAD:  Proximal diffuse 30%; Mid 40%; Calcified;\nLCX:  Diffuse disease with mid 40%;\nRCA:  Heavily calcified; Severe diffuse ectasia and tortuosity;Lesion severity difficult to assess due to tortuosity;  Visual estimate is 60-70% proximal, 70% mid and 60-70% distal.\n\n# Trans-thoracic Echocardiogram:\nThe left atrium is mildly dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is low normal (LVEF 50%) secondary to apical hypokinesis with focal apical dyskinesis. The inferior and posterior walls (suboptimally visualized) may also be hypokinetic. Right ventricular chamber size and free wall motion are normal. There are focal calcifications in the aortic arch. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. The left ventricular inflow pattern suggests impaired relaxation. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion.\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17105161-DS-12.json

@@ -0,0 +1,87 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "CK-MB-41* MB Indx-7.2* cTropnT-1.63*$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "CK-MB-57* MB Indx-8.6* cTropnT-2.08*$Input6": {}
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "There is likely underlying complete heart block with demand ventricular pacing. Findings are similar to tracing #1.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "Patient trying to fall asleep when she developed chest pressure with radiation to back and both shoulders, associated with nausea, and later felt clammy.\n isa sign of acs$Cause_1": {
+                    "Patient trying to fall asleep when she developed chest pressure with radiation to back and both shoulders, associated with nausea, and later felt clammy.$Input2": {}
+                },
+                "Hypertension is a risk factor$Cause_1": {
+                    "Hypertension$Input3": {}
+                },
+                "Atrial fibrillation s/p ablation is a risk factor$Cause_1": {
+                    "Atrial fibrillation s/p ablation$Input3": {}
+                },
+                "Bradycardia s/p dual-chamber permanent pacemaker is a risk factor$Cause_1": {
+                    "Bradycardia s/p dual-chamber permanent pacemaker$Input3": {}
+                },
+                "CHF (unknown EF is a risk factor$Cause_1": {
+                    "CHF (unknown EF$Input3": {}
+                },
+                "Asthma (never intubated) is a risk factor$Cause_1": {
+                    "Asthma (never intubated)$Input3": {}
+                },
+                "Hypothyroidism is a risk factor$Cause_1": {
+                    "Hypothyroidism$Input3": {}
+                },
+                "Anxietyis a risk factor$Cause_1": {
+                    "Anxiety$Input3": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "with atrial fibrillation status post ablation, heart block s/p pacemaker (with EF at most 40%, per pt report) presents with gradual onset of substernal chest pressure that radiates to her back.$Input2": {}
+                },
+                "The atrial flutter waves are more defined. is a strongly sign of acs$Cause_1": {
+                    "EKG: The atrial flutter waves are more defined.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "Chest pain$Input1": {}
+                    },
+                    "Patient trying to fall asleep when she developed chest pressure with radiation to back and both shoulders, associated with nausea, and later felt clammy.\n isa sign of acs$Cause_1": {
+                        "Patient trying to fall asleep when she developed chest pressure with radiation to back and both shoulders, associated with nausea, and later felt clammy.$Input2": {}
+                    },
+                    "Hypertension is a risk factor$Cause_1": {
+                        "Hypertension$Input3": {}
+                    },
+                    "Atrial fibrillation s/p ablation is a risk factor$Cause_1": {
+                        "Atrial fibrillation s/p ablation$Input3": {}
+                    },
+                    "Bradycardia s/p dual-chamber permanent pacemaker is a risk factor$Cause_1": {
+                        "Bradycardia s/p dual-chamber permanent pacemaker$Input3": {}
+                    },
+                    "CHF (unknown EF is a risk factor$Cause_1": {
+                        "CHF (unknown EF$Input3": {}
+                    },
+                    "Asthma (never intubated) is a risk factor$Cause_1": {
+                        "Asthma (never intubated)$Input3": {}
+                    },
+                    "Hypothyroidism is a risk factor$Cause_1": {
+                        "Hypothyroidism$Input3": {}
+                    },
+                    "Anxietyis a risk factor$Cause_1": {
+                        "Anxiety$Input3": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "with atrial fibrillation status post ablation, heart block s/p pacemaker (with EF at most 40%, per pt report) presents with gradual onset of substernal chest pressure that radiates to her back. Patient trying to fall asleep when she developed chest pressure with radiation to back and both shoulders, associated with nausea, and later felt clammy. Pressure was ongoing from 9:30PM, unrelieved by SLNTG x 3 in ambulance, and finally subsided after morphine 5mg given ~1AM in ED. The only other time she has had this kind of chest pressure, when a catheterization showed \"no obstructions or clots.\"  Patient denies any shortness of breath, vomiting, abdominal pain, fevers, chills, cough. Patient did have a recent car trip.\n",
+    "input3": "+ Hypertension\n+ Dyslipidemia\n+ Atrial fibrillation s/p ablation\n+ Bradycardia s/p dual-chamber permanent pacemaker\n+ Bilateral subdural hematoma while on warfarin for Afib, s/p \ncraniotomy\n+ CHF (unknown EF)\n+ Asthma (never intubated)\n+ Carcinoid s/p proximal colon and appendix resection\n+ Temporal arteritis\n+ Diverticulitis c/b abscess, s/p resection\n+ Hypothyroidism\n+ Anxiety\n",
+    "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n",
+    "input5": "ADMISSION\nVS: 97.6  159/86-170/93  72  14  94%RA\nGeneral: WDWN woman appearing stated age in no distress\nHEENT: MMM, OP clear  \nNeck: no JVD appreciated  \nCV: RRR, nl S1, loud S2, no murmur appreciated\nLungs: trace inspiratory crackles and faint expiratory wheeze on left\nAbdomen: soft, NT, normoactive BS, vertical scar below umbilicus\nGU: no foley\nExt: warm, no edema  \nNeuro: Pt with slight droop of left face, however appears normal to her husband. nerve strength equal bilaterally. \nstrength in  upper and lower compartments bilaterally. \nSkin: no rashes noted\nPULSES: 2+ DP pulses\n",
+    "input6": "ADMISSION LABS\n01:25AM BLOOD WBC-10.2 RBC-4.33 Hgb-13.0 Hct-39.9 \nMCV-92 MCH-30.0 MCHC-32.6 RDW-13.2\n01:25AM BLOOD Neuts-79.6* Lymphs-12.4* Monos-3.4 \nEos-3.7 Baso-0.9\n01:25AM BLOOD Glucose-167* UreaN-25* Creat-1.0 Na-136 \nK-3.8 Cl-100 HCO3-25 AnGap-15\n07:10AM BLOOD Calcium-9.3 Phos-4.1 Mg-2.0\n01:25AM BLOOD cTropnT-<0.01\n07:10AM BLOOD cTropnT-0.14*\n02:44PM BLOOD CK-MB-57* MB Indx-8.6* cTropnT-2.08*\n09:56PM BLOOD CK-MB-41* MB Indx-7.2* cTropnT-1.63*\n07:40AM BLOOD CK-MB-24* MB Indx-6.0 cTropnT-1.11*\n07:40AM BLOOD Cholest-111\n07:40AM BLOOD HDL-41 CHOL/HD-2.7\n03:10PM BLOOD %HbA1c-6.1* eAG-128*\n07:40AM BLOOD TSH-4.1\n\ufeff\nEKG: Extensive baseline artifact precludes accurate rhythm identification. It is a ventricularly paced rhythm and the atrial mechanism appears to be an atrial flutter versus tachycardia with variable block. No previous tracing available for comparison.\n\ufeff\nEKG: The atrial flutter waves are more defined. The ventricular rhythm remains paced given the regular ventricular rate of 65 beats per minute. There is likely underlying complete heart block with demand ventricular pacing. Findings are similar to tracing #1.\n\ufeff\nCXR: FINDINGS:  Portable upright frontal view of the \nchest.  A dual-chamber cardiac pacer is present.  There is moderate \ncardiomegaly, and an unfolded, slightly tortuous aorta.  There are coarse increased interstitial markings throughout both lung bases, consistent with mild interstitial edema. There is no overt pulmonary edema. lines are noted and could reflect chronic CHF. Increased retrocardiac density may represent a combination of atelectasis and CHF findings.  No definite focal consolidation. No pleural effusion or pneumothorax is detected.   Incidental note made of soft tissue anchor over left humeral head.\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17132866-DS-21.json

@@ -0,0 +1,144 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L$Cause_1": {
+            "BLOOD CK-MB-9 cTropnT-0.23*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain, shortness of breath\n is a symptom of ACS.$Cause_1": {
+                "Chest pain, shortness of breath$Input1": {}
+            },
+            "he awoke w left sided arm and chest pain, mild, not a/w SOB.\n is sign of acs$Cause_1": {
+                "2d later while at home he awoke w left sided arm and chest pain, mild, not a/w SOB.$Input2": {}
+            },
+            "Diabetes is a risk factor$Cause_1": {
+                "Diabetes$Input3": {}
+            },
+            "Dyslipidemia is a risk factor$Cause_1": {
+                "Dyslipidemia$Input3": {}
+            },
+            "Hypertension is a risk factorv$Cause_1": {
+                "Hypertension$Input3": {}
+            },
+            "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE is a risk factor$Cause_1": {
+                "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE$Input3": {}
+            },
+            "NEPHROPATHY - DIABETIC stage 3 CKD is a risk factor$Cause_1": {
+                "NEPHROPATHY - DIABETIC stage 3 CKD$Input3": {}
+            },
+            "HYPERLIPIDEMIA is a risk factor$Cause_1": {
+                "HYPERLIPIDEMIA$Input3": {}
+            },
+            "DM - TYPE 1 DIABETES MELLITUS is a risk factor$Cause_1": {
+                "DM - TYPE 1 DIABETES MELLITUS$Input3": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "hx single vessel CAD s/p BMS$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain, shortness of breath\n is a symptom of ACS.$Cause_1": {
+                    "Chest pain, shortness of breath$Input1": {}
+                },
+                "he awoke w left sided arm and chest pain, mild, not a/w SOB.\n is sign of acs$Cause_1": {
+                    "2d later while at home he awoke w left sided arm and chest pain, mild, not a/w SOB.$Input2": {}
+                },
+                "Diabetes is a risk factor$Cause_1": {
+                    "Diabetes$Input3": {}
+                },
+                "Dyslipidemia is a risk factor$Cause_1": {
+                    "Dyslipidemia$Input3": {}
+                },
+                "Hypertension is a risk factorv$Cause_1": {
+                    "Hypertension$Input3": {}
+                },
+                "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE is a risk factor$Cause_1": {
+                    "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE$Input3": {}
+                },
+                "NEPHROPATHY - DIABETIC stage 3 CKD is a risk factor$Cause_1": {
+                    "NEPHROPATHY - DIABETIC stage 3 CKD$Input3": {}
+                },
+                "HYPERLIPIDEMIA is a risk factor$Cause_1": {
+                    "HYPERLIPIDEMIA$Input3": {}
+                },
+                "DM - TYPE 1 DIABETES MELLITUS is a risk factor$Cause_1": {
+                    "DM - TYPE 1 DIABETES MELLITUS$Input3": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "EKG w new TWI inferiorly, obs'd for 2 sets.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain, shortness of breath\n is a symptom of ACS.$Cause_1": {
+                    "Chest pain, shortness of breath$Input1": {}
+                },
+                "he awoke w left sided arm and chest pain, mild, not a/w SOB.\n is sign of acs$Cause_1": {
+                    "2d later while at home he awoke w left sided arm and chest pain, mild, not a/w SOB.$Input2": {}
+                },
+                "Diabetes is a risk factor$Cause_1": {
+                    "Diabetes$Input3": {}
+                },
+                "Dyslipidemia is a risk factor$Cause_1": {
+                    "Dyslipidemia$Input3": {}
+                },
+                "Hypertension is a risk factorv$Cause_1": {
+                    "Hypertension$Input3": {}
+                },
+                "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE is a risk factor$Cause_1": {
+                    "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE$Input3": {}
+                },
+                "NEPHROPATHY - DIABETIC stage 3 CKD is a risk factor$Cause_1": {
+                    "NEPHROPATHY - DIABETIC stage 3 CKD$Input3": {}
+                },
+                "HYPERLIPIDEMIA is a risk factor$Cause_1": {
+                    "HYPERLIPIDEMIA$Input3": {}
+                },
+                "DM - TYPE 1 DIABETES MELLITUS is a risk factor$Cause_1": {
+                    "DM - TYPE 1 DIABETES MELLITUS$Input3": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "hx single vessel CAD s/p BMS$Input2": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest pain, shortness of breath\n is a symptom of ACS.$Cause_1": {
+                        "Chest pain, shortness of breath$Input1": {}
+                    },
+                    "he awoke w left sided arm and chest pain, mild, not a/w SOB.\n is sign of acs$Cause_1": {
+                        "2d later while at home he awoke w left sided arm and chest pain, mild, not a/w SOB.$Input2": {}
+                    },
+                    "Diabetes is a risk factor$Cause_1": {
+                        "Diabetes$Input3": {}
+                    },
+                    "Dyslipidemia is a risk factor$Cause_1": {
+                        "Dyslipidemia$Input3": {}
+                    },
+                    "Hypertension is a risk factorv$Cause_1": {
+                        "Hypertension$Input3": {}
+                    },
+                    "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE is a risk factor$Cause_1": {
+                        "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE$Input3": {}
+                    },
+                    "NEPHROPATHY - DIABETIC stage 3 CKD is a risk factor$Cause_1": {
+                        "NEPHROPATHY - DIABETIC stage 3 CKD$Input3": {}
+                    },
+                    "HYPERLIPIDEMIA is a risk factor$Cause_1": {
+                        "HYPERLIPIDEMIA$Input3": {}
+                    },
+                    "DM - TYPE 1 DIABETES MELLITUS is a risk factor$Cause_1": {
+                        "DM - TYPE 1 DIABETES MELLITUS$Input3": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain, shortness of breath\n",
+    "input2": "hx single vessel CAD s/p BMS, DM1 on insulin pump, HTN, HLP, CKD, legally blind who is s/p cataract surgery with trabeculectomy. 2d later while at home he awoke w left sided arm and chest pain, mild, not a/w SOB. Noted his BS to be in the 400-500s that morning, and went to hosptial for eval. There, initial trop 0.02, EKG w new TWI inferiorly, obs'd for 2 sets. Per pt he stopped all of his cardiac meds (except insulin) for unclear reasons. Was given ASA 325, plavix 75 (not loaded), metop, atorva and heparin gtt and transferred here.  On the floor he has no acute complaints.\n",
+    "input3": "+ Diabetes\n+ Dyslipidemia\n+ Hypertension  \n+ CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE  \n+ SEIZURE DISORDER, UNSPEC  \n+ OSTEOARTHRITIS, UNSPEC  \n+ CATARACT, UNSPEC  \n+ NEPHROPATHY - DIABETIC stage 3 CKD  \n+ HYPERLIPIDEMIA  \n+ VITREOUS HEMORRHAGE  \n+ DM - TYPE 1 DIABETES MELLITUS  \n+ NEUROPATHY - DIABETIC\n",
+    "input4": "No DM in family. Reports no medical illnesses in his family\n",
+    "input5": "Vitals - 98.5 132/77 59 95%RA  \nGENERAL: NAD  \nHEENT: AT/NC, EOMI  \nNECK: no JVD  \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs  \nLUNG: CTAB, no wheezes, rales, rhonchi  \nABDOMEN: nondistended, +BS, nontender in all quadrants  \nEXTREMITIES: moving all extremities well, no cyanosis, clubbing \nor edema  \nPULSES: 2+ DP pulses bilaterally  \nNEURO: grossly intact  \nSKIN: warm and well perfused, no excoriations or lesions, no \nrashes\n",
+    "input6": "07:00AM BLOOD WBC-4.4 RBC-3.70* Hgb-12.4* Hct-39.8* \nMCV-108* MCH-33.5* MCHC-31.2 RDW-12.2\n07:00AM BLOOD UreaN-22* Creat-1.2 Na-137 K-5.0 Cl-104 \nHCO3-25 AnGap-13\n12:00AM BLOOD CK-MB-9 cTropnT-0.23*\n\ufeff\n07:10AM BLOOD UreaN-24* Creat-1.4* Na-136 K-3.8 Cl-98 \nHCO3-26 AnGap-16\n11:31PM BLOOD CK-MB-12* cTropnT-0.35*\n06:55AM BLOOD CK-MB-120* cTropnT-1.61*\n07:00AM BLOOD CK-MB-82* cTropnT-3.86*\n07:10AM BLOOD CK-MB-25*  cTropnT-2.65*\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17183564-DS-13.json

@@ -0,0 +1,108 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "cTropnT-0.60*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "Chest Pain$Input1": {}
+            },
+            "PMHx of HTN and chronic hepatitis are risk facts and Chest Pain is a symptom of ACS$Cause_1": {
+                "a man with PMHx of HTN and chronic hepatitis C who presents with substernal chest pain.$Input2": {}
+            },
+            "experience chest pain is a symptom of ACS.$Cause_1": {
+                "The patient reports that he was sitting in a recliner this AM drinking coffee, when he began to experience chest pain. The pain dissipated sponatneously after a few minutes, and then returned for approximately 30 minutes.$Input2": {}
+            },
+            "HTN is a risk factor$Cause_1": {
+                "HTN$Input3": {}
+            },
+            "Chronic hepatitis C\n is a risk factor$Cause_1": {
+                "Chronic hepatitis C$Input3": {}
+            },
+            "father deceased before, h/o alcoholism and pancreatitis is a risk fact$Cause_1": {
+                "father deceased before, h/o alcoholism and pancreatitis$Input4": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "acute thrombotic 1 vessel coronary artery disease is a strongly sign of acs$Cause_1": {
+                "Selective coronary angiography in this right dominant system demonstrated acute thrombotic 1 vessel coronary artery disease.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "PMHx of HTN and chronic hepatitis are risk facts and Chest Pain is a symptom of ACS$Cause_1": {
+                    "a man with PMHx of HTN and chronic hepatitis C who presents with substernal chest pain.$Input2": {}
+                },
+                "experience chest pain is a symptom of ACS.$Cause_1": {
+                    "The patient reports that he was sitting in a recliner this AM drinking coffee, when he began to experience chest pain. The pain dissipated sponatneously after a few minutes, and then returned for approximately 30 minutes.$Input2": {}
+                },
+                "HTN is a risk factor$Cause_1": {
+                    "HTN$Input3": {}
+                },
+                "Chronic hepatitis C\n is a risk factor$Cause_1": {
+                    "Chronic hepatitis C$Input3": {}
+                },
+                "father deceased before, h/o alcoholism and pancreatitis is a risk fact$Cause_1": {
+                    "father deceased before, h/o alcoholism and pancreatitis$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "ECG:non-ST-elevation$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "PMHx of HTN and chronic hepatitis are risk facts and Chest Pain is a symptom of ACS$Cause_1": {
+                    "a man with PMHx of HTN and chronic hepatitis C who presents with substernal chest pain.$Input2": {}
+                },
+                "experience chest pain is a symptom of ACS.$Cause_1": {
+                    "The patient reports that he was sitting in a recliner this AM drinking coffee, when he began to experience chest pain. The pain dissipated sponatneously after a few minutes, and then returned for approximately 30 minutes.$Input2": {}
+                },
+                "HTN is a risk factor$Cause_1": {
+                    "HTN$Input3": {}
+                },
+                "Chronic hepatitis C\n is a risk factor$Cause_1": {
+                    "Chronic hepatitis C$Input3": {}
+                },
+                "father deceased before, h/o alcoholism and pancreatitis is a risk fact$Cause_1": {
+                    "father deceased before, h/o alcoholism and pancreatitis$Input4": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "acute thrombotic 1 vessel coronary artery disease is a strongly sign of acs$Cause_1": {
+                    "Selective coronary angiography in this right dominant system demonstrated acute thrombotic 1 vessel coronary artery disease.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "Chest Pain$Input1": {}
+                    },
+                    "PMHx of HTN and chronic hepatitis are risk facts and Chest Pain is a symptom of ACS$Cause_1": {
+                        "a man with PMHx of HTN and chronic hepatitis C who presents with substernal chest pain.$Input2": {}
+                    },
+                    "experience chest pain is a symptom of ACS.$Cause_1": {
+                        "The patient reports that he was sitting in a recliner this AM drinking coffee, when he began to experience chest pain. The pain dissipated sponatneously after a few minutes, and then returned for approximately 30 minutes.$Input2": {}
+                    },
+                    "HTN is a risk factor$Cause_1": {
+                        "HTN$Input3": {}
+                    },
+                    "Chronic hepatitis C\n is a risk factor$Cause_1": {
+                        "Chronic hepatitis C$Input3": {}
+                    },
+                    "father deceased before, h/o alcoholism and pancreatitis is a risk fact$Cause_1": {
+                        "father deceased before, h/o alcoholism and pancreatitis$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest Pain\n",
+    "input2": "a man with PMHx of HTN and chronic hepatitis C who presents with substernal chest pain. The patient reports that he was sitting in a recliner this AM drinking coffee, when he began to experience chest pain. The pain dissipated sponatneously after a few minutes, and then returned for approximately 30 minutes. The pain resolved immediately with nitro and aspirin administered by the EMTs. Reports tingling down both extremities and associated diaphoresis and shortness of breath. Denies nausea, vomiting, palpitations, and loss of conscioussness. The patient reports no cardiac history, and has never experienced chest pain like this before.\n",
+    "input3": "+ HTN\n+ Chronic hepatitis C\n+ h/o H. pylori\n+ h/o bacterial PNA\n+ h/o acute pancreatitis\n+ s/p lap cholecystectomy\n",
+    "input4": "father deceased before, h/o alcoholism and pancreatitis\n",
+    "input5": "VS -  98.9  134/82  59  97% RA\nGen: WDWN middle aged male in NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: PERRL, EOMI.   \nNeck: Supple.\nCV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \n \nChest: Resp were unlabored, no accessory muscle use. CTAB anteriorly.\nAbd: Soft, NTND. No HSM or tenderness. \nExt: No c/c/e. No femoral bruits. No hematoma.\n",
+    "input6": "Labs:\n06:20AM BLOOD WBC-5.6 RBC-4.43* Hgb-13.9* Hct-40.7 MCV-92 MCH-31.3 MCHC-34.0 RDW-13.1\n06:20AM BLOOD Neuts-53.1 Monos-4.1 Eos-1.4 Baso-1.1\n06:20AM BLOOD Glucose-120* UreaN-21* Creat-1.0 Na-140 \nK-3.9 Cl-107 HCO3-27 AnGap-10\n06:20AM BLOOD cTropnT-0.60*\n06:20AM BLOOD CK-MB-3 cTropnT-0.09*\n06:20AM BLOOD Triglyc-128 HDL-38 CHOL/HD-3.8 LDLcalc-81\n\ufeff\nCath Report:\n1.  Selective coronary angiography in this right dominant system demonstrated acute thrombotic 1 vessel coronary artery disease.  The LMCA, LAD, and LCx had no angiographically apparent flow-limiting disease.  The RCA had a 90% proximal stenosis with extensive thrombus,as well as a 70% mid to distal segment stenosis.\n2.  Limited resting hemodynamics revealed mild systemic systolic arterial hypertension with an SBP of 145 mmHg.\n3.  Successful angiojet/PTCA/stenting of the mid and distal RCA: the mid-distal RCA was stented with a VISIOn 3.5x12mm bare-metal stent (BMS) and post-dilated with an NC Quantum Apex MR 3.75x20mm balloon and the mid RCA was stented with a VISION 3.5x28mm BMS and then postdilated with an NC Quantum Apex OTW 4.0x20mm balloon. Final angiography revealed 0%residual stenosis, no angiographically apparent dissection and normal flow.\n4. femoral artery angioseal closure device deployed without complications.\n\nECG:non-ST-elevation\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17357689-DS-2.json

@@ -0,0 +1,147 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "BLOOD CK-MB-20* MB Indx-9.4* cTropnT-0.18*$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "BLOOD CK-MB-16* MB Indx-9.7* cTropnT-0.17*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "T2DM, HTN are risk facts$Cause_1": {
+                "with T2DM, HTN who presents with exertional chest tightness and dyspnea x3 days.$Input2": {}
+            },
+            "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.\n is signs of acs$Cause_1": {
+                "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.$Input2": {}
+            },
+            "HTN is a risk factor$Cause_1": {
+                "HTN$Input3": {}
+            },
+            "T2DM is a risk factor$Cause_1": {
+                "T2DM$Input3": {}
+            },
+            "Hypercholesterolemia is a risk factor$Cause_1": {
+                "Hypercholesterolemia$Input3": {}
+            },
+            "Family history:Brothers x2 w/ CABG  is a big risk factor$Cause_1": {
+                "Brothers x2 w/ CABG$Input4": {}
+            },
+            "Family history:Sister with MI  is a big risk factor$Cause_1": {
+                "Sister with MI$Input4": {}
+            },
+            "Family history:Father died of MI  is a big risk factor$Cause_1": {
+                "Father died of MI$Input4": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "Compared to tracing xx wave abnormalities. The small Q waves are unchanged. Clinical correlation is suggested.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "T2DM, HTN are risk facts$Cause_1": {
+                    "with T2DM, HTN who presents with exertional chest tightness and dyspnea x3 days.$Input2": {}
+                },
+                "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.\n is signs of acs$Cause_1": {
+                    "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.$Input2": {}
+                },
+                "HTN is a risk factor$Cause_1": {
+                    "HTN$Input3": {}
+                },
+                "T2DM is a risk factor$Cause_1": {
+                    "T2DM$Input3": {}
+                },
+                "Hypercholesterolemia is a risk factor$Cause_1": {
+                    "Hypercholesterolemia$Input3": {}
+                },
+                "Family history:Brothers x2 w/ CABG  is a big risk factor$Cause_1": {
+                    "Brothers x2 w/ CABG$Input4": {}
+                },
+                "Family history:Sister with MI  is a big risk factor$Cause_1": {
+                    "Sister with MI$Input4": {}
+                },
+                "Family history:Father died of MI  is a big risk factor$Cause_1": {
+                    "Father died of MI$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "EKG: Sinus rhythm. Modest inferolateral ST-T wave abnormalities. Cannot rule out myocardial ischemia. Prominent early R wave progression. No previous tracing available for comparison. Clinical correlation is suggested.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "T2DM, HTN are risk facts$Cause_1": {
+                    "with T2DM, HTN who presents with exertional chest tightness and dyspnea x3 days.$Input2": {}
+                },
+                "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.\n is signs of acs$Cause_1": {
+                    "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.$Input2": {}
+                },
+                "HTN is a risk factor$Cause_1": {
+                    "HTN$Input3": {}
+                },
+                "T2DM is a risk factor$Cause_1": {
+                    "T2DM$Input3": {}
+                },
+                "Hypercholesterolemia is a risk factor$Cause_1": {
+                    "Hypercholesterolemia$Input3": {}
+                },
+                "Family history:Brothers x2 w/ CABG  is a big risk factor$Cause_1": {
+                    "Brothers x2 w/ CABG$Input4": {}
+                },
+                "Family history:Sister with MI  is a big risk factor$Cause_1": {
+                    "Sister with MI$Input4": {}
+                },
+                "Family history:Father died of MI  is a big risk factor$Cause_1": {
+                    "Father died of MI$Input4": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "Compared to tracing xx wave abnormalities. The small Q waves are unchanged. Clinical correlation is suggested.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "Chest pain$Input1": {}
+                    },
+                    "T2DM, HTN are risk facts$Cause_1": {
+                        "with T2DM, HTN who presents with exertional chest tightness and dyspnea x3 days.$Input2": {}
+                    },
+                    "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.\n is signs of acs$Cause_1": {
+                        "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.$Input2": {}
+                    },
+                    "HTN is a risk factor$Cause_1": {
+                        "HTN$Input3": {}
+                    },
+                    "T2DM is a risk factor$Cause_1": {
+                        "T2DM$Input3": {}
+                    },
+                    "Hypercholesterolemia is a risk factor$Cause_1": {
+                        "Hypercholesterolemia$Input3": {}
+                    },
+                    "Family history:Brothers x2 w/ CABG  is a big risk factor$Cause_1": {
+                        "Brothers x2 w/ CABG$Input4": {}
+                    },
+                    "Family history:Sister with MI  is a big risk factor$Cause_1": {
+                        "Sister with MI$Input4": {}
+                    },
+                    "Family history:Father died of MI  is a big risk factor$Cause_1": {
+                        "Father died of MI$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "with T2DM, HTN who presents with exertional chest tightness and dyspnea x3 days. Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm. Associated with nausea and dyspepsia. Denies vomiting, abdominal pain. Reports having had a prior stress test that showed a \"minor blockage.\" but has never had a cardiac cath. Strong FH of CAD in 1st degree relatives. pain free in the ED.\n",
+    "input3": "+ HTN\n+ T2DM\n+ Hypercholesterolemia\n+ Carpal tunnel syndrome\n+ Claudication (ABI's negative)\n",
+    "input4": "Brothers x2 w/ CABG\nSister with MI\nFather died of MI\nNo family history of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n",
+    "input5": "ADMISSION PHYSICAL EXAMINATION:  \nVS: T 98.2, 146/71, 78, 18, 100%RA\nGeneral: Middle-aged woman in NAD\nHEENT: Anicteric sclera, MMM\nNeck: No JVD\nCV: RRR w/o m/r/g\nLungs: CTAB\nAbdomen: Soft, NTND\nGU: No foley\nExt: No clubbing, cyanosis or edema \nNeuro:  A&Ox3, moving all extremities\nPULSES: 2+ radial and DP pulses bilaterally\n",
+    "input6": "==== ADMISSION LABS ====\n\ufeff\n07:00AM BLOOD WBC-9.8 RBC-4.22 Hgb-12.4 Hct-37.2 MCV-88 MCH-29.4 MCHC-33.4 RDW-13.4\n07:00AM BLOOD Neuts-75.6* Lymphs-15.7* Monos-4.8 \nEos-3.6 Baso-0.4\n07:00AM BLOOD Glucose-327* UreaN-23* Creat-0.7 Na-139 K-4.2 Cl-102 HCO3-29 AnGap-12\n05:50AM BLOOD Calcium-8.8 Phos-3.5 Mg-2.0\n\ufeff\n==== PERTINENT LABS ====\n\ufeff\n07:00AM BLOOD proBNP-429*\n07:00AM BLOOD cTropnT-0.05*\n02:00PM BLOOD cTropnT-0.12*\n07:37PM BLOOD CK-MB-20* MB Indx-9.4* cTropnT-0.18*\n___ 05:50AM BLOOD CK-MB-16* MB Indx-9.7* cTropnT-0.17*\n\ufeff\n==== IMAGING ====\n\ufeff\nCXR:\nNo acute cardiopulmonary process.\n\ufeff\nEKG: Sinus rhythm. Compared to tracing xx wave abnormalities. The small Q waves are unchanged. Clinical correlation is suggested.  \n\ufeff\nEKG: Sinus rhythm. Prominent early R wave progression. Inferior ST-T wave abnormality. Cannot rule out myocardial ischemia. Compared to the previous tracing there is no significant diagnostic change. \n\ufeff\nEKG: Sinus rhythm. Modest inferolateral ST-T wave abnormalities. Cannot rule out myocardial ischemia. Prominent early R wave progression. No previous tracing available for comparison. Clinical correlation is suggested.\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17399182-DS-7.json

@@ -0,0 +1,111 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "Seen at and was reportedly found to have a troponin of 4.55 (could have been trop I?).$Input2": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L$Cause_1": {
+            "BLOOD cTropnT-0.33*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "1 week of exertional angina and dyspnea. is a sign of acs$Cause_1": {
+                "man presents emergency room today with 1 week of exertional angina and dyspnea.$Input2": {}
+            },
+            "fistula (rectal) repair is a risk factor$Cause_1": {
+                "fistula (rectal) repair$Input3": {}
+            },
+            "hemorrhoids is a risk factor$Cause_1": {
+                "hemorrhoids$Input3": {}
+            },
+            "Family history:Mother with stroke and MI is a big risk factor$Cause_1": {
+                "Mother with stroke and MI$Input4": {}
+            },
+            "Family history:Sister with MI  is a big risk factor$Cause_1": {
+                "Sister with DM$Input4": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "Mild to moderate aortic regurgitation is seen. The mitral valve leaflets are structurally normal. Moderate (2+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "1 week of exertional angina and dyspnea. is a sign of acs$Cause_1": {
+                    "man presents emergency room today with 1 week of exertional angina and dyspnea.$Input2": {}
+                },
+                "fistula (rectal) repair is a risk factor$Cause_1": {
+                    "fistula (rectal) repair$Input3": {}
+                },
+                "hemorrhoids is a risk factor$Cause_1": {
+                    "hemorrhoids$Input3": {}
+                },
+                "Family history:Mother with stroke and MI is a big risk factor$Cause_1": {
+                    "Mother with stroke and MI$Input4": {}
+                },
+                "Family history:Sister with MI  is a big risk factor$Cause_1": {
+                    "Sister with DM$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "ECG:non-ST-elevation$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "1 week of exertional angina and dyspnea. is a sign of acs$Cause_1": {
+                    "man presents emergency room today with 1 week of exertional angina and dyspnea.$Input2": {}
+                },
+                "fistula (rectal) repair is a risk factor$Cause_1": {
+                    "fistula (rectal) repair$Input3": {}
+                },
+                "hemorrhoids is a risk factor$Cause_1": {
+                    "hemorrhoids$Input3": {}
+                },
+                "Family history:Mother with stroke and MI is a big risk factor$Cause_1": {
+                    "Mother with stroke and MI$Input4": {}
+                },
+                "Family history:Sister with MI  is a big risk factor$Cause_1": {
+                    "Sister with DM$Input4": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "Mild to moderate aortic regurgitation is seen. The mitral valve leaflets are structurally normal. Moderate (2+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "Chest pain$Input1": {}
+                    },
+                    "1 week of exertional angina and dyspnea. is a sign of acs$Cause_1": {
+                        "man presents emergency room today with 1 week of exertional angina and dyspnea.$Input2": {}
+                    },
+                    "fistula (rectal) repair is a risk factor$Cause_1": {
+                        "fistula (rectal) repair$Input3": {}
+                    },
+                    "hemorrhoids is a risk factor$Cause_1": {
+                        "hemorrhoids$Input3": {}
+                    },
+                    "Family history:Mother with stroke and MI is a big risk factor$Cause_1": {
+                        "Mother with stroke and MI$Input4": {}
+                    },
+                    "Family history:Sister with MI  is a big risk factor$Cause_1": {
+                        "Sister with DM$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "This is an otherwise healthy man presents emergency room today with 1 week of exertional angina and dyspnea. Seen at and was reportedly found to have a troponin of 4.55 (could have been trop I?). Started on heparin and given aspirin at OS, then transferred for higher level of care. \n\ufeff\nThe pt is accompanied by his son and daughter, whom are both college students. He is currently in the visiting his children and is in for 17 more days.  The son provided translation. The pt started having substernal chest pain 1 week ago, only with walking.  He has never had the pain at rest.  He denies accompanying symptoms, including diaphoresis, nausea, arm/jaw pain.\n",
+    "input3": "+ fistula (rectal) repair\n+ hemorrhoids\n",
+    "input4": "Mother with stroke and MI\nSister with DM\n",
+    "input5": "ADMISSION PHYSICAL EXAM:\n\ufeff\nVS:  1547 98.2 135/85 60 18 95 Ra \nGENERAL: WDWN. Pleasant. Accompanied by daughter and son. In NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma.  \n\ufeff\nNECK: Supple with no JVD. \nCARDIAC: PMI located in intercostal space, midclavicular \nline. RRR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts.  \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi.  \nABDOMEN: Soft, NTND. No HSM or tenderness.  \nEXTREMITIES: No c/c/e. No femoral bruits.  \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.  \nPULSES: 2+ peripheral pulses\n",
+    "input6": "ADMISSION LABS:\n=====================\n01:45PM BLOOD WBC-7.2 RBC-5.59 Hgb-15.8 Hct-47.5 MCV-85 MCH-28.3 MCHC-33.3 RDW-12.6 RDWSD-39.2\n01:45PM BLOOD Neuts-73.5* Monos-5.7 \nEos-0.4* Baso-0.1 AbsNeut-5.29 AbsLymp-1.44 AbsMono-0.41 AbsEos-0.03* AbsBaso-0.01\n01:45PM BLOOD Glucose-102* UreaN-12 Creat-1.0 Na-139 K-4.2 Cl-101 HCO3-26 AnGap-16\n01:45PM BLOOD cTropnT-0.33*\n\ufeff\nCardiovascular ECHO:\nThe left atrial volume index is normal. No atrial septal defect is seen by 2D or color Doppler. Normal left ventricular wall thickness, cavity size, and global systolic function (3D LVEF = 55 %). Right ventricular chamber size and free wall motion are normal. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. Mild to moderate aortic regurgitation is seen. The mitral valve leaflets are structurally normal. Moderate (2+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion. \n\ufeff\nIMPRESSION: Normal biventricular cavity sizes with preserved regional and global biventricular systolic function. Mild-moderate aortic regurgitation. Moderate mitral regurgitation. Mild pulmonary artery systolic hypertension.\n\nECG:non-ST-elevation \n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17409962-DS-5.json

@@ -0,0 +1,123 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L.$Cause_1": {
+            "CK-MB-12* MB Indx-3.8 cTropnT-0.33*$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L$Cause_1": {
+            "CK-MB-5 cTropnT-0.45*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "Chest Pain$Input1": {}
+            },
+            "HTN and yperlipidemia who presents with weeks of exterional chest pain.\n is a risk fact$Cause_1": {
+                "He is a gentleman with with HTN and yperlipidemia who presents with weeks of exterional chest pain.$Input2": {}
+            },
+            "he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.\n is a sign of acs$Cause_1": {
+                "atient reports that for the last two weeks he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.$Input2": {}
+            },
+            "Dyslipidemia, Hypertension is a risk factor$Cause_1": {
+                "CARDIAC RISK FACTORS: Dyslipidemia, Hypertension$Input3": {}
+            },
+            "BPH, depression is a risk factor$Cause_1": {
+                "OTHER PAST MEDICAL HISTORY: BPH, depression$Input3": {}
+            },
+            "Family history:Brother with MI  is a big risk factor$Cause_1": {
+                "Brother with MI$Input4": {}
+            },
+            "Family history:Father with MI  is a big risk factor$Cause_1": {
+                "Father with MI$Input4": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "Cardiac silhouette size is normal.  Mediastinal and hilar contours are unremarkable. No pulmonary vascular congestion is present.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "HTN and yperlipidemia who presents with weeks of exterional chest pain.\n is a risk fact$Cause_1": {
+                    "He is a gentleman with with HTN and yperlipidemia who presents with weeks of exterional chest pain.$Input2": {}
+                },
+                "he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.\n is a sign of acs$Cause_1": {
+                    "atient reports that for the last two weeks he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.$Input2": {}
+                },
+                "Dyslipidemia, Hypertension is a risk factor$Cause_1": {
+                    "CARDIAC RISK FACTORS: Dyslipidemia, Hypertension$Input3": {}
+                },
+                "BPH, depression is a risk factor$Cause_1": {
+                    "OTHER PAST MEDICAL HISTORY: BPH, depression$Input3": {}
+                },
+                "Family history:Brother with MI  is a big risk factor$Cause_1": {
+                    "Brother with MI$Input4": {}
+                },
+                "Family history:Father with MI  is a big risk factor$Cause_1": {
+                    "Father with MI$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "EKG (resident read): \nNSR 80, NA/NI, ST depressions in III, aVF, V2-3$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "HTN and yperlipidemia who presents with weeks of exterional chest pain.\n is a risk fact$Cause_1": {
+                    "He is a gentleman with with HTN and yperlipidemia who presents with weeks of exterional chest pain.$Input2": {}
+                },
+                "he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.\n is a sign of acs$Cause_1": {
+                    "atient reports that for the last two weeks he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.$Input2": {}
+                },
+                "Dyslipidemia, Hypertension is a risk factor$Cause_1": {
+                    "CARDIAC RISK FACTORS: Dyslipidemia, Hypertension$Input3": {}
+                },
+                "BPH, depression is a risk factor$Cause_1": {
+                    "OTHER PAST MEDICAL HISTORY: BPH, depression$Input3": {}
+                },
+                "Family history:Brother with MI  is a big risk factor$Cause_1": {
+                    "Brother with MI$Input4": {}
+                },
+                "Family history:Father with MI  is a big risk factor$Cause_1": {
+                    "Father with MI$Input4": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "Cardiac silhouette size is normal.  Mediastinal and hilar contours are unremarkable. No pulmonary vascular congestion is present.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "Chest Pain$Input1": {}
+                    },
+                    "HTN and yperlipidemia who presents with weeks of exterional chest pain.\n is a risk fact$Cause_1": {
+                        "He is a gentleman with with HTN and yperlipidemia who presents with weeks of exterional chest pain.$Input2": {}
+                    },
+                    "he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.\n is a sign of acs$Cause_1": {
+                        "atient reports that for the last two weeks he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.$Input2": {}
+                    },
+                    "Dyslipidemia, Hypertension is a risk factor$Cause_1": {
+                        "CARDIAC RISK FACTORS: Dyslipidemia, Hypertension$Input3": {}
+                    },
+                    "BPH, depression is a risk factor$Cause_1": {
+                        "OTHER PAST MEDICAL HISTORY: BPH, depression$Input3": {}
+                    },
+                    "Family history:Brother with MI  is a big risk factor$Cause_1": {
+                        "Brother with MI$Input4": {}
+                    },
+                    "Family history:Father with MI  is a big risk factor$Cause_1": {
+                        "Father with MI$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest Pain\n",
+    "input2": "He is a gentleman with with HTN and yperlipidemia who presents with weeks of exterional chest pain. \n\ufeff\nPatient reports that for the last two weeks he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home. He tried to continue activities despite the discomfort, which would resolve spontaneously. He has not had previous episodes of chest pain and has never needed cardiac evaluation, though he does have a strong family history of CAD. He was driving from house to company and awoke yesterday with the same chest pain; however, unlike previous episodes it did not resolve completely. This morning, he awoke with the same pain, now radiating to his back and right shoulder. He denies lightheadedness, nausea, lightheadedness, diaphoresis, SOB with these episodes of chest pain. He has had left calf pain for several years when standing for prolonged periods of time; this has not changed.\n",
+    "input3": "1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension  \n2. CARDIAC HISTORY: None  \n3. OTHER PAST MEDICAL HISTORY: BPH, depression\n",
+    "input4": "Brother with MI\nFather with MI\n",
+    "input5": "ADMISSION EXAM\nVS: 98.6 129/94 72 18 96%RA  \nGENERAL: WDWN male in NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma.  \n\ufeff\nNECK: Supple, no JVD  \nCARDIAC: PMI located in ___ intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.  \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi.  \nABDOMEN: Soft, NTND. No HSM or tenderness.  \nEXTREMITIES: No c/c/e.  \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.  \nPULSES:  \nNEURO: A & O x 3, no focal neuro deficits\n",
+    "input6": "ADMISSION LABS\n08:40PM BLOOD WBC-10.7 RBC-4.54* Hgb-14.1 Hct-40.7 MCV-90 MCH-31.0 MCHC-34.6 RDW-12.8\n08:40PM BLOOD Glucose-110* UreaN-12 Creat-0.9 Na-137 \nK-4.3 Cl-98 HCO3-25 AnGap-18\n08:40PM BLOOD CK(CPK)-344*\n05:40AM BLOOD Calcium-9.6 Phos-3.5 Mg-2.2 Cholest-358*\n08:40PM BLOOD D-Dimer-655*\n05:40AM BLOOD Triglyc-296* HDL-44 CHOL/HD-8.1 \nLDLcalc-255*\n\ufeff\nENZYMES\n08:40PM BLOOD CK-MB-15* MB Indx-4.4\n08:40PM BLOOD cTropnT-0.17*\n05:40AM BLOOD CK-MB-12* MB Indx-3.8 cTropnT-0.33*\n04:50PM BLOOD CK-MB-7 cTropnT-0.45*\n06:45AM BLOOD CK-MB-5 cTropnT-0.45*\n08:40PM BLOOD CK(CPK)-344*\n05:40AM BLOOD ALT-37 AST-53* CK(CPK)-317\n04:50PM BLOOD CK(CPK)-255\n\ufeff\nSTUDIES\nCTA\n1. No pulmonary embolus. \n2. Esophageal thickening which may represent reflux \n\ufeff\nCXR\nCardiac silhouette size is normal.  Mediastinal and hilar contours are unremarkable. No pulmonary vascular congestion is present. Aside from mild bibasilar atelectasis, the lungs are clear.  No focal consolidation, pleural effusion or pneumothorax is seen.  There are multilevel degenerative changes in the thoracic spine. IMPRESSION: No acute cardiopulmonary abnormality.  \n\ufeff\nEKG (resident read): \nNSR 80, NA/NI, ST depressions in III, aVF, V2-3\n\ufeff\nCardiac Catheterization:\nFINAL REPORT PENDING\nPLEASE SEE DISC AND PRELIM REPORT (disc and hardcopies provided to patient)\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17505744-DS-20.json

@@ -0,0 +1,108 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "but tropoin I peaked at 1.09.$Input2": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "chest pain is a symptom of ACS.$Cause_1": {
+                "chest pain$Input1": {}
+            },
+            "\"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank. is sign ofa acs$Cause_1": {
+                "she described her CP as \"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank$Input2": {}
+            },
+            "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery\n is a risk factor$Cause_1": {
+                "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery$Input3": {}
+            },
+            "AAA- 4.9cm on OSH CT extending superiorly ofof the  is a risk factor$Cause_1": {
+                "AAA- 4.9cm on OSH CT extending superiorly ofof the \nrenal arteies$Input3": {}
+            },
+            "COPD is a risk factor$Cause_1": {
+                "COPD$Input3": {}
+            },
+            "family histoy:brother and sister with MIs. is a risk fact.$Cause_1": {
+                "brother and sister with MIs.$Input4": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "OSH Echo: EF 55%, no signifiacnt valvular dz, and mild distal septal hypokinesis. Aortic root was normal in size.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "chest pain is a symptom of ACS.$Cause_1": {
+                    "chest pain$Input1": {}
+                },
+                "\"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank. is sign ofa acs$Cause_1": {
+                    "she described her CP as \"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank$Input2": {}
+                },
+                "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery\n is a risk factor$Cause_1": {
+                    "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery$Input3": {}
+                },
+                "AAA- 4.9cm on OSH CT extending superiorly ofof the  is a risk factor$Cause_1": {
+                    "AAA- 4.9cm on OSH CT extending superiorly ofof the \nrenal arteies$Input3": {}
+                },
+                "COPD is a risk factor$Cause_1": {
+                    "COPD$Input3": {}
+                },
+                "family histoy:brother and sister with MIs. is a risk fact.$Cause_1": {
+                    "brother and sister with MIs.$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "EKG: NSR, no ST changes, no q waves, TWI in V1,2,3, TW flattening V5,V6$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "chest pain is a symptom of ACS.$Cause_1": {
+                    "chest pain$Input1": {}
+                },
+                "\"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank. is sign ofa acs$Cause_1": {
+                    "she described her CP as \"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank$Input2": {}
+                },
+                "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery\n is a risk factor$Cause_1": {
+                    "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery$Input3": {}
+                },
+                "AAA- 4.9cm on OSH CT extending superiorly ofof the  is a risk factor$Cause_1": {
+                    "AAA- 4.9cm on OSH CT extending superiorly ofof the \nrenal arteies$Input3": {}
+                },
+                "COPD is a risk factor$Cause_1": {
+                    "COPD$Input3": {}
+                },
+                "family histoy:brother and sister with MIs. is a risk fact.$Cause_1": {
+                    "brother and sister with MIs.$Input4": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "OSH Echo: EF 55%, no signifiacnt valvular dz, and mild distal septal hypokinesis. Aortic root was normal in size.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "chest pain is a symptom of ACS.$Cause_1": {
+                        "chest pain$Input1": {}
+                    },
+                    "\"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank. is sign ofa acs$Cause_1": {
+                        "she described her CP as \"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank$Input2": {}
+                    },
+                    "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery\n is a risk factor$Cause_1": {
+                        "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery$Input3": {}
+                    },
+                    "AAA- 4.9cm on OSH CT extending superiorly ofof the  is a risk factor$Cause_1": {
+                        "AAA- 4.9cm on OSH CT extending superiorly ofof the \nrenal arteies$Input3": {}
+                    },
+                    "COPD is a risk factor$Cause_1": {
+                        "COPD$Input3": {}
+                    },
+                    "family histoy:brother and sister with MIs. is a risk fact.$Cause_1": {
+                        "brother and sister with MIs.$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "chest pain\n",
+    "input2": "F with h/o thoracic and abdominal aortic aneurysm with recent NSTEMI medically managed w/o intervention, now presenting with new CP begining today, transferred from OSH ED for possible cardiac cath. With pt's NSTEMI, she described her CP as \"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank. No EKG changes, but tropoin I peaked at 1.09. Echo on d/c showed EF 55%. Pt was transferred for \ntertiary care/cardiac and vascular eval, but she left AMA after being scared off by the vascular surgeon. Then today she had another episode of CP at 5am. Pt described it as similar in quality, and was brought to the ED. The CP resolved there with NTG sl. The EKG was changed from previous in now having TWI V2/3, flattening V4-6, .5 mm depression v4. She was then transferred from the ED for possible cath.  \n.  \nIn the ED, initial vitals were 97.3, 122/82, 60, 18, 99%2L pt was CP free. Currently she denies any CP, says she is a little SOB but this is chronic.  \n.  \nOn review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative.  \n.  \nCardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope\n",
+    "input3": "+ thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery  \n+ AAA- 4.9cm on OSH CT extending superiorly ofof the \nrenal arteies  \n+ COPD \n+ diffuse panlobar  \n+ h/o diverticulitis  \n+ fibromyalgia  \n+ migraine headaches  \n+ recent UTI -GNR >100,000, tx w/ levaquin\n",
+    "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death. Father was a police and was killed in duty. brother and sister with MIs.\n",
+    "input5": "VS: 97.8, 112/73, 66, 20, 98%3L  \nGENERAL: NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.  \n\n\nNECK: Supple with flat  \nCARDIAC: PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.  \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. bibasilar rales\n",
+    "input6": "Trop-T: <0.01 CK: 98 MB: Notdone  \n140 101 10  \n---------------< 90  \n3.7 29 0.5  \nMCV: 88  \n11.2  \n6.1 >------< 345  \n33.5  \nN:72 Band:0 M:6 E:1 Bas:0  \nEKG: NSR, no ST changes, no q waves, TWI in V1,2,3, TW flattening V5,V6  \n.  \nOSH Echo: EF 55%, no signifiacnt valvular dz, and mild distal septal hypokinesis. Aortic root was normal in size.\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17509032-DS-16.json

@@ -0,0 +1,72 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "CK-MB-31* cTropnT-0.25*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain is a symptom of ACS.$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "old with DM,CAD, CABG, HTN, DM, PVD, are risk facts$Cause_1": {
+                "PMH: PVD, CAD s/p MI, HTN, hyperlipidemia, DM,$Input3": {}
+            },
+            "GERD,hypothyroidism are risk facts$Cause_1": {
+                "GERD,hypothyroidism$Input3": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "CP/NSTEMI. He underwent diagnostic cath which showed occluded OM and diagonal vessels filling via collaterals and patent LIMA to LAD and SVG to PDA.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "old with DM,CAD, CABG, HTN, DM, PVD, are risk facts$Cause_1": {
+                    "PMH: PVD, CAD s/p MI, HTN, hyperlipidemia, DM,$Input3": {}
+                },
+                "GERD,hypothyroidism are risk facts$Cause_1": {
+                    "GERD,hypothyroidism$Input3": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "ECG:non-ST-elevation$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "old with DM,CAD, CABG, HTN, DM, PVD, are risk facts$Cause_1": {
+                    "PMH: PVD, CAD s/p MI, HTN, hyperlipidemia, DM,$Input3": {}
+                },
+                "GERD,hypothyroidism are risk facts$Cause_1": {
+                    "GERD,hypothyroidism$Input3": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "CP/NSTEMI. He underwent diagnostic cath which showed occluded OM and diagonal vessels filling via collaterals and patent LIMA to LAD and SVG to PDA.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest pain is a symptom of ACS.$Cause_1": {
+                        "Chest pain$Input1": {}
+                    },
+                    "old with DM,CAD, CABG, HTN, DM, PVD, are risk facts$Cause_1": {
+                        "PMH: PVD, CAD s/p MI, HTN, hyperlipidemia, DM,$Input3": {}
+                    },
+                    "GERD,hypothyroidism are risk facts$Cause_1": {
+                        "GERD,hypothyroidism$Input3": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain \n",
+    "input2": "old with DM,CAD, CABG, HTN, DM, PVD, cardiomyopathy with EF 30% and BiV ICD who was tx for a cath after NSTEMI/CP. He is s/p diagnostic cath. Left radial, which showed occluded OM and diagonal vessels filling via collaterals and patent LIMA to LAD and SVG to PDA (see cath report for details).\n",
+    "input3": "+ PMH: PVD, CAD s/p MI, HTN, hyperlipidemia, DM, \n+ GERD,hypothyroidism\n",
+    "input4": "Non-contributory\n",
+    "input5": "VS: temp 98.3 HR 59 RR 18 BP 120-61 O2 sat 96% on room air\nGen: alert, in no acute distress\nCV: RRR, S1S2, no murmurs\nLungs: CTAB\nAbd: NT, ND, soft\nExt: no edema\nNeuro: alert, oriented X3, no focal deficits\nTele: AS-VP\n",
+    "input6": "03:55PM   WBC-9.2 RBC-4.30* HGB-13.0* HCT-39.1* MCV-91 \nMCH-30.2 MCHC-33.2 RDW-13.6 RDWSD-45.4\n03:55PM   PLT COUNT-155\n03:47PM   UREA N-12 CREAT-0.7 SODIUM-137 POTASSIUM-4.1 \nCHLORIDE-104 TOTAL CO2-24 ANION GAP-13\n03:47PM   estGFR-Using this\n03:47PM   CK-MB-31* cTropnT-0.25*\n03:47PM   CALCIUM-8.8 PHOSPHATE-4.5 MAGNESIUM-1.male with DM, CAD, CM was admitted with \nCP/NSTEMI. He underwent diagnostic cath which showed occluded OM and diagonal vessels filling via collaterals and patent LIMA to LAD and SVG to PDA. He had no complications post procedure and was admitted to the telemetry floor for overnight monitoring. He had no further symptoms and is  being continued on all his home cardiac medications and started on isosorbide 30mg PO daily. His labs remained stable. He is being discharge to home today.\nECG:non-ST-elevation \n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17511292-DS-12.json

@@ -0,0 +1,114 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "BLOOD CK-MB-3 cTropnT-0.38*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain on exertion is a symptom of ACS.$Cause_1": {
+                "Chest pain on exertion$Input1": {}
+            },
+            "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.\n is sign of acs$Cause_1": {
+                "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.$Input2": {}
+            },
+            "Diabetes is a risk factor$Cause_1": {
+                "Diabetes$Input3": {}
+            },
+            "Dyslipidemia is a risk factor$Cause_1": {
+                "Dyslipidemia$Input3": {}
+            },
+            "Hypertension is a risk factor$Cause_1": {
+                "Hypertension$Input3": {}
+            },
+            "family fistory: brother has hypertension is a risk fact$Cause_1": {
+                "brother has hypertension$Input4": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "PERCUTANEOUS CORONARY INTERVENTIONS: 2 x DES to RCA per report. Most recent cath - LAD w/ 40% mid-occlusion, normal LCx, RCA w/ 99% occlusion at the origin of the PDA, and 40% occluded ramus.  \n+ PACING/ICD: pacemaker for complete heart block s/p multiple lead revisions$Input3": {}
+            },
+            "The heart structure is abnormalwhich is a strongly sign of acs\n\n\n.$Cause_1": {
+                "The large high OM1 (functionally a ramus intermedius) had a mild ostial plaque and patent stents. Flow was slightly slow and pulsatile, consistent with microvascular dysfunction.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain on exertion is a symptom of ACS.$Cause_1": {
+                    "Chest pain on exertion$Input1": {}
+                },
+                "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.\n is sign of acs$Cause_1": {
+                    "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.$Input2": {}
+                },
+                "Diabetes is a risk factor$Cause_1": {
+                    "Diabetes$Input3": {}
+                },
+                "Dyslipidemia is a risk factor$Cause_1": {
+                    "Dyslipidemia$Input3": {}
+                },
+                "Hypertension is a risk factor$Cause_1": {
+                    "Hypertension$Input3": {}
+                },
+                "family fistory: brother has hypertension is a risk fact$Cause_1": {
+                    "brother has hypertension$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "She went outside hospital had a negative EKG$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain on exertion is a symptom of ACS.$Cause_1": {
+                    "Chest pain on exertion$Input1": {}
+                },
+                "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.\n is sign of acs$Cause_1": {
+                    "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.$Input2": {}
+                },
+                "Diabetes is a risk factor$Cause_1": {
+                    "Diabetes$Input3": {}
+                },
+                "Dyslipidemia is a risk factor$Cause_1": {
+                    "Dyslipidemia$Input3": {}
+                },
+                "Hypertension is a risk factor$Cause_1": {
+                    "Hypertension$Input3": {}
+                },
+                "family fistory: brother has hypertension is a risk fact$Cause_1": {
+                    "brother has hypertension$Input4": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "PERCUTANEOUS CORONARY INTERVENTIONS: 2 x DES to RCA per report. Most recent cath - LAD w/ 40% mid-occlusion, normal LCx, RCA w/ 99% occlusion at the origin of the PDA, and 40% occluded ramus.  \n+ PACING/ICD: pacemaker for complete heart block s/p multiple lead revisions$Input3": {}
+                },
+                "The heart structure is abnormalwhich is a strongly sign of acs\n\n\n.$Cause_1": {
+                    "The large high OM1 (functionally a ramus intermedius) had a mild ostial plaque and patent stents. Flow was slightly slow and pulsatile, consistent with microvascular dysfunction.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest pain on exertion is a symptom of ACS.$Cause_1": {
+                        "Chest pain on exertion$Input1": {}
+                    },
+                    "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.\n is sign of acs$Cause_1": {
+                        "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.$Input2": {}
+                    },
+                    "Diabetes is a risk factor$Cause_1": {
+                        "Diabetes$Input3": {}
+                    },
+                    "Dyslipidemia is a risk factor$Cause_1": {
+                        "Dyslipidemia$Input3": {}
+                    },
+                    "Hypertension is a risk factor$Cause_1": {
+                        "Hypertension$Input3": {}
+                    },
+                    "family fistory: brother has hypertension is a risk fact$Cause_1": {
+                        "brother has hypertension$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain on exertion\n",
+    "input2": "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.Patient denies any shortness of breath. But does note fatigue when he gets chest pain. Patient states when he stops ambulating and improves. He denies any fevers or chills. She went outside hospital had a negative EKG \n",
+    "input3": "+ Diabetes\n+ Dyslipidemia\n+ Hypertension\n+ CABG: none\n+ PERCUTANEOUS CORONARY INTERVENTIONS: 2 x DES to RCA per report. Most recent cath - LAD w/ 40% mid-occlusion, normal LCx, RCA w/ 99% occlusion at the origin of the PDA, and 40% occluded ramus.  \n+ PACING/ICD: pacemaker for complete heart block s/p multiple lead revisions  \n+ RBBB\n+ GERD  \n+ B12 deficiency  \n+ allergic rhinitis  \n+ chronic sinusitis  \n+ AAA  \n+ peripheral neuropathy  \n+ lumbar degenerative disc disease  \n+ h/o strokes  \n+ BPH\n",
+    "input4": "-father died from liver disease  \n-mother died from complications after cholecystectomy  \n-brother has hypertension\n",
+    "input5": "Admission PE: \nVitals - T: 98.3 BP: 174-190/81-93 HR: 62 RR: 18 02 sat: 98% RA  \n\ufeff\nGENERAL: NAD  \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva, patent nares, MMM, good dentition  \nNECK: nontender supple neck, no LAD, no JVD (8cm)  \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs  \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles  \nABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding. \nEXTREMITIES: moving all extremities well, no cyanosis, clubbing or edema  \nPULSES: 2+ DP pulses bilaterally  \nNEURO: CN II-XII intact  \nSKIN: warm and well perfused, no excoriations or lesions, no rashes\n",
+    "input6": "Admission Labs: \n\ufeff\n07:00AM BLOOD WBC-5.6 RBC-4.61 Hgb-13.0* Hct-40.4 \nMCV-88 MCH-28.3 MCHC-32.3 RDW-15.0\n07:00AM BLOOD Glucose-111* UreaN-13 Creat-1.3* Na-141 \nK-3.6 Cl-106 HCO3-28 AnGap-11\n01:00AM BLOOD CK(CPK)-125\n01:00AM BLOOD CK-MB-3 cTropnT-0.08*\n07:00AM BLOOD CK-MB-3 cTropnT-0.38*\n07:00AM BLOOD Calcium-8.9 Phos-2.7 Mg-2.1\n\ufeff\nIMAGING:\n\ufeff\nCath: \nCoronary angiography: right dominant\nLMCA: The moderate long LMCA tapered to 35% distally.\nLAD: The LAD had an ostial 30% stenosis. There was a proximal-mid diffuse LAD lesion to 60% beginning just before S1. A mildly diseased segment of the mid LAD may have been intramyocardial. There was a very distal apical 75% stenosis (unchanged from previous) before the LAD wrapped around the apex in a terminal bifurcation. The distal diagonals were fairly large and long vessels. Flow in the LAD was slow, consistent with microvascular dysfunction. There were septal collaterals to the\nRPDA.\nLCX: The large high OM1 (functionally a ramus intermedius) had a mild ostial plaque and patent stents. Flow was slightly slow and pulsatile, consistent with microvascular dysfunction. The true AV groove CX was small, diffusely diseased and supplied several small OM and LPL branches, as well as several small atrial branches.\nRCA: The RCA had diffuse disease throughout the mid-distal vessel to 35% mid vessel and 45% in the mid-distal RCA. The prior stent(s) in the distal RCA before the RPDA were patent. The RPDA was subtotally occluded with 99% stenosis at its origin and minimal antegrade filling (TIMI 1), likely the culprit lesion for the current (? recent vs. subacute) NSTEMI. The AV groove RCA just after the RPDA had an 85% stenosis (distal stent edge restenosis) with TIMI 2 pulsatile flow. The RPL1 just beyond this 85% stenosis had an origin 50% stenosis. RPL2 was of modest caliber and diffusely diseased. RPL3 had a laterally oriented sidebranch. The RCA ran well up the lateral aspect of the AV\ngroove.\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17539265-DS-9.json

@@ -0,0 +1,102 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "Initial troponin was elevated to .53, which trended down to .38.$Input2": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Shortness of breath is a symptom of ACS.$Cause_1": {
+                "Shortness of breath$Input1": {}
+            },
+            "CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism\n are risk facts$Cause_1": {
+                "This is a F w/ a h/o CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism$Input2": {}
+            },
+            "CAD s/p MI, heparin stent to the RCA isrisk fact$Cause_1": {
+                "CAD s/p MI, heparin stent to the RCA$Input3": {}
+            },
+            "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema \nare risk facts$Cause_1": {
+                "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema$Input3": {}
+            },
+            "HTN is risk fact$Cause_1": {
+                "HTN$Input3": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "the patient had an inferior wall STEMI where she was found during cardiac cathaterization to have 3 vessel disease including a 70% lesion of the proximal RCA, which received a hepacoat stent.$Input2": {}
+            },
+            "The heart structure is abnormalwhich is a strongly sign of acs.$Cause_1": {
+                "Echo following this incident showed an EF, hypo to akinesis of the distal anterior septum, apex and basal/mid inferior and inferolateral segments and moderate mitral regurgitation.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Shortness of breath is a symptom of ACS.$Cause_1": {
+                    "Shortness of breath$Input1": {}
+                },
+                "CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism\n are risk facts$Cause_1": {
+                    "This is a F w/ a h/o CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism$Input2": {}
+                },
+                "CAD s/p MI, heparin stent to the RCA isrisk fact$Cause_1": {
+                    "CAD s/p MI, heparin stent to the RCA$Input3": {}
+                },
+                "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema \nare risk facts$Cause_1": {
+                    "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema$Input3": {}
+                },
+                "HTN is risk fact$Cause_1": {
+                    "HTN$Input3": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "EKG was significant for old inferior wall infarct.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Shortness of breath is a symptom of ACS.$Cause_1": {
+                    "Shortness of breath$Input1": {}
+                },
+                "CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism\n are risk facts$Cause_1": {
+                    "This is a F w/ a h/o CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism$Input2": {}
+                },
+                "CAD s/p MI, heparin stent to the RCA isrisk fact$Cause_1": {
+                    "CAD s/p MI, heparin stent to the RCA$Input3": {}
+                },
+                "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema \nare risk facts$Cause_1": {
+                    "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema$Input3": {}
+                },
+                "HTN is risk fact$Cause_1": {
+                    "HTN$Input3": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "the patient had an inferior wall STEMI where she was found during cardiac cathaterization to have 3 vessel disease including a 70% lesion of the proximal RCA, which received a hepacoat stent.$Input2": {}
+                },
+                "The heart structure is abnormalwhich is a strongly sign of acs.$Cause_1": {
+                    "Echo following this incident showed an EF, hypo to akinesis of the distal anterior septum, apex and basal/mid inferior and inferolateral segments and moderate mitral regurgitation.$Input2": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Shortness of breath is a symptom of ACS.$Cause_1": {
+                        "Shortness of breath$Input1": {}
+                    },
+                    "CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism\n are risk facts$Cause_1": {
+                        "This is a F w/ a h/o CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism$Input2": {}
+                    },
+                    "CAD s/p MI, heparin stent to the RCA isrisk fact$Cause_1": {
+                        "CAD s/p MI, heparin stent to the RCA$Input3": {}
+                    },
+                    "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema \nare risk facts$Cause_1": {
+                        "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema$Input3": {}
+                    },
+                    "HTN is risk fact$Cause_1": {
+                        "HTN$Input3": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Shortness of breath\n",
+    "input2": "This is a F w/ a h/o CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism who presents as a transfer from OSH where she initially presented with acute pulmonary edema and an elevated Troponin, now stable without dyspnea. \n\ufeff\nThe patient was in her usual state of health when she suddenly became short of breath while eating breakfast. According to her son she was not short of breath prior to this event and has been walking distances of several miles, including stairs. No orthopnea or edema in her lower extremities. She did not have any chest pain prior to or during this event and denies any angina in the past six months. She denies recent illness. \n\ufeff\nthe patient was short of breath but without chest pain. Initial CXR indicated pulmonary edema and a BNP was elevated to 341. EKG was significant for old inferior wall infarct. Initial troponin was elevated to .53, which trended down to .38. She was given 40 of IV Lasix at which time her symptoms improved significantly. She was transferred for possible cardiac cath. Upon transfer she was no longer short of breath and had no signs of fluid overload on exam. \n\ufeff\nthe patient is not short of breath and denies chest pain. Initial vitals were 84 135/93 19 96% on Room O2.\n\ufeff\nOf note the patient had an inferior wall STEMI where she was found during cardiac cathaterization to have 3 vessel disease including a 70% lesion of the proximal RCA, which received a hepacoat stent. Successful PTCA of the small rPDA was performed. she was again hospitalized following a PEA arrest which was thought to be secondary to respiratory arrest in the setting of severe CAP. She was successfully \nresuscitated using a cooling protocol, treated with antibiotics and subsequently extubated with recovery of function. At that time she was found to have a chronic type B dissection distal to the L subclavian. Echo following this incident showed an EF, hypo to akinesis of the distal anterior septum, apex and basal/mid inferior and inferolateral segments and moderate mitral regurgitation. She has been healthy since being discharged to rehab after this admission.\n",
+    "input3": "+ CAD s/p MI, heparin stent to the RCA \n+ PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema \n+ HTN\n+ HL\n+ Grave's s/p radioactive iodine ablation now on thyroid replacement\n+ Vitiligo\n",
+    "input4": "None\n",
+    "input5": "Admission Exam:\nVS- T= 98.3...BP= 135/93...HR= 84...RR= 19...O2 sat=  96% Room \nO2 \nGENERAL- WA, Asian-female, NAD, alert and oriented x 3, does not \ngive a clear history  \nHEENT- NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.  \n\ufeff\nNECK- Supple with estimated JVD of 5cm from the right atrium  \nCARDIAC- PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.  \nLUNGS- No chest wall deformities. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi.  \nABDOMEN- Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits.  \nEXTREMITIES- No c/c/e. No femoral bruits.  \nSKIN- No stasis dermatitis, ulcers, scars, or xanthomas.  \nPULSES-  \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP\nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP\n",
+    "input6": "Admission Labs:\n04:57PM BLOOD WBC-6.5 RBC-4.71# Hgb-15.4# Hct-45.8# \nMCV-97 MCH-32.7* MCHC-33.7 RDW-13.7\n\ufeff\n04:57PM BLOOD Glucose-86 UreaN-38* Creat-0.9 Na-140 \nK-4.7 Cl-104 HCO3-25 AnGap-16\n04:57PM BLOOD Calcium-10.2 Phos-4.3# Mg-2.2\n.\nCardiac Labs:\n04:57PM BLOOD CK-MB-5 cTropnT-0.06*\n06:36AM BLOOD cTropnT-0.05*\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17577620-DS-14.json

@@ -0,0 +1,108 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "cTropnT-0.33*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "chest pain is a symptom of ACS.$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "family history :male with history of CAD s/p CABG grafts patent is risk fact$Cause_1": {
+                "male with history of CAD s/p CABG grafts patent, tachybrady syndrome s/p PPM, atrial fibrillation on Coumadin, who presents with chest pain.$Input2": {}
+            },
+            "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.\nis sign of acs$Cause_1": {
+                "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.$Input2": {}
+            },
+            "CAD s/p CABG is a risk factor$Cause_1": {
+                "CAD s/p CABG$Input3": {}
+            },
+            "Hyperlipidemia is a risk factor$Cause_1": {
+                "Hyperlipidemia$Input3": {}
+            },
+            "HTN is a risk factor$Cause_1": {
+                "HTN$Input3": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "Per EMS report, en route patient began having frequent PVCs. Per initial report there was concern about wide-complex tachycardia for which patient received 150mg amiodarone.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "chest pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "family history :male with history of CAD s/p CABG grafts patent is risk fact$Cause_1": {
+                    "male with history of CAD s/p CABG grafts patent, tachybrady syndrome s/p PPM, atrial fibrillation on Coumadin, who presents with chest pain.$Input2": {}
+                },
+                "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.\nis sign of acs$Cause_1": {
+                    "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.$Input2": {}
+                },
+                "CAD s/p CABG is a risk factor$Cause_1": {
+                    "CAD s/p CABG$Input3": {}
+                },
+                "Hyperlipidemia is a risk factor$Cause_1": {
+                    "Hyperlipidemia$Input3": {}
+                },
+                "HTN is a risk factor$Cause_1": {
+                    "HTN$Input3": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "EKG was performed which showed atrial fibrillation, regular and paced beats. No change from EKG.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "chest pain is a symptom of ACS.$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "family history :male with history of CAD s/p CABG grafts patent is risk fact$Cause_1": {
+                    "male with history of CAD s/p CABG grafts patent, tachybrady syndrome s/p PPM, atrial fibrillation on Coumadin, who presents with chest pain.$Input2": {}
+                },
+                "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.\nis sign of acs$Cause_1": {
+                    "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.$Input2": {}
+                },
+                "CAD s/p CABG is a risk factor$Cause_1": {
+                    "CAD s/p CABG$Input3": {}
+                },
+                "Hyperlipidemia is a risk factor$Cause_1": {
+                    "Hyperlipidemia$Input3": {}
+                },
+                "HTN is a risk factor$Cause_1": {
+                    "HTN$Input3": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "Per EMS report, en route patient began having frequent PVCs. Per initial report there was concern about wide-complex tachycardia for which patient received 150mg amiodarone.$Input2": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "chest pain is a symptom of ACS.$Cause_1": {
+                        "Chest pain$Input1": {}
+                    },
+                    "family history :male with history of CAD s/p CABG grafts patent is risk fact$Cause_1": {
+                        "male with history of CAD s/p CABG grafts patent, tachybrady syndrome s/p PPM, atrial fibrillation on Coumadin, who presents with chest pain.$Input2": {}
+                    },
+                    "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.\nis sign of acs$Cause_1": {
+                        "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.$Input2": {}
+                    },
+                    "CAD s/p CABG is a risk factor$Cause_1": {
+                        "CAD s/p CABG$Input3": {}
+                    },
+                    "Hyperlipidemia is a risk factor$Cause_1": {
+                        "Hyperlipidemia$Input3": {}
+                    },
+                    "HTN is a risk factor$Cause_1": {
+                        "HTN$Input3": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "This is a pleasant male with history of CAD s/p CABG grafts patent, tachybrady syndrome s/p PPM, atrial fibrillation on Coumadin, who presents with chest pain. \n\ufeff\nPatient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure. The pain was not positional, not exertional, had mild associated SOB but no n/v/diaphoresis. After that time, the chest pain began improving spontaneously and by the time he went to his scheduled PCP appointment this morning, he had some remnant left sided chest pressure but his other symptoms had resolved. \n\ufeff\nAt his PCP's office, he reported these symptoms and was given SL nitro x1, aspirin 324mg, and an EKG was performed which showed atrial fibrillation, regular and paced beats. No change from EKG.\n\ufeff\nPer EMS report, en route patient began having frequent PVCs. Per initial report there was concern about wide-complex tachycardia for which patient received 150mg amiodarone. His BP was stable,no chest pain, mentating well. On review of the rhythm strips this rhythm was likely more consistent with V-pacing, heart rate of about 100 bpm rather than a wide-complex tachycardia or VT.\n\ufeff\nIn the ED, patient reported feeling well without any ongoing chest pain. \n- Initial vitals were: T 96.9 HR 97 BP 124/91 RR 18 O2 sat 97% RA\n- EKG afib/aflutter, V pacing. Normal rate. \n- Labs/studies notable for: trop 0.13, Mg 1.3, WBC 14.3. Cr at baseline 0.9. LFTs wnl. \n- Patient was given: 2g Mg\n\ufeff\nOn ROS, patient denies shortness of breath, palpitations, lightheadedness, nausea, diaphoresis, recent exertional chest pain, lower extremity edema, cough, fevers. He does state that for the past 4 or 5 days he has had several episodes of diarrhea daily, though he has a history of intermittent diarrhea for which he sees GI and this is not significantly different. Earlier in the week he had some abdominal pain that has since resolved.\n",
+    "input3": "+ PAF  \n+ CAD s/p CABG\n+ Hyperlipidemia  \n+ Colonic Adenoma  \n+ Throat CA s/p XRT completed\n+ Vocal cord polyp  \n+ Diverticulosis  \n+ HTN  \n+ Positive PPD as a child with negative CXR  \n+ GERD  \n+ Tonsillectomy  \n+ Right Inguinal Hernia Repair\n",
+    "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n",
+    "input5": "VS: T 97.9 BP 135 / 85 HR 71 RR 16 98 RA \nGENERAL: Well developed, well nourished, in NAD. Oriented x3.\nMood, affect appropriate.  \nHEENT: Normocephalic atraumatic. Sclera anicteric. PERRL. EOMI.\nNECK: Supple. No JVD. \nCARDIAC: Regular rate and rhythm. Normal S1, S2. No murmurs, rubs, or gallops. no thrills or lifts.  \nLUNGS: CTAB. Respiration is unlabored with no accessory muscle use. No crackles, wheezes or rhonchi.  \nABDOMEN: Soft, non-tender, non-distended. No HSM. \nEXTREMITIES: Warm, well perfused. Trace bilateral lower extremity\nedema. \nSKIN: No significant skin lesions or rashes.  \nPULSES: Distal pulses palpable and symmetric.\n",
+    "input6": "ADMISSION LABS\n===========================\n11:10AM BLOOD WBC-14.7* RBC-4.80 Hgb-16.1 Hct-48.7 \nMCV-102* MCH-33.5* MCHC-33.1 RDW-15.3 RDWSD-57.5*\n11:10AM BLOOD Neuts-74.7* Lymphs-15.1* Monos-7.5 Eos-0.9* Baso-0.5 AbsNeut-11.02* AbsLymp-2.22 \nAbsMono-1.11* AbsEos-0.13 AbsBaso-0.07\n11:10AM BLOOD Glucose-103* UreaN-22* Creat-0.9 Na-140 \nK-4.4 Cl-103 HCO3-22 AnGap-15\n11:10AM BLOOD CK-MB-29* MB Indx-10.3*\n11:10AM BLOOD cTropnT-0.33*\n11:10AM BLOOD Albumin-3.8 Calcium-9.8 Phos-2.9 Mg-1.3*\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17581064-DS-6.json

@@ -0,0 +1,156 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "initial troponin negative, repeat troponin elevated at 0.21,$Input2": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain is a symptom of ACS.$Cause_1": {
+                "Chest Pain$Input1": {}
+            },
+            "with history of hypertension and dyslipidemia are risk facts$Cause_1": {
+                "with history of hypertension and dyslipidemia$Input2": {}
+            },
+            "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.\n is sign of acs$Cause_1": {
+                "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.$Input2": {}
+            },
+            "Hypertension is a risk factor$Cause_1": {
+                "Hypertension$Input3": {}
+            },
+            "Dyslipidemia is a risk factor$Cause_1": {
+                "Dyslipidemia$Input3": {}
+            },
+            "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.\n is a risk factor$Cause_1": {
+                "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.$Input3": {}
+            },
+            "family history\uff1a Hypertension is risk fact$Cause_1": {
+                "Hypertension$Input4": {}
+            },
+            "family history\uff1aDyslipidemia is risk fact$Cause_1": {
+                "Dyslipidemia$Input4": {}
+            },
+            "family history\uff1aStress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis\nis risk fact$Cause_1": {
+                "Stress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis$Input4": {}
+            },
+            "family history\uff1aMI in mother is risk fact$Cause_1": {
+                "MI in mother$Input5": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "Mild (1+) mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is high normal. There is a trivial/physiologic pericardial effusion.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS.$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "with history of hypertension and dyslipidemia are risk facts$Cause_1": {
+                    "with history of hypertension and dyslipidemia$Input2": {}
+                },
+                "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.\n is sign of acs$Cause_1": {
+                    "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.$Input2": {}
+                },
+                "Hypertension is a risk factor$Cause_1": {
+                    "Hypertension$Input3": {}
+                },
+                "Dyslipidemia is a risk factor$Cause_1": {
+                    "Dyslipidemia$Input3": {}
+                },
+                "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.\n is a risk factor$Cause_1": {
+                    "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.$Input3": {}
+                },
+                "family history\uff1a Hypertension is risk fact$Cause_1": {
+                    "Hypertension$Input4": {}
+                },
+                "family history\uff1aDyslipidemia is risk fact$Cause_1": {
+                    "Dyslipidemia$Input4": {}
+                },
+                "family history\uff1aStress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis\nis risk fact$Cause_1": {
+                    "Stress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis$Input4": {}
+                },
+                "family history\uff1aMI in mother is risk fact$Cause_1": {
+                    "MI in mother$Input5": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "Patient was evaluated with a similar presentation. At that time, the EKG was unremarkable and trops x 3 were negative. A stress test was also negative.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS.$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "with history of hypertension and dyslipidemia are risk facts$Cause_1": {
+                    "with history of hypertension and dyslipidemia$Input2": {}
+                },
+                "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.\n is sign of acs$Cause_1": {
+                    "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.$Input2": {}
+                },
+                "Hypertension is a risk factor$Cause_1": {
+                    "Hypertension$Input3": {}
+                },
+                "Dyslipidemia is a risk factor$Cause_1": {
+                    "Dyslipidemia$Input3": {}
+                },
+                "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.\n is a risk factor$Cause_1": {
+                    "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.$Input3": {}
+                },
+                "family history\uff1a Hypertension is risk fact$Cause_1": {
+                    "Hypertension$Input4": {}
+                },
+                "family history\uff1aDyslipidemia is risk fact$Cause_1": {
+                    "Dyslipidemia$Input4": {}
+                },
+                "family history\uff1aStress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis\nis risk fact$Cause_1": {
+                    "Stress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis$Input4": {}
+                },
+                "family history\uff1aMI in mother is risk fact$Cause_1": {
+                    "MI in mother$Input5": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "Mild (1+) mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is high normal. There is a trivial/physiologic pericardial effusion.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest pain is a symptom of ACS.$Cause_1": {
+                        "Chest Pain$Input1": {}
+                    },
+                    "with history of hypertension and dyslipidemia are risk facts$Cause_1": {
+                        "with history of hypertension and dyslipidemia$Input2": {}
+                    },
+                    "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.\n is sign of acs$Cause_1": {
+                        "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.$Input2": {}
+                    },
+                    "Hypertension is a risk factor$Cause_1": {
+                        "Hypertension$Input3": {}
+                    },
+                    "Dyslipidemia is a risk factor$Cause_1": {
+                        "Dyslipidemia$Input3": {}
+                    },
+                    "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.\n is a risk factor$Cause_1": {
+                        "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.$Input3": {}
+                    },
+                    "family history\uff1a Hypertension is risk fact$Cause_1": {
+                        "Hypertension$Input4": {}
+                    },
+                    "family history\uff1aDyslipidemia is risk fact$Cause_1": {
+                        "Dyslipidemia$Input4": {}
+                    },
+                    "family history\uff1aStress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis\nis risk fact$Cause_1": {
+                        "Stress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis$Input4": {}
+                    },
+                    "family history\uff1aMI in mother is risk fact$Cause_1": {
+                        "MI in mother$Input5": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest Pain\n",
+    "input2": "with history of hypertension and dyslipidemia, who presented with chest pain. Patient reported onset at 4:30 AM as patient was doing her normal am routine. She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation. Of note, reported a similar episodes 1 month ago that resolved within about 2 hours.\n\ufeff\nPatient was evaluated with a similar presentation. At that time, the EKG was unremarkable and trops x 3 were negative. A stress test was also negative. She was discharged from the ED with cardiology outpatient follow-up (did not find any records in the Atrius Epicweb). \n\ufeff\nIn the ED initial vitals were: 97.9 72 144/83 18 100% RA EKG: sinus at 58, nl axis, nl intervals, no TWI, 0.5mm ST elevation in aVR, repeat EKG stable from prior Labs/studies notable for: unremarkable CBC/chem-7, CXR wnl, initial troponin negative, repeat troponin elevated at 0.21, ETT w/ ECHO ordered but subsequently canceled. Patient was given: aspirin with Zofran given history of GI tolerance with aspirin, started on heparin gtt. She was taken to the cath lab with catheterization results showing subtotal occluded OM s/p DES as well as 95% RCA that was not intervened upon given contrast load. Initially, they attempted radial access but that was unsuccessful given small radial artery. Also, patient developed radial hematoma. She had groin access. She was treated with bivalirusin drip during the case and 30 minutes afterwards. She was loaded with Plavix. She was also started on ICF for hydration. \n\ufeff\nOn the floor, patient was tired but chest pain free. She was surrounded by family and they confirmed the history detailed above.\n",
+    "input3": "1. CARDIAC RISK FACTORS\n- Hypertension\n- Dyslipidemia\n2. CARDIAC HISTORY\n- Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise. \n3. OTHER PAST MEDICAL HISTORY\n- Herpes progenitalis \n- Sciatica  \n- Anemia \n- Monilal vulvovaginitis \n- Cervical radiculopathy\n",
+    "input4": "+ Hypertension\n+ Dyslipidemia\n+ Stress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis \n+ Sciatica  \n+ Anemia \n+ Monilal vulvovaginitis \n+ Cervical radiculopathy\n",
+    "input5": "MI in mother\n",
+    "input6": "LABS:\n=====\n08:25AM BLOOD CK-MB-7 cTropnT-0.13*\n07:58AM   GLUCOSE-96 UREA N-20 CREAT-0.7 SODIUM-139 \nPOTASSIUM-3.8 CHLORIDE-101 TOTAL CO2-26 ANION GAP-16\n06:40AM   GLUCOSE-144* UREA N-22* CREAT-0.8 SODIUM-131* \nPOTASSIUM-7.1* CHLORIDE-96 TOTAL CO2-21* ANION GAP-21*\n06:40AM   estGFR-Using this\n06:40AM   cTropnT-<0.01\n06:40AM   WBC-5.4 RBC-4.78 HGB-13.7 HCT-41.3 MCV-86 \nMCH-28.7 MCHC-33.2 RDW-14.7 RDWSD-46.9*\n06:40AM   NEUTS-55.7 MONOS-7.3 EOS-2.4 BASOS-0.7 IM AbsNeut-2.98 AbsLymp-1.78 AbsMono-0.39 AbsEos-0.13 AbsBaso-0.04\n06:40AM   PLT COUNT-228\n\ufeff\nIMAGING:\n========\nCXR:\nNo acute cardiopulmonary process. \n\ufeff\nTTE:\nThe left atrial volume index is normal. Normal left ventricular wall thickness, cavity size, and regional/global systolic function (biplane LVEF = 61 %). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve leaflets are structurally normal. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is high normal. There is a trivial/physiologic pericardial effusion. \n\ufeff\nIMPRESSION: Normal biventricular cavity sizes with preserved regional and global biventricular systolic function. Mild mitral regurgitation with normal valve morphology.\n\ufeff\nCLINICAL IMPLICATIONS: \nAHA endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is NOT recommended. Clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data.\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17685057-DS-12.json

@@ -0,0 +1,132 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "02:30PM BLOOD cTropnT-0.91*\n06:30PM BLOOD cTropnT-1.09*\n01:26AM BLOOD cTropnT-1.24*\n05:55AM BLOOD CK-MB-4 cTropnT-1.16*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain is a symptom of ACS.$Cause_1": {
+                "Chest Pain$Input1": {}
+            },
+            "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.\n is sign of acs$Cause_1": {
+                "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.$Input2": {}
+            },
+            "DMII is a risk factor$Cause_1": {
+                "DMII$Input3": {}
+            },
+            "Hypertension is a risk factor$Cause_1": {
+                "Hypertension$Input3": {}
+            },
+            "Hyperlipidemia is a risk factor$Cause_1": {
+                "Hyperlipidemia$Input3": {}
+            },
+            "Chronic Kidney Disease is a risk factor$Cause_1": {
+                "Chronic Kidney Disease$Input3": {}
+            },
+            "family history\uff1a Both parents died of reasons unknown to him.  is risk fact$Cause_1": {
+                "Both parents died of reasons unknown to him.$Input4": {}
+            },
+            "family history\uff1a Two sisters and a brother died of reasons unknown as well.  is risk fact$Cause_1": {
+                "Two sisters and a brother died of reasons unknown as well.$Input4": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "EKG taken today showed sinus rhythm, incomplete right bundle-branch block, which appeared new, possible septal infarct and T-wave inversions in the lateral precordial leads, possible anterolateral ischemia, which were changed from prior.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS.$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.\n is sign of acs$Cause_1": {
+                    "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.$Input2": {}
+                },
+                "DMII is a risk factor$Cause_1": {
+                    "DMII$Input3": {}
+                },
+                "Hypertension is a risk factor$Cause_1": {
+                    "Hypertension$Input3": {}
+                },
+                "Hyperlipidemia is a risk factor$Cause_1": {
+                    "Hyperlipidemia$Input3": {}
+                },
+                "Chronic Kidney Disease is a risk factor$Cause_1": {
+                    "Chronic Kidney Disease$Input3": {}
+                },
+                "family history\uff1a Both parents died of reasons unknown to him.  is risk fact$Cause_1": {
+                    "Both parents died of reasons unknown to him.$Input4": {}
+                },
+                "family history\uff1a Two sisters and a brother died of reasons unknown as well.  is risk fact$Cause_1": {
+                    "Two sisters and a brother died of reasons unknown as well.$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "EKG taken today showed sinus rhythm, incomplete right bundle-branch block, which appeared new, possible septal infarct and T-wave inversions in the lateral precordial leads, possible anterolateral ischemia, which were changed from prior. He was given aspirin 325mg.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS.$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.\n is sign of acs$Cause_1": {
+                    "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.$Input2": {}
+                },
+                "DMII is a risk factor$Cause_1": {
+                    "DMII$Input3": {}
+                },
+                "Hypertension is a risk factor$Cause_1": {
+                    "Hypertension$Input3": {}
+                },
+                "Hyperlipidemia is a risk factor$Cause_1": {
+                    "Hyperlipidemia$Input3": {}
+                },
+                "Chronic Kidney Disease is a risk factor$Cause_1": {
+                    "Chronic Kidney Disease$Input3": {}
+                },
+                "family history\uff1a Both parents died of reasons unknown to him.  is risk fact$Cause_1": {
+                    "Both parents died of reasons unknown to him.$Input4": {}
+                },
+                "family history\uff1a Two sisters and a brother died of reasons unknown as well.  is risk fact$Cause_1": {
+                    "Two sisters and a brother died of reasons unknown as well.$Input4": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "EKG taken today showed sinus rhythm, incomplete right bundle-branch block, which appeared new, possible septal infarct and T-wave inversions in the lateral precordial leads, possible anterolateral ischemia, which were changed from prior.$Input2": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest pain is a symptom of ACS.$Cause_1": {
+                        "Chest Pain$Input1": {}
+                    },
+                    "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.\n is sign of acs$Cause_1": {
+                        "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.$Input2": {}
+                    },
+                    "DMII is a risk factor$Cause_1": {
+                        "DMII$Input3": {}
+                    },
+                    "Hypertension is a risk factor$Cause_1": {
+                        "Hypertension$Input3": {}
+                    },
+                    "Hyperlipidemia is a risk factor$Cause_1": {
+                        "Hyperlipidemia$Input3": {}
+                    },
+                    "Chronic Kidney Disease is a risk factor$Cause_1": {
+                        "Chronic Kidney Disease$Input3": {}
+                    },
+                    "family history\uff1a Both parents died of reasons unknown to him.  is risk fact$Cause_1": {
+                        "Both parents died of reasons unknown to him.$Input4": {}
+                    },
+                    "family history\uff1a Two sisters and a brother died of reasons unknown as well.  is risk fact$Cause_1": {
+                        "Two sisters and a brother died of reasons unknown as well.$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "Mr. Mike is a man with PMH significant for COPD, HTN, HLD who presents with progressive shortness of breath and chest pain.\n\ufeff\nThe patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks. THe pain lasts for about 1 hour and took a pain medication called \"coltaradin\" with relief. The pain occurred both at rest and on exertion and he did not report any clear exaccerbating factors. He noted associated radiation to his bilateral shoulders. He denies associated shortness of breath, nausea, and diaphoresis. He notes it does not feel like his acid reflux pain. The pain does not wake him from sleep. He also usually plants a garden, but his sister found him very short of breath and lacking energy, so she did not let him plant the garden this year.\n\ufeff\nHe presented today to see his Atrius Pulmonologist Dr.Wang for these symptoms. Vitals in clinic were Temp afebirle, BP 132/84, HR 108, RR 18, O2 sat 95% RA. EKG taken today showed sinus rhythm, incomplete right bundle-branch block, which appeared new, possible septal infarct and T-wave inversions in the lateral precordial leads, possible anterolateral ischemia, which were changed from prior. He was given aspirin 325mg. \n\ufeff\ninitial vitals were Temp 99.4, BP 167/95, HR 113, RR 22, O2 sat 100% RA. Labs were significatn for TropI 4.8, WBC 4.1, H/H 11.3/36.0, Plt 140, Na 138, K 4.0, LFTs wnl. He was started on heparin ggt for suspected NSTEMI. CXR with increased interstitial markings and concern for adenopathy with recommendation for CT scan to evaluate for mass. He was transferred to someplace for cardiac cath.\n \n- In the ED, initial vitals were: 99.1 104 148/97 18 99% RA.\n- Labs were significant for WBC 4.0, H/H 10.8, Plt 115, INR 1.1, PTT 123.5 -> repeat 81.7, Cr 0.9, K 3.1, TropT 0.91 -> 1.09.\n- Patient was continued on heparin gtt at 700 units/hr.\n- Atrius Cards consulted and on schedule for cath lab tomorrow first case.\n- Vitals prior on transfer were: 97.8 98 146/88 20 99% RA. \n \nOn arrival to the floor, he denies chest pain. He denies fevers/chills, nausea/vomiting, abdominal pain, diarrhea, dysuria, and lower extremity swelling.\n",
+    "input3": "+ DMII\n+ Hypertension\n+ Hyperlipidemia\n+ Chronic Kidney Disease\n+ GERD\n+ BPH\n+ Rhinitis\n+ Asthma/COPD\n+ Bronchiectasis\n+ Alpha Thalassemia Trait\n+ Hematuria\n+ Gastric Adenoma\n+ Pneumonia\n+ s/p cataract surgery\n",
+    "input4": "Both parents died of reasons unknown to him. Two sisters and a brother died of reasons unknown as well.\n",
+    "input5": "ADMISSION PHYSICAL EXAMINATION:  \nVS: Temp 97.7, BP 168/90, HR 108, RR 20, O2 sat 99% 2L, Weight 55.6 kg\nGeneral: Well-appearing man in no acute distress. \nHEENT: EOMI, PERRLA, clear oropharynx, moist mucous membranes. \nNeck: Supple, no JVP, no lympadenopathy.\nCV: RRR, normal s1/s2, no m/r/g. \nLungs: Transmitted upper airway sounds, no crackles, poor air movement bilaterally.\nAbdomen: Soft, mildly distended, non-tender, normal bowel sounds, no organomegaly. \nExt: Warm, well-perfused, no edema.\nNeuro: A&Ox3, CNII-XII intact, gross motor and sensory intact bilaterally.\nSkin: No rashes.\n",
+    "input6": "ADMISSION LABS\n==============\n02:30PM BLOOD WBC-4.0 RBC-4.67 Hgb-10.8* Hct-32.6* \nMCV-70* MCH-23.2* MCHC-33.3 RDW-18.7*\n02:30PM BLOOD Neuts-57.8 Monos-7.8 Eos-6.2* Baso-0.2\n02:30PM BLOOD Glucose-101* UreaN-13 Creat-0.9 Na-135 \nK-3.1* Cl-108 HCO3-21* AnGap-9\n02:30PM BLOOD Calcium-8.5 Phos-2.7 Mg-1.9\n\ufeff\nPERTINENT LABS\n==============\n02:30PM BLOOD cTropnT-0.91*\n06:30PM BLOOD cTropnT-1.09*\n01:26AM BLOOD cTropnT-1.24*\n05:55AM BLOOD CK-MB-4 cTropnT-1.16*\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17753691-DS-7.json

@@ -0,0 +1,126 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "labs showed a 0.87 trop-i, w/ 0.9 Cr,$Input2": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L$Cause_1": {
+            "BLOOD CK-MB-7 cTropnT-0.23*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Epigastric pain is a symptom of ACS.$Cause_1": {
+                "Epigastric pain$Input1": {}
+            },
+            "DM is a risk fact of acs$Cause_1": {
+                "a Man w/ hx of DM on insulin w/ neuropathy- on lantus, HTN hx of non-compliance who presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday.$Input2": {}
+            },
+            "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,\n are sign of acs$Cause_1": {
+                "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,$Input2": {}
+            },
+            "DMII is risk fact$Cause_1": {
+                "DMII$Input3": {}
+            },
+            "VITAMIN D DEFICIENC is risk fact$Cause_1": {
+                "VITAMIN D DEFICIENCY$Input3": {}
+            },
+            "HYPERLIPIDEMIA is risk fact$Cause_1": {
+                "HYPERLIPIDEMIA$Input3": {}
+            },
+            "family history\uff1aFather passed away from an MI is risk fact$Cause_1": {
+                "Father passed away from an MI$Input4": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs.$Cause_1": {
+                "2.Successful PTCA and stenting of totally occluded LAD with Resolute Integrtity drug-eluting stent (3.0x18 mm)$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Epigastric pain is a symptom of ACS.$Cause_1": {
+                    "Epigastric pain$Input1": {}
+                },
+                "DM is a risk fact of acs$Cause_1": {
+                    "a Man w/ hx of DM on insulin w/ neuropathy- on lantus, HTN hx of non-compliance who presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday.$Input2": {}
+                },
+                "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,\n are sign of acs$Cause_1": {
+                    "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,$Input2": {}
+                },
+                "DMII is risk fact$Cause_1": {
+                    "DMII$Input3": {}
+                },
+                "VITAMIN D DEFICIENC is risk fact$Cause_1": {
+                    "VITAMIN D DEFICIENCY$Input3": {}
+                },
+                "HYPERLIPIDEMIA is risk fact$Cause_1": {
+                    "HYPERLIPIDEMIA$Input3": {}
+                },
+                "family history\uff1aFather passed away from an MI is risk fact$Cause_1": {
+                    "Father passed away from an MI$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "ekg showed inf t wave changes,$Input2": {}
+            },
+            "non-ST-elevation is a sign of NSTE-ACS.$Cause_1": {
+                "EKG demonstrated sinus at 87 Q in III, avf and lateral t-wave flattening similar to prior. The patient was continued on a heparin gtt.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Epigastric pain is a symptom of ACS.$Cause_1": {
+                    "Epigastric pain$Input1": {}
+                },
+                "DM is a risk fact of acs$Cause_1": {
+                    "a Man w/ hx of DM on insulin w/ neuropathy- on lantus, HTN hx of non-compliance who presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday.$Input2": {}
+                },
+                "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,\n are sign of acs$Cause_1": {
+                    "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,$Input2": {}
+                },
+                "DMII is risk fact$Cause_1": {
+                    "DMII$Input3": {}
+                },
+                "VITAMIN D DEFICIENC is risk fact$Cause_1": {
+                    "VITAMIN D DEFICIENCY$Input3": {}
+                },
+                "HYPERLIPIDEMIA is risk fact$Cause_1": {
+                    "HYPERLIPIDEMIA$Input3": {}
+                },
+                "family history\uff1aFather passed away from an MI is risk fact$Cause_1": {
+                    "Father passed away from an MI$Input4": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs.$Cause_1": {
+                    "2.Successful PTCA and stenting of totally occluded LAD with Resolute Integrtity drug-eluting stent (3.0x18 mm)$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Epigastric pain is a symptom of ACS.$Cause_1": {
+                        "Epigastric pain$Input1": {}
+                    },
+                    "DM is a risk fact of acs$Cause_1": {
+                        "a Man w/ hx of DM on insulin w/ neuropathy- on lantus, HTN hx of non-compliance who presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday.$Input2": {}
+                    },
+                    "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,\n are sign of acs$Cause_1": {
+                        "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,$Input2": {}
+                    },
+                    "DMII is risk fact$Cause_1": {
+                        "DMII$Input3": {}
+                    },
+                    "VITAMIN D DEFICIENC is risk fact$Cause_1": {
+                        "VITAMIN D DEFICIENCY$Input3": {}
+                    },
+                    "HYPERLIPIDEMIA is risk fact$Cause_1": {
+                        "HYPERLIPIDEMIA$Input3": {}
+                    },
+                    "family history\uff1aFather passed away from an MI is risk fact$Cause_1": {
+                        "Father passed away from an MI$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Epigastric pain\n",
+    "input2": "a Man w/ hx of DM on insulin w/ neuropathy- on lantus, HTN hx of non-compliance who presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit, improved with rest and increasing in frequency. Pain has been constant over the past week. He has also subsequently developed associated diaphoresis, dizziness and nausea without vomiting over the past weeks. He had new back pain also several weeks ago that starts in the back and goes  down toward his groin- it feel like muscle spasms to him but is now resolved. No chest pain during any of these episodes. He denies being sob. Denies leg pain or swelling. He went into hospital because he thought he was having ulcers and was expected some \"tums\" and being d/ced. However labs showed a 0.87 trop-i, w/ 0.9 Cr, and ekg showed inf t wave changes, abd labs were unremarkable, glu 279. he was given asa, heparin and nitro drips for hypertension. Transfer was attmpted to hospital where the pt has his pcp, but transfer was not possible.\n \nIn the ED, initial vitals were 94 122/83 13 99%. Labs were notable for a WBC of 14, trop of 0.1 with a normal CK-MB and INR of 1.2. EKG demonstrated sinus at 87 Q in III, avf and lateral t-wave flattening similar to prior. The patient was continued on a heparin gtt. Given metoprolol 25 mg and taken to the cath lab. \nThere he was given a plavix load, ASA, and bival. In the cath lab he was noted to have an extremely tight LAD (near complete occlusion) without evidence of collaterals. He underwent placement of a DES to the LAD with good restoration of flow. The procedure was complicated by a vagal event for which the patient recieved 1 mg of atropine and L fluid with improvement in blood pressure and heart rate.\n",
+    "input3": "+ DMII\n+ VITAMIN D DEFICIENCY  \n+ HYPERLIPIDEMIA  \n+ HYPERTENSION NOS\n",
+    "input4": "Father passed away from an MI\n",
+    "input5": "PHYSICAL EXAMINATION:  \nVS: T= 97.5 BP= 134/81 HR= 91 RR= 18 O2 sat= 99% RA  \nGENERAL: WDWN male in NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were  pink, no pallor or cyanosis of the oral mucosa. No xanthelasma.  \n\ufeff\nNECK: Supple with JVP difficult to assess  \nCARDIAC: midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.  \nLUNGS:CTA ant  \nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominal bruits.  \nEXTREMITIES: No c/c/e.  \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.  \nPULSES:  \nRight: R TR band in place, 2+ DP  \nLeft: DP 2+ Radial 2+\n",
+    "input6": "ADMISSION:\n04:15PM BLOOD WBC-14.3* RBC-5.61 Hgb-16.7 Hct-47.8 \nMCV-85 MCH-29.7 MCHC-34.9 RDW-13.7\n04:15PM BLOOD Glucose-246* UreaN-12 Creat-0.7 Na-138 \nK-3.6 Cl-101 HCO3-27 AnGap-14\n\ufeff\nCARDIAC:\n0.87 tropI at OSH\n04:15PM BLOOD cTropnT-0.10*\n08:18AM BLOOD CK-MB-7 cTropnT-0.23*\n08:45AM BLOOD CK-MB-7 cTropnT-0.18*\n\ufeff\nCARDIAC:\nAssessment & Recommendations\n1.One vessel CAD\n2.Successful PTCA and stenting of totally occluded LAD with Resolute Integrtity drug-eluting stent (3.0x18 mm) \n\ufeff\nwith excellent result\n3.Successful removal of R radail sheath and placement of Terumo band\n4.Prasugrel 60 mg po given post procedure x mg daily for 12 months (option to switch to Clopidogrel in 3 months)\n5.ASA 325 mg po daily x minimum 3 months then 162 mg daily indefinitely\n\ufeff\n7.Cardiac rehab after submaximal ETT (to be arranged by PCP/cardiologist).\n\ufeff\nECG ON ADMISSION: sinus at 87 Q in III, avf and lateral t-wave flattening similar to prior.\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17822063-DS-15.json

@@ -0,0 +1,52 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "Labs were significant for an elevated troponin of 0.41$Input2": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "BLOOD cTropnT-0.41*$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09..$Cause_1": {
+            "03:23PM BLOOD CK-MB-38*\n03:23PM BLOOD cTropnT-0.41*\n11:15PM BLOOD CK-MB-29* cTropnT-1.85*\n06:04AM BLOOD CK-MB-21* cTropnT-0.99*$Input6": {}
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "His ECG revealed new ST depressions and trop-I was elevated to 3.23. He was given Lovenox ,$Input2": {}
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs.$Cause_1": {
+                    "He was treated with metoprolol, nitro gtt, dilaudid, and was sent to the cath lab where a DES was placed to his LCX. After the procedure he continued to have chest pain and ECG changes so was started on an Eptifibatide gtt and admitted to the CCU.$Input2": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest pain is a symptom of ACS.$Cause_1": {
+                        "Chest pain$Input1": {}
+                    },
+                    "CAD s/p stents, DM, HTN are risk facts$Cause_1": {
+                        "h/o CAD s/p stents, DM, HTN, who presented with chest pain,$Input2": {}
+                    },
+                    "He began having chest/epigastric discomfort over the weekend while doing chores. The pain would come and go, was pressure and stinging like in sensation, pain at its worst, was associated with SOB, diaphoresis, nausea, and arm tingling.\n are signs of acs$Cause_1": {
+                        "He began having chest/epigastric discomfort over the weekend while doing chores. The pain would come and go, was pressure and stinging like in sensation, pain at its worst, was associated with SOB, diaphoresis, nausea, and arm tingling.$Input2": {}
+                    },
+                    "Essential hypertension is risk fact$Cause_1": {
+                        "Essential hypertension$Input3": {}
+                    },
+                    "CAD (coronary artery disease) is risk fact$Cause_1": {
+                        "CAD (coronary artery disease)$Input3": {}
+                    },
+                    "Type II diabetes mellitus is risk fact$Cause_1": {
+                        "Type II diabetes mellitus$Input3": {}
+                    },
+                    "family history\uff1amother: CAD, asthma\n   is risk fact$Cause_1": {
+                        "mother: CAD, asthma$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "h/o CAD s/p stents, DM, HTN, who presented with chest pain, found to have NSTEMI and is now s/p DES to the LCX. \n\ufeff\nHe began having chest/epigastric discomfort over the weekend while doing chores. The pain would come and go, was pressure and stinging like in sensation, pain at its worst, was associated with SOB, diaphoresis, nausea, and arm tingling. Although this pain was similar to his cardiac chest pain during his last heart attack, he thought it was indigestion and treated it at home with Tums. He also had an associated sore throat for which he visited his PCP. He did not endorse chest pain at the time and did not have an ECG or cardiac workup. Today, he called his PCP again, endorsed chest pain, He tried SL nitro x 1 at home without relief. He initially presented to hospital where he was treated with ASA 324 and GI cocktail. His ECG revealed new ST depressions and trop-I was elevated to 3.23. He was given Lovenox , \n\ufeff\ninitial vitals were: 98.6 83 146/78 16 96%. ECG was significant for ST depressions in the lateral leads. Labs were significant for an elevated troponin of 0.41 and normal CBC/chem7. He was treated with metoprolol, nitro gtt, dilaudid, and was sent to the cath lab where a DES was placed to his LCX. After the procedure he continued to have chest pain and ECG changes so was started on an Eptifibatide gtt and admitted to the CCU. \n\ufeff\nUpon arrival to the floor,  he continued to complain of chest pain. He was treated with SL nitro with relief to pain. A second SL NTG resulted in reduction to pain. A nitroglycerin drip was started.\n",
+    "input3": "+ Pure hypercholesterolemia \n+ Lumbosacral spondylosis without myelopathy \n+ Diarrhea \n+ Ankylosing spondylitis vs. Rheumatoid Arthritis\n+ Essential hypertension\n+ Malignant neoplasm of testis \n+ Impotence \n+ CAD (coronary artery disease) \n+ Raynaud's disease \n+ Type II diabetes mellitus \n+ Polyneuropathy in diabetes \n+ Microalbuminuria \n+ Rosacea \n+ Depression\n+ Headaches\n+ Remote h/o bleeding GI ulcer\n",
+    "input4": "mother: CAD, asthma\nsister: RA\nbrother: GERD\n",
+    "input5": "ADMISSION EXAM:\nVS: T=98.5 BP=126/70 HR=88 RR=19 O2 sat=96% RA  \nGeneral:  alert, nad\nHEENT:  poor dentition, sclera anicteric\nNeck:  no JVD\nCV:  rrr, no murmurs\nLungs:  ctab\nAbdomen:  epigastric tenderness\nExt:  trace BLE edema\nNeuro:  EOMI, PERRL, alert, moving all extreities\nSkin:  no rash\nPULSES:  2+ distal pulses (DP bilat, L radial (R radial in cuff))\n",
+    "input6": "ADMISSION LABS:\n\ufeff\n03:23PM BLOOD WBC-10.9 RBC-4.77 Hgb-14.5 Hct-44.7 \nMCV-94 MCH-30.4 MCHC-32.4 RDW-13.1\n03:23PM BLOOD Neuts-69.3 Monos-6.0 Eos-2.6 \nBaso-0.6\n03:23PM BLOOD Glucose-88 UreaN-14 Creat-1.1 Na-136 \nK-4.0 Cl-101 HCO3-23 AnGap-16\n03:23PM BLOOD CK-MB-38*\n03:23PM BLOOD cTropnT-0.41*\n\ufeff\nCARDIAC ENZYME TREND:\n\ufeff\n03:23PM BLOOD CK-MB-38*\n03:23PM BLOOD cTropnT-0.41*\n11:15PM BLOOD CK-MB-29* cTropnT-1.85*\n06:04AM BLOOD CK-MB-21* cTropnT-0.99*\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17842926-DS-8.json

@@ -0,0 +1,108 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "BLOOD CK-MB-23* cTropnT-0.52**$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "headache, HTNis a symptom of ACS.$Cause_1": {
+                "headache, HTN$Input1": {}
+            },
+            "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.\n is risk fact and sign of acs$Cause_1": {
+                "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.$Input2": {}
+            },
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "The patient also reported some dull left-sided chest pressure that lasted several hours, however resolved prior to the time that she arrived. She no longer reports any headache. She only residual symptoms are left arm pain.$Input2": {}
+            },
+            "DM (diet controlled) is a risk factor$Cause_1": {
+                "DM (diet controlled)$Input3": {}
+            },
+            "chronic cough is a risk factor$Cause_1": {
+                "chronic cough$Input3": {}
+            },
+            "HTN (not on medical therapy) is a risk factor$Cause_1": {
+                "HTN (not on medical therapy)$Input3": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "Suboptimal image quality. Moderate aortic stenosis. Mild symmetric left ventricular hypertrophy with preserved regional and global biventricular systolic function. Mild-moderate mitral regurgitation. Mild pulmonary artery systolic hypertension. Increased PCWP.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "headache, HTNis a symptom of ACS.$Cause_1": {
+                    "headache, HTN$Input1": {}
+                },
+                "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.\n is risk fact and sign of acs$Cause_1": {
+                    "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.$Input2": {}
+                },
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "The patient also reported some dull left-sided chest pressure that lasted several hours, however resolved prior to the time that she arrived. She no longer reports any headache. She only residual symptoms are left arm pain.$Input2": {}
+                },
+                "DM (diet controlled) is a risk factor$Cause_1": {
+                    "DM (diet controlled)$Input3": {}
+                },
+                "chronic cough is a risk factor$Cause_1": {
+                    "chronic cough$Input3": {}
+                },
+                "HTN (not on medical therapy) is a risk factor$Cause_1": {
+                    "HTN (not on medical therapy)$Input3": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "EKG: Sinus rhythm, 95, normal axis,, first degree heart block QTC 473 Imaging showed$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "headache, HTNis a symptom of ACS.$Cause_1": {
+                    "headache, HTN$Input1": {}
+                },
+                "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.\n is risk fact and sign of acs$Cause_1": {
+                    "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.$Input2": {}
+                },
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "The patient also reported some dull left-sided chest pressure that lasted several hours, however resolved prior to the time that she arrived. She no longer reports any headache. She only residual symptoms are left arm pain.$Input2": {}
+                },
+                "DM (diet controlled) is a risk factor$Cause_1": {
+                    "DM (diet controlled)$Input3": {}
+                },
+                "chronic cough is a risk factor$Cause_1": {
+                    "chronic cough$Input3": {}
+                },
+                "HTN (not on medical therapy) is a risk factor$Cause_1": {
+                    "HTN (not on medical therapy)$Input3": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "Suboptimal image quality. Moderate aortic stenosis. Mild symmetric left ventricular hypertrophy with preserved regional and global biventricular systolic function. Mild-moderate mitral regurgitation. Mild pulmonary artery systolic hypertension. Increased PCWP.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "headache, HTNis a symptom of ACS.$Cause_1": {
+                        "headache, HTN$Input1": {}
+                    },
+                    "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.\n is risk fact and sign of acs$Cause_1": {
+                        "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.$Input2": {}
+                    },
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "The patient also reported some dull left-sided chest pressure that lasted several hours, however resolved prior to the time that she arrived. She no longer reports any headache. She only residual symptoms are left arm pain.$Input2": {}
+                    },
+                    "DM (diet controlled) is a risk factor$Cause_1": {
+                        "DM (diet controlled)$Input3": {}
+                    },
+                    "chronic cough is a risk factor$Cause_1": {
+                        "chronic cough$Input3": {}
+                    },
+                    "HTN (not on medical therapy) is a risk factor$Cause_1": {
+                        "HTN (not on medical therapy)$Input3": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "headache, HTN\n",
+    "input2": "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain. This afternoon, the patient 60 ibuprofen for left arm pain, after which time she began having a headache, and found her blood pressure to be elevated. The patient also reported some dull left-sided chest pressure that lasted several hours, however resolved prior to the time that she arrived. She no longer reports any headache. She only residual symptoms are left arm pain. The patient denies visual changes headache, chest pain, shortness of breath, abdominal pain.  In the ED  \n=============  \nInitial vitals: 99.0 90 194/81 16 97% RA  \nLabs were significant for  \nTrop-T: 0.04  \n140 100 15 AGap=19  \n-------------< 117  \n4.2 25 0.7  \n11.5 MCV= 82  \n9.2 >-----<276  \n38.0  \n \nUA negative.  \nEKG: Sinus rhythm, 95, normal axis,, first degree heart block QTC 473 Imaging showed  \nCXR: Low lung volumes with probable mild pulmonary vascular congestion but no overt pulmonary edema. Re-demonstration rightward tracheal deviation due to known multinodular thyroid goiter  \nThe patient received:  \n21:59 PO Aspirin 243 mg  \n22:10 IV Morphine Sulfate 4 mg  \n22:10 IV Heparin 3800 UNIT  \n22:10 IV Heparin  \nThe patient was shifted to the floor. On the floor, the patient feels that her health is not normal and feels tired. however, denies chest pain, SOB or palpitations. complains of mild OA pain in the left wrist.  \n \nROS:  \nNo fevers, chills, night sweats, or weight changes.  \nNo changes in vision or hearing, no changes in balance.  \nNo nausea or vomiting. No diarrhea or constipation.  \nNo dysuria or hematuria.  \nNo hematochezia, no melena.  \nNo numbness or weakness, no focal deficits.  \n\ufeff\nPatient with sons at bedside this AM. Report that patient was sitting at home, doing normal activities and stated she had L arm pain, headache and chest pain. The patient states the arm pain started prior to the chest pain. she states she asked her son for tylenol/motrin but it did not help. \n\ufeff\nPer her son, her BP was higher than usual (normally 110-160). Patient states she has never had this chest pain before and she denies associated nausea, vomiting, recent illness, or history of MI/stroke (though son is unsure if she may have had \"small heart attack\" in the past.\n",
+    "input3": "+ DM (diet controlled)\n+ chronic cough\n+ HTN (not on medical therapy)\n+ osteoporosis\n+ osteoarthritis\n+ goiter\n+ hearing loss\n+ spinal stenosis/chronic back pain\n",
+    "input4": "She does not know majority of her family history. There is no cancer as far as she knows.\n",
+    "input5": "PHYSICAL EXAM ON ADMISSION:  \n===============================================================  \n\ufeff\nVS: 98.0 188/76 90 22 96% wt 61.8kg  \nGEN: Alert, lying in bed, no acute distress  \nHEENT: Moist MM, anicteric sclerae, no conjunctival pallor. \nPERRLA, EOMI.  \nNECK: Supple without LAD . no JVP elevation.  \nPULM: full air entry bilaterally. crackles heard on the right base which cleared with cough. no wheeze. no rhonchi  \nHEART: RRR (+)S1/S2 no m/r/g  \nABD: Soft, non-distended, non-tender. No rebound/guarding. BS+  \n\ufeff\nEXTREM: Warm, well-perfused, no edema  \nNEURO: CN II-XII intact, SLIT\n",
+    "input6": "LABS ON ADMISSION\n==================\n08:00PM BLOOD WBC-9.2 RBC-4.64 Hgb-11.5 Hct-38.0 MCV-82 \nMCH-24.8* MCHC-30.3* RDW-15.9* RDWSD-47.2*\n08:00PM BLOOD Glucose-117* UreaN-15 Creat-0.7 Na-140 \nK-4.2 Cl-100 HCO3-25 AnGap-19\n04:25AM BLOOD Calcium-8.8 Phos-4.0 Mg-1.7\n\ufeff\nTROPONINS\n=========\n08:00PM BLOOD cTropnT-0.04*\n04:25AM BLOOD CK-MB-44* cTropnT-0.14*\n12:40PM BLOOD CK-MB-57* cTropnT-0.35*\n06:46PM BLOOD CK-MB-46* MB Indx-11.0* cTropnT-0.60*\n02:25AM BLOOD CK-MB-24* cTropnT-0.51*\n04:25AM BLOOD CK-MB-23* cTropnT-0.52**\n\ufeff\nIMAGING\n========\nIMPRESSION:  \n  \nLow lung volumes with probable mild pulmonary vascular congestion but no overt pulmonary edema.  Re-demonstration of rightward tracheal deviation due to known multinodular thyroid goiter. \n\ufeff\nECHO\nThe left atrium is elongated. The estimated right atrial pressure is xx mmHg. Mild symmetric left ventricular hypertrophy with normal cavity size, and regional/global systolic function (biplane LVEF = 64 %). The estimated cardiac index is normal (>=2.5L/min/m2). Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). The aortic valve leaflets are mildly thickened (?#). There is mild aortic valve stenosis (valve area 1.2-1.9cm2). Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild to moderate mitral regurgitation is seen. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. \n\ufeff\nIMPRESSION: Suboptimal image quality. Moderate aortic stenosis. Mild symmetric left ventricular hypertrophy with preserved regional and global biventricular systolic function. Mild-moderate mitral regurgitation. Mild pulmonary artery systolic hypertension. Increased PCWP. \n\ufeff\nCompared with the prior study (images reviewed), the findings are similar.\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17915457-DS-19.json

@@ -0,0 +1,132 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "cTropnT-0.26*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "chest pain$Input1": {}
+            },
+            "history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.\n are risk facts$Cause_1": {
+                "He is a yo man with history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.$Input2": {}
+            },
+            "chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in  his chest, with occasional radiation to his back and L arm.\n is sign of acs$Cause_1": {
+                "he developed chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in  his chest, with occasional radiation to his back and L arm.$Input2": {}
+            },
+            "Psoriatic Arthritis is a risk factor$Cause_1": {
+                "Psoriatic Arthritis$Input3": {}
+            },
+            "Hypothyroidism is a risk factor$Cause_1": {
+                "Hypothyroidism$Input3": {}
+            },
+            "Hyperlipidemia is a risk factor$Cause_1": {
+                "Hyperlipidemia$Input3": {}
+            },
+            "Obstructive sleep apnea is a risk factor$Cause_1": {
+                "Obstructive sleep apnea$Input3": {}
+            },
+            "Family history:PGF had MI  is a big risk factor$Cause_1": {
+                "PGF had MI$Input4": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild (1+) aortic regurgitation is seen.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "chest pain$Input1": {}
+                },
+                "history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.\n are risk facts$Cause_1": {
+                    "He is a yo man with history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.$Input2": {}
+                },
+                "chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in  his chest, with occasional radiation to his back and L arm.\n is sign of acs$Cause_1": {
+                    "he developed chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in  his chest, with occasional radiation to his back and L arm.$Input2": {}
+                },
+                "Psoriatic Arthritis is a risk factor$Cause_1": {
+                    "Psoriatic Arthritis$Input3": {}
+                },
+                "Hypothyroidism is a risk factor$Cause_1": {
+                    "Hypothyroidism$Input3": {}
+                },
+                "Hyperlipidemia is a risk factor$Cause_1": {
+                    "Hyperlipidemia$Input3": {}
+                },
+                "Obstructive sleep apnea is a risk factor$Cause_1": {
+                    "Obstructive sleep apnea$Input3": {}
+                },
+                "Family history:PGF had MI  is a big risk factor$Cause_1": {
+                    "PGF had MI$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "EKG: sinus rhythm, 68 bpm, PVCs, early R-wave progressions, no significant ischemic changes$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "chest pain$Input1": {}
+                },
+                "history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.\n are risk facts$Cause_1": {
+                    "He is a yo man with history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.$Input2": {}
+                },
+                "chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in  his chest, with occasional radiation to his back and L arm.\n is sign of acs$Cause_1": {
+                    "he developed chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in  his chest, with occasional radiation to his back and L arm.$Input2": {}
+                },
+                "Psoriatic Arthritis is a risk factor$Cause_1": {
+                    "Psoriatic Arthritis$Input3": {}
+                },
+                "Hypothyroidism is a risk factor$Cause_1": {
+                    "Hypothyroidism$Input3": {}
+                },
+                "Hyperlipidemia is a risk factor$Cause_1": {
+                    "Hyperlipidemia$Input3": {}
+                },
+                "Obstructive sleep apnea is a risk factor$Cause_1": {
+                    "Obstructive sleep apnea$Input3": {}
+                },
+                "Family history:PGF had MI  is a big risk factor$Cause_1": {
+                    "PGF had MI$Input4": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild (1+) aortic regurgitation is seen.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "chest pain$Input1": {}
+                    },
+                    "history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.\n are risk facts$Cause_1": {
+                        "He is a yo man with history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.$Input2": {}
+                    },
+                    "chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in  his chest, with occasional radiation to his back and L arm.\n is sign of acs$Cause_1": {
+                        "he developed chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in  his chest, with occasional radiation to his back and L arm.$Input2": {}
+                    },
+                    "Psoriatic Arthritis is a risk factor$Cause_1": {
+                        "Psoriatic Arthritis$Input3": {}
+                    },
+                    "Hypothyroidism is a risk factor$Cause_1": {
+                        "Hypothyroidism$Input3": {}
+                    },
+                    "Hyperlipidemia is a risk factor$Cause_1": {
+                        "Hyperlipidemia$Input3": {}
+                    },
+                    "Obstructive sleep apnea is a risk factor$Cause_1": {
+                        "Obstructive sleep apnea$Input3": {}
+                    },
+                    "Family history:PGF had MI  is a big risk factor$Cause_1": {
+                        "PGF had MI$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "chest pain\n",
+    "input2": "He is a yo man with history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.\n\ufeff\nPatient reports he developed chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in  his chest, with occasional radiation to his back and L arm. He took Tums, omeprazole with no relief. Pain persisted throughout the following day. It is constant, no association with activity or positioning. No associated dyspnea, diaphoresis, nausea or vomiting. No cardiac history and reports normal stress test year ago. his pain was in severity. EKG showed no ischemic changes but trop I was elevated, so he was started on heparin gtt. CTA was performed and showed no aortic dissection. Pain improved with SL nitro and morphine. He was transferred for further evaluation and management. \n\ufeff\nIn the ED, initial VS were: 97.7, 68, 138/76, 19, 99% RA Exam was unremarkable, no murmurs, lungs CTAB, no edema. EKG: sinus rhythm, 68 bpm, PVCs, early R-wave progressions, no significant ischemic changes Labs notable for troponin 0.26, CK 407, MB 29, BNP 766, K 5.3 (non hemolyzed), Cr 1.2 (baseline 1.1-1.3 per OSH records), WBC 9.8, Hb 13.2, lactate 1.6.  \nImaging showed:  OSH imaging revealed no aortic dissection, no acute cardiopulmonary process. \nConsults: Cardiology, who recommended patient stat on heparin \nand nitro gtt, with admission for cardiac catheterization.  \nPatient received: Morphine IV 4mg, SL nitro, ASA 324, continued\non heparin gtt and started on nitroglycerin gtt.  \n \nTransfer VS were: 97.4, 66, 118/78, 20, 97% RA. \n\ufeff\nOn arrival to the floor, patient reports ongoing chest pain. No associated shortness of breath, nausea, diaphoresis. Feeling anxious about pain, possibility of procedure in the morning. No additional complaints.\n",
+    "input3": "+ Psoriatic Arthritis\n+ Hypothyroidism\n+ Hyperlipidemia\n+ Obstructive sleep apnea (not on CPAP)\n+ GERD\n+ Peptic Ulcer \n+ Multiple orthopedic procedures:\n+ L shoulder implant\n+ R hip implant\n+ Back surgery (Distectomy)\n+ R hand carpal tunnel relase\n",
+    "input4": "No family history of sudden cardiac death or early MI.\n",
+    "input5": "ADMISSION PHYSICAL EXAM\n=======================  \nVS: 98.3 PO 126 / 66 72 19 94 Ra  \nGENERAL: NAD  \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva, MMM  \nNECK: supple, no LAD, no JVD  \nHEART: RRR, S1/S2, no murmurs, gallops, or rubs  \nLUNGS: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles  \nABDOMEN: nondistended, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly  \nEXTREMITIES: no cyanosis, clubbing, or edema  \nPULSES: 2+ DP pulses bilaterally  \nNEURO: A&Ox3, moving all 4 extremities with purpose  \nSKIN: warm and well perfused, no excoriations or lesions, no rashes\n",
+    "input6": "ADMISSION LABS\n==============\n09:30PM BLOOD WBC-9.8 RBC-4.28* Hgb-13.2* Hct-40.4 MCV-94 MCH-30.8 MCHC-32.7 RDW-13.1 RDWSD-44.5\n09:30PM BLOOD Neuts-72.4* Lymphs-18.5* Monos-6.5 Eos-1.5 Baso-0.7 AbsNeut-7.10* AbsLymp-1.82 \nAbsMono-0.64 AbsEos-0.15 AbsBaso-0.07\n09:30PM BLOOD Glucose-111* UreaN-17 Creat-1.2 Na-139 K-5.3* Cl-99 HCO3-27 AnGap-13\n\ufeff\nPERTINENT LABS\n=============\n09:30PM BLOOD CK(CPK)-407*\n09:30PM BLOOD CK-MB-29* MB Indx-7.1* proBNP-766*\n09:30PM BLOOD cTropnT-0.26*\n\ufeff\nIMAGING\n==================\nTTE  Conclusions\nLVEF 56%\nThe left atrial volume index is normal. No atrial septal defect is seen by 2D or color Doppler. The estimated right atrial pressure is xx mmHg. Normal left ventricular wall thickness, cavity size, and regional/global systolic function (3D LVEF = 56 %). Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion. \n\ufeff\n\ufeff\nIMPRESSION: Normal left ventricular wall thickness, cavity size, and regional/global systolic function. Mild aortic regurgitation. \n\ufeff\nCardiac Cath\nCoronary Anatomy\nDominance: Right\n* Left Main Coronary Artery\nThe LMCA is without significant disease.\n* Left Anterior Descending\nThe LAD is with mild irregularities, tapering to a small apical vessel.\nDiagonal is very small caliber with focal 95% stenosis.\nThe Diagonal is with mild disease.\n* Circumflex\nThe Circumflex is without significant disease.\nThe Marginal is without significant disease.\n* Right Coronary Artery\nThe RCA is with diffuse mid and 50% origin PL.\n"
+}

Finished/Acute Coronary Syndrome/NSTEMI/17923616-DS-20.json

@@ -0,0 +1,93 @@
+{
+    "NSTEMI$Intermedia_5": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "BLOOD CK-MB-14* MB Indx-7.0* cTropnT-0.65*$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "BLOOD CK-MB-33* MB Indx-9.3* cTropnT-0.59*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest Pain is a symptom of ACS.$Cause_1": {
+                "chest pain$Input1": {}
+            },
+            "hyperlipidemia is arisk fact and Chest Pain is a symptom of ACS.$Cause_1": {
+                "He is a gentleman with hyperlipidemia who presented to the ED with chest pain while walking to work yesterday evening.$Input2": {}
+            },
+            "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times. is a symptom of ACS.$Cause_1": {
+                "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times.$Input2": {}
+            },
+            "Hyperlipidemia is a risk factor$Cause_1": {
+                "+ Hyperlipidemia$Input3": {}
+            }
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "high hs-cTn is a strong value for ACS$Cause_1": {
+                "In the ED, the patient was found to have elevated troponin with TWI in V2-V6.$Input2": {}
+            },
+            "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                "he was found to have a 90% LAD lesion and 90% ramus lesion, for which he received DES to each. He had a 60% distal RCA lesion that was not intervened on.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "chest pain$Input1": {}
+                },
+                "hyperlipidemia is arisk fact and Chest Pain is a symptom of ACS.$Cause_1": {
+                    "He is a gentleman with hyperlipidemia who presented to the ED with chest pain while walking to work yesterday evening.$Input2": {}
+                },
+                "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times. is a symptom of ACS.$Cause_1": {
+                    "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times.$Input2": {}
+                },
+                "Hyperlipidemia is a risk factor$Cause_1": {
+                    "+ Hyperlipidemia$Input3": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "ECG:non-ST-elevation$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a symptom of ACS.$Cause_1": {
+                    "chest pain$Input1": {}
+                },
+                "hyperlipidemia is arisk fact and Chest Pain is a symptom of ACS.$Cause_1": {
+                    "He is a gentleman with hyperlipidemia who presented to the ED with chest pain while walking to work yesterday evening.$Input2": {}
+                },
+                "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times. is a symptom of ACS.$Cause_1": {
+                    "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times.$Input2": {}
+                },
+                "Hyperlipidemia is a risk factor$Cause_1": {
+                    "+ Hyperlipidemia$Input3": {}
+                }
+            },
+            "Strongly Suspected ACS$Intermedia_3": {
+                "high hs-cTn is a strong value for ACS$Cause_1": {
+                    "In the ED, the patient was found to have elevated troponin with TWI in V2-V6.$Input2": {}
+                },
+                "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": {
+                    "he was found to have a 90% LAD lesion and 90% ramus lesion, for which he received DES to each. He had a 60% distal RCA lesion that was not intervened on.$Input2": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest Pain is a symptom of ACS.$Cause_1": {
+                        "chest pain$Input1": {}
+                    },
+                    "hyperlipidemia is arisk fact and Chest Pain is a symptom of ACS.$Cause_1": {
+                        "He is a gentleman with hyperlipidemia who presented to the ED with chest pain while walking to work yesterday evening.$Input2": {}
+                    },
+                    "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times. is a symptom of ACS.$Cause_1": {
+                        "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times.$Input2": {}
+                    },
+                    "Hyperlipidemia is a risk factor$Cause_1": {
+                        "+ Hyperlipidemia$Input3": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "chest pain\n",
+    "input2": "He is a gentleman with hyperlipidemia who presented to the ED with chest pain while walking to work yesterday evening. The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times. He reported no shortness of breath, nausea, or vomiting.\n\ufeff\nIn the ED, the patient was found to have elevated troponin with TWI in V2-V6. He was given aspirin and atorvastatin 80 mg and started on heparin drip. He was taken to the cath lab where he was found to have a 90% LAD lesion and 90% ramus lesion, for which he received DES to each. He had a 60% distal RCA lesion that was not intervened on. He received a ticagrelor load in the lab.\n\ufeff\nOn the floor, patient recounts story as above. States he's doing well without chest pain.  \n\ufeff\nREVIEW OF SYSTEMS: On review of systems, denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. Denies recent fevers, chills or rigors. Denies exertional buttock or calf pain. All of the other review of systems were negative.  \n\ufeff\nCardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n",
+    "input3": "+ Hyperlipidemia\n",
+    "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n",
+    "input5": "ADMISSION PHYSICAL\nVS: 97.8 18 97%RA\nGENERAL: WDWN M in NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma.  \n\ufeff\nNECK: Supple without JVD \nCARDIAC: PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi.  \nABDOMEN: Soft, NTND. No HSM or tenderness.  \nEXTREMITIES: No c/c/e. No femoral bruits.  R wrist dressed, without hematoma + pulses\nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.  \nPULSES:  Distal pulses palpable and symmetric\n",
+    "input6": "ADMISSION LABS\n03:05AM BLOOD WBC-5.4 RBC-4.54* Hgb-14.3 Hct-42.2 MCV-93 MCH-31.5 MCHC-33.9 RDW-12.8 RDWSD-43.8\n03:05AM BLOOD Neuts-72.0* Lymphs-14.8* Monos-10.0 Eos-2.4 Baso-0.6 AbsNeut-3.90 AbsLymp-0.80* \nAbsMono-0.54 AbsEos-0.13 AbsBaso-0.03\n03:05AM BLOOD Glucose-106* UreaN-37* Creat-1.3* Na-139 \nK-4.4 Cl-106 HCO3-17* AnGap-20\n03:05AM BLOOD CK(CPK)-179\n07:35AM BLOOD Calcium-9.4 Phos-3.0 Mg-2.1\n\ufeff\nCARDIAC ENZYME TREND \n03:05AM BLOOD CK-MB-6\n03:05AM BLOOD cTropnT-0.04*\n08:50AM BLOOD CK-MB-10 MB Indx-5.9 cTropnT-0.21*\n05:15PM BLOOD cTropnT-0.33*\n12:04AM BLOOD CK-MB-45* MB Indx-12.6* cTropnT-0.47*\n07:35AM BLOOD CK-MB-64* MB Indx-13.6* cTropnT-0.61*\n01:15PM BLOOD CK-MB-50* MB Indx-11.2* cTropnT-0.63*\n07:38PM BLOOD CK-MB-33* MB Indx-9.3* cTropnT-0.59*\n07:40AM BLOOD CK-MB-14* MB Indx-7.0* cTropnT-0.65*\n\nECG:non-ST-elevation\n"
+}

Finished/Acute Coronary Syndrome/STEMI/11514847-DS-14.json

@@ -0,0 +1,52 @@
+{
+    "NSTE-ACS$Intermedia_4": {
+        "ST-elevations is a symotom of acs-stemi$Cause_1": {
+            "Post-PCI EKG demonstrated improvement in ST-elevations$Input2": {}
+        },
+        "Cardiac structural abnormalities is a sigh of ACS$Cause_1": {
+            "Mild inferolateral hypokinesis consistent with single vessel coronary artery disease. Mild tricuspid regurgitation. Moderate pulmonary hypertension.$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Shortness of breath is a symptom of ACS$Cause_1": {
+                "Shortness of breath$Input1": {}
+            },
+            "chest pain is a symptom of ACS$Cause_1": {
+                "chest pain$Input1": {}
+            },
+            "family history of heart issues is a risk factor$Cause_1": {
+                "Father \"heart issues.\"$Input4": {}
+            },
+            "family history oCAD is a risk factor.$Cause_1": {
+                "Mother with CAD.$Input4": {}
+            }
+        },
+        "Strongly suspected ACS$Intermedia_3": {
+            "chest pain is a symptom of ACS.$Cause_1": {
+                "he began to experience non-radiating chest pressure. The chest pain was non-exertional and seemed to be triggered by alcohol use over the weekend.$Input2": {}
+            },
+            "Cardiac surgery is one of the risk factors$Cause_1": {
+                "He was transferred for cardiac catheterization. He underwent cardiac cath and had 1 DES placed left CX-OM with good result via right radial approach.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Shortness of breath is a symptom of ACS$Cause_1": {
+                    "Shortness of breath$Input1": {}
+                },
+                "chest pain is a symptom of ACS$Cause_1": {
+                    "chest pain$Input1": {}
+                },
+                "family history of heart issues is a risk factor$Cause_1": {
+                    "Father \"heart issues.\"$Input4": {}
+                },
+                "family history oCAD is a risk factor.$Cause_1": {
+                    "Mother with CAD.$Input4": {}
+                }
+            }
+        }
+    },
+    "input1": "Shortness of breath, chest pain\n",
+    "input2": "A 46 yo male otherwise healthy gentlemen. Patient was in his normal state of health until approximately 4 days prior to admission when he began to experience non-radiating chest pressure. The chest pain was non-exertional and seemed to be triggered by alcohol use over the weekend.  He initially experienced chest discomfort without any associated symptoms after taking Metronidazole and Maalox for recent H. pylori diagnosis. He thought the combination of Metronidazole and Flagyl triggered this chest discomfort, which resolved in a few hours. He had a similar experience, which again persisted for a few hours before resolving. He denies any prior history of chest pain, and maintains that he is active and runs without any limitations inflicted by chest pain or shortness of breath.\n\nEarlier on the day of presentation, patient was driving home and began to experience a similar chest discomfort, though this time was more severe. The chest pressure was  unremitting without any associated symptoms and patient presented to OSH for further evaluation. \n\nAt OSH, he was loaded with ASA, heparin and trailed SL nitro. He was transferred for cardiac catheterization. He underwent cardiac cath and had 1 DES placed left CX-OM with good result via right radial approach. Post-PCI EKG demonstrated improvement in ST-elevations\n\nOn arrival to CCU, patient is chest pain free. He denies any shortness of breath, nausea/vomiting, palpitations, dizziness or lightheadedness.\n\nROS: Positive per HPI. Remaining 10 point ROS reviewed and negative.\n",
+    "input3": "Recently diagnosed H. pylori\n",
+    "input4": "Father \"heart issues.\" Mother with CAD. MGM with MI. HTN in maternal aunts/uncles. No history of diabetes. No history of sudden unexplained death in young individuals. No history of arrhythmias.\n",
+    "input5": "GENERAL: Well developed, well nourished in NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: Normocephalic, atraumatic. Sclera anicteric. PERRL.  EOMI.\n\nNECK: Supple. JVP not elevated  \nCARDIAC: Normal rate, regular rhythm. No murmurs, rubs, or gallops.  \nLUNGS: No chest wall deformities or tenderness. Respiration is unlabored with no accessory muscle use. No adventitious breath sounds.  \nABDOMEN: Soft, non-tender, non-distended. No palpable hepatomegaly or splenomegaly.  \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or peripheral edema.  \nSKIN: No significant lesions or rashes.  \nPULSES: Right radial with bandage and good distal pulse \nNEURO:  No focal deficits\n",
+    "input6": "Hematology \nCOMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW RDWSD Plt \n\nCt \n___ 06:26AM    8.3 4.52* 13.5* 41.9 93 29.9 32.2 13.1 \n44.6 221 Import Result \n___ 02:20AM    10.6* 4.60 13.9 41.6 90 30.2 33.4 12.9 \n42.3 232 Import Result \n BASIC COAGULATION ___, PTT, PLT, INR) ___ PTT Plt Ct ___ \n___ 06:26AM        221   Import Result \n___ 02:20AM        232   Import Result \n___ 02:20AM    13.1* 36.7*   1.2* Import Result \n\n \n \nChemistry \n RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap \n___ 06:26AM    ___ 142 4.1 ___ Import Result \n___ 02:20AM    115* 10 0.7 142 4.1 ___ Import \nResult \nESTIMATED GFR (MDRD CALCULATION) estGFR \n___ 02:20AM    Using this Import Result \nCHEMISTRY TotProt Albumin Globuln Calcium Phos Mg UricAcd Iron \n___ 06:26AM          8.8 3.5 2.4     Import Result \n___ 02:20AM          8.7 3.3 2.0     Import Result \n \n\nTTE: \nIMPRESSION: Mild inferolateral hypokinesis consistent with single vessel coronary artery disease. Mild tricuspid regurgitation. Moderate pulmonary hypertension.\n\nPCI: Percutaneous Coronary Intervention: Percutaneous coronary intervention (PCI) was performed on an ad hoc basis based on the coronary angiographic findings from the diagnostic portion of this procedure. A 6___ EBU3.5 guide provided adequate support. Crossed with a Prowater wire into the distal OM.\n\nPredilated with a 2.5 mm balloon and then deployed a 3.0 mm x 24 mm DES. Postdilated with a 3.5 x 15mm NC balloon in proximal segment at 18 ATM. Final angiography revealed normal flow, no dissection and 0% residual stenosis.\nComplications: There were no clinically significant complications.\n"
+}

Finished/Acute Coronary Syndrome/STEMI/11528474-DS-10.json

@@ -0,0 +1,44 @@
+{
+    "NSTE-ACS$Intermedia_4": {
+        "ST-elevations is a symotom of acs-stemi$Cause_1": {
+            "His EKG showed worsening ST elevations$Input2": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "BLOOD cTropnT-5.18*$Input6": {}
+        },
+        "Cardiac structural abnormalities is a sigh of ACS.$Cause_1": {
+            "There is a 95% stenosis in the proximal segment.$Input6": {}
+        },
+        "Cardiac structural abnormalities is a sigh of ACS$Cause_1": {
+            "There is a 70% stenosis in the mid and distal segments.$Input6": {}
+        },
+        "Strongly suspected ACS$Intermedia_3": {
+            "More severe clinical presentations of acs$Cause_1": {
+                "he developed sudden onset dizziness, sweating, and chest pain that he described as \"knifelike\". He became so uncomfortable that he \"could not speak\"$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "Chest pain to OSH$Input1": {}
+                },
+                "Kidney stones can be a risk factor$Cause_1": {
+                    "Kidney stones$Input3": {}
+                },
+                "anxiety can be a risk factor$Cause_1": {
+                    "Anxiety$Input3": {}
+                },
+                "family history of CABG is a risk factor$Cause_1": {
+                    "Mom with CABG.$Input4": {}
+                },
+                "family history of CAD is a risk factor$Cause_1": {
+                    "Brother with CAD with stents.$Input4": {}
+                }
+            }
+        }
+    },
+    "input1": "Chest pain to OSH\n",
+    "input2": "Patient was in his usual state of health today, but did note some discomfort in his left shoulder while he was at the gym. He says his discomfort has been going on for a few weeks, and he has been attributing it to a musculoskeletal injury from working out. The pain subsided after working out at the gym, and he subsequently went to work. At some point later in the morning at work, he developed sudden onset dizziness, sweating, and chest pain that he described as \"knifelike\". He became so uncomfortable that he \"could not speak\". His wife, who works in the same office as him, called ___. He also had one episode of vomiting.\n\nHe was brought to cath lab where he had total occlusion of LAD. 3 DES (2.5mmx15mm, 3mmx15mm, 3.5mmx15mm) placed in LAD. There was no reflow which minimally responded to intracoronary agents. Given ongoing angina and poor flow in LAD, he was started on an IABP in addition to IV eptifibitide and IV heparin. Given 180 mcg of 325 mg, and 4000U heparin. Subsequently transferred here for further workup and management.\n\nVitals prior to transfer 138/77 w O2 sats 99% on 4L NC.\n\nOn arrival to the CCU, patient was having persistent chest pain and nausea. He was started on a nitro drip with little relief. His EKG showed worsening ST elevations, and the decision was made to bring him to the cath lab. In our Cath Lab his balloon pump was removed and replaced with an Impella via the right groin. His LVEDP went from ___ after balloon placement. Per verbal sign out from the Cath Lab, the stents placed earlier in the day appeared patent but there was residual disease distal to them. Ultimately 2 additional stents were placed in the LAD. Angiography of the LAD revealed TIMI III flow, 0% residual, occluded diagnoal branch likely due to pre-existing dissection, but no dissection in the LAD proper. \n\nHe also had another stent placed in his OM1 which was 95% occluded. Final angiography of the OM revealed TIMI III flow, 0% residual, and no dissection. He received about 1 L of IV fluid in the Cath Lab, as well as 210 cc of contrast.\n\nUpon return to the CCU, his Impella was noted to be properly placed on bedside ultrasound, and his chest pain had improved.\n\nLABS NOTABLE FOR: WBC 10.9 HGB 15.4 PLT GLC 126\n\nROS: Positive per HPI. Remaining 10 point ROS reviewed and negative.\n",
+    "input3": "+Kidney stones\n+Anxiety\n+Hypospadias surgery in childhood\n",
+    "input4": "Mom with CABG.\nBrother with CAD with stents.\n",
+    "input5": "ADMISSION EXAM\n\nHEENT: Normocephalic, atraumatic. Sclera anicteric. PERRL. EOMI. \nCARDIAC: Normal rate, regular rhythm. No murmurs, rubs, or gallops.  \nLUNGS: No chest wall deformities or tenderness. Respiration is unlabored with no accessory muscle use. No adventitious breath sounds.  \nABDOMEN: Soft, non-tender, non-distended. No palpable hepatomegaly or splenomegaly.  \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or peripheral edema.  Right wrist with TR band in place.  Right groin with Impala in place, some blood under dressing but no surrounding erythema\nSKIN: No significant lesions or rashes.  \nPULSES: Distal pulses palpable and symmetric.  \nNEURO: AAO x3\n",
+    "input6": "ADMISSION LABS\n\n___ 02:45PM BLOOD WBC-15.4* RBC-4.68 Hgb-14.3 Hct-41.0 MCV-88 MCH-30.6 MCHC-34.9 RDW-11.7 RDWSD-37.5 Plt ___\n___ 02:45PM BLOOD WBC-15.4* RBC-4.68 Hgb-14.3 Hct-41.0 MCV-88 MCH-30.6 MCHC-34.9 RDW-11.7 RDWSD-37.5 Plt ___\n___ 02:45PM BLOOD Neuts-91.3* Lymphs-5.2* Monos-2.9* Eos-0.0* Baso-0.1 Im ___ AbsNeut-14.07* AbsLymp-0.80*  AbsMono-0.44 AbsEos-0.00* AbsBaso-0.02\n___ 05:45PM BLOOD ___ PTT-31.3 ___\n___ 02:45PM BLOOD Glucose-108* UreaN-19 Creat-1.1 Na-138 K-4.7 Cl-103 HCO3-20* AnGap-15\n___ 02:45PM BLOOD ALT-33 AST-187* ___ AlkPhos-57 TotBili-0.7\n___ 02:45PM BLOOD CK-MB-124* MB Indx-6.5* cTropnT-3.32*\n___ 06:02AM BLOOD CK-MB-252* cTropnT-6.42*\n___ 01:49PM BLOOD cTropnT-5.18*\n___ 02:45PM BLOOD Calcium-9.1 Phos-3.0 Mg-2.1 Cholest-206*\n___ 02:45PM BLOOD Triglyc-141 HDL-46 CHOL/HD-4.5 LDLcalc-132*\n___ 02:45PM BLOOD %HbA1c-5.3 eAG-105\n\n\nIMAGING\n=======\nCXR ___No previous images.  The tip of the IABP is approximately 3 cm above the carina.  No evidence of vascular congestion, pleural effusion, or acute focal pneumonia. \n \nSTUDIES\n======\nCARDIAC CATH ___\nLM: The Left Main, arising from the left cusp, is a large caliber vessel. This vessel bifurcates into the Left Anterior Descending and Left Circumflex systems.\n \nLAD: The Left Anterior Descending artery, which arises from the LM, is a large caliber vessel. There is a stent in the proximal segment. There is a stent in the proximal segment. There is a 90% ulcerated plaque/dissction in the mid segment of the LAD after the bend of stents. The Septal Perforator, arising from the proximal segment, is a small caliber vessel. The Diagonal, arising from the proximal segment, is a medium caliber vessel. There is a 100% stenosis in the ostium.\n \nLeft Circumflex: The Circumflex artery, which arises from the LM, is a large caliber vessel. The Obtuse Marginal, arising from the proximal segment, is a large caliber vessel. There is a 95% stenosis in the proximal segment. The Superior lateral of the 1stOM, arising from the distal segment, is a medium caliber vessel. The Obtuse Marginal, arising from the proximal segment, is a medium caliber vessel. The Atrioventricular Circumflex, arising from the mid segment, is a medium caliber vessel. There is a 70% stenosis in the mid and distal segments. The Left Posterior Descending Artery, arising from the distal segment, is a medium caliber vessel. One injection show a small degree of air into the distal LCx but this resolved with 100% oxygen.\n\nRCA: The Right Coronary Artery, arising from the right cusp, is a small caliber \n\nTTE\nEF 35%. Moderate regional left ventricular systolic dysfunction, c/w CAD. Well-positioned Impella CP device.\n"
+}

Finished/Acute Coronary Syndrome/STEMI/11801858-DS-13.json

@@ -0,0 +1,55 @@
+{
+    "NSTE-ACS$Intermedia_4": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "cTropnT-5.97*$Input6": {}
+        },
+        "Cardiac structural abnormalities is a sigh of ACS.$Cause_1": {
+            "The LAD had a ___ mid vessel stenosis. The Cx had a 100% mid vessel thrombotic occlusion. The RCA had a mid vessel stenosis.$Input6": {}
+        },
+        "Cardiac structural abnormalities is a sigh of ACS$Cause_1": {
+            "Overall left ventricular systolic function is severely depressed (LVEF= 15X %). with depressed free wall contractility. The number of aortic valve leaflets cannot be determined. The aortic valve leaflets are moderately thickened. The mitral valve leaflets are structurally normal. Moderate to severe (3+) mitral regurgitation is seen. There is a trivial/physiologic pericardial effusion.$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain is a symptom of ACS$Cause_1": {
+                "chest pain$Input1": {}
+            },
+            "history of HTN, dCHF, severe AS, HLD ARE risk factors$Cause_1": {
+                "Female with history of HTN, dCHF, severe AS, HLD$Input2": {}
+            },
+            "HTN is the risk fact for ACS$Cause_1": {
+                "HTN$Input3": {}
+            },
+            "Severe AS is the risk fact for ACS$Cause_1": {
+                "Severe AS$Input3": {}
+            }
+        },
+        "Strongly suspected ACS$Intermedia_3": {
+            "More severe clinical presentations of acs$Cause_1": {
+                "She felt exhausted and lightheaded and also had some diarrhea last night. Also noticed some numbness in her right leg whihc comes and goes$Input2": {}
+            },
+            "EKG changes are sign of ACS$Cause_1": {
+                "Was found to have EKG changes.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "chest pain$Input1": {}
+                },
+                "history of HTN, dCHF, severe AS, HLD ARE risk factors$Cause_1": {
+                    "Female with history of HTN, dCHF, severe AS, HLD$Input2": {}
+                },
+                "HTN is the risk fact for ACS$Cause_1": {
+                    "HTN$Input3": {}
+                },
+                "Severe AS is the risk fact for ACS$Cause_1": {
+                    "Severe AS$Input3": {}
+                }
+            }
+        }
+    },
+    "input1": "chest pain\n",
+    "input2": "Female with history of HTN, dCHF, severe AS, HLD who presented initially with complaint of chest pressure anteriorly. She described it as substernal, constant since last night. She felt exhausted and lightheaded and also had some diarrhea last night. Also noticed some numbness in her right leg whihc comes and goes. Was found to have EKG changes.  She had no prior cardiac history.  Had been seen last week at ED and ruled out with -ve sets after \"strained muscle in her chest moving her arm\". A CTA of the chest showed mild emphysema, but no evidence of PE.  \n\nInitial VS were 97.8, HR 109, BP 121/84, RR 22, 02 sat 78% and pain. In ED she was noted to have an o2 sat of 80% and was lightheaded. Found to be guaiac positive. She got ASA and was started on a heaprin gtt (w/o bolus). IN cath lab,  they went in through the lt radial huge and found a thrombus in lcx, mild right disease. She got 600 plavix after cath, bival, bms in lcx, and had a hematoma in lt radial. Transferred to CCU after procedure.\n",
+    "input3": "+HTN\n+HL\n+dCHF\n+Severe AS\n+GERD\n+Osteoprosis: Pseudoclaudication, likely because of spinal stenosis, history of falls and shoulder injury, s/p ORIF right patellar fracture\n",
+    "input4": "non-contributory\n",
+    "input5": "On transfer to CCU\nVS: 98.4, 103, 131/87, 19, 90% on NRB\nGENERAL: NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma.  \n\nCARDIAC: PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.  \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi.  \nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits.  \nEXTREMITIES: No c/c/e. No femoral bruits.  \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nNEURO: AAOx3, CNII-XII intact, strength biceps, triceps, wrist, knee/hip flexors/extensors, 2+ reflexes biceps, brachioradialis, patellar, ankle. \nPULSES:  \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+   \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+\n",
+    "input6": "___ 05:22PM BLOOD CK(CPK)-___*\n___ 05:22PM BLOOD CK-MB-114* MB Indx-6.2* cTropnT-5.97*\n\nCardiac Cath\n1. Selective coronary angiography in this right dominant systemdemonstrated one vessel disease. The LMCA had noangiographically apparent disease. The LAD had a ___ mid vessel stenosis. The Cx had a 100% mid vessel thrombotic occlusion. The RCA had a mid vessel stenosis. \n\n2. Limited resting hemodynamics revealed a central aortic pressure of 132.86 mmHg. \n\n3. Successful PTCA and stenting of the mid Cx with a 2.25x8mm INTEGRITY stent which was postdilated to 2.75mm. Final angiography revealed no residual stenosis, no angiographically apparent dissection and TIMI II to III flow. \n  \nBedside TTE\nOverall left ventricular systolic function is severely depressed (LVEF= 15X %). with depressed free wall contractility. The number of aortic valve leaflets cannot be determined. The aortic valve leaflets are moderately thickened. The mitral valve leaflets are structurally normal. Moderate to severe (3+) mitral regurgitation is seen. There is a trivial/physiologic pericardial effusion. \n\nCXR (___)\nWide spread bilateral dense reticular opacities with relative left lower lung and right mid lung sparing, likely representing flash pulmonary edema due to acute cardiac decompensation in the setting of ischemia/infarct.\n"
+}

Finished/Acute Coronary Syndrome/STEMI/12238650-DS-22.json

@@ -0,0 +1,82 @@
+{
+    "NSTE-ACS$Intermedia_4": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "cTropnT-6.61*$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "cTropnT-12.62*$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09 .$Cause_1": {
+            "cTropnT-11.69*$Input6": {}
+        },
+        "Cardiac structural abnormalities is a sigh of ACS.$Cause_1": {
+            "Left\nThe LMCA was short with nearly separate ostia in the LAD and Cx. The LAD was widely patent with no thrombosis in the stent and only mild luminal irregularities. The Cx had mild plaquing. The RCA was nondominant with luminal irregularities as before.$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain is a symptom of ACS$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "history of coronary artery disease is a risk factor$Cause_1": {
+                "Male with history of coronary artery disease$Input2": {}
+            },
+            "Chest pain is a symptom of ACS.$Cause_1": {
+                "The patient has been complaining of progressive, exertional, left sided chest pain.$Input2": {}
+            },
+            "HTN is the risk fact for ACS$Cause_1": {
+                "HTN$Input3": {}
+            },
+            "DM2 is the risk fact for ACS$Cause_1": {
+                "DM2$Input3": {}
+            },
+            "HLD is the risk fact for ACS$Cause_1": {
+                "HLD$Input3": {}
+            },
+            "family history of HTN is a risk factor$Cause_1": {
+                "HTN in both parents$Input4": {}
+            }
+        },
+        "Strongly suspected ACS$Intermedia_3": {
+            "Coronary stenosis isa sign of acs$Cause_1": {
+                "The patient underwent elective coronary angiography which demonstrated a 90% proximal LAD lesion for which a 3.0x12 Xience (DES).$Input2": {}
+            },
+            "More severe clinical presentations of acs$Cause_1": {
+                "before the patient could pick up with prescription, he had the sudden onset of sharp, mid-abdominal pain. This was without radiation, nausea, vomiting or diarrhea.$Input2": {}
+            },
+            "More severe clinical presentations of acs.$Cause_1": {
+                "the patient reported sudden onset of dyspnea, nausea/vomiting and diaphoresis.$Input2": {}
+            },
+            "EKG changes are sign of ACS$Cause_1": {
+                "An ECG was obtained which demonstrated sinus rhythm at a rate of 89 with STE V2-V5 and aVL with reciprocal changed in II and III.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "history of coronary artery disease is a risk factor$Cause_1": {
+                    "Male with history of coronary artery disease$Input2": {}
+                },
+                "Chest pain is a symptom of ACS.$Cause_1": {
+                    "The patient has been complaining of progressive, exertional, left sided chest pain.$Input2": {}
+                },
+                "HTN is the risk fact for ACS$Cause_1": {
+                    "HTN$Input3": {}
+                },
+                "DM2 is the risk fact for ACS$Cause_1": {
+                    "DM2$Input3": {}
+                },
+                "HLD is the risk fact for ACS$Cause_1": {
+                    "HLD$Input3": {}
+                },
+                "family history of HTN is a risk factor$Cause_1": {
+                    "HTN in both parents$Input4": {}
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "Male with history of coronary artery disease s/p recent PCI presents with in-stent thrombosis.\n\nThe patient has been complaining of progressive, exertional, left sided chest pain. He underwent a nuclearstress test that demonstrated METs with chest pain symptoms. Normal myocardial perfusion study. LVEF 46&\". In addition, a TTE demonstrated \"LVEF 60-65%, normal RV, mild MR\".\n\nHe was seen that his chest pain was attributed to possible angina though this was deemed less likely given his negative stress testing. Given his risk factors and family history the patient, along with his cardiologist elected to pursue angiography. \n\nThe patient underwent elective coronary angiography which demonstrated a 90% proximal LAD lesion for which a 3.0x12 Xience (DES). He was loaded with ticagrelor and discharged the same day. \n\nThe patient was seen in the CDAC for abdominal discomfort that is exacerbated after eating food ever since he started taking his ticagrelor. He was instructed to start pantoprazole and to discontinue his ticagrelor. He was given a prescription for clopidogrel 75mg daily after a 300mg loading dose. \n\nHe had taken his morning dose of ticagrelor. He was instructed to hold his evening dose and load with clopidogrel 300mg the next morning. The patient went to his pharmacy that evening to pick up his prescription. The pharmacist said they did not have the 300mg loading dose available but that the patient should come back the next day to pick it up. The patient took clopidogrel 75mg the next morning with plans to  pick up his loading dose later in the day. \n\nHowever, before the patient could pick up with prescription, he had the sudden onset of sharp, mid-abdominal pain. This was without radiation, nausea, vomiting or diarrhea. \n\nHis vitals on presentation were notable for T 98.2 HR 73 R 16 BP146/101 SpO2 99. His Chemistry panel was wnl. LFTs were notable for AST 20 ALT 38 AP 62 and Lipase 128. INR was 1.2 CBC was wnl.\n\nHe underwent a CT abd which showed evidence of mild pancreatitis. He was admitted for abdominal pain with concern for pancretitis.\n\nHis ECG on admission demonstrated normal sinus rhythm at a rate of 66 with normal axis and intervals. There was TWI in V4-6 and STD I-II. \n\nThe next day, the patient reported sudden onset of dyspnea, nausea/vomiting and diaphoresis. An ECG was obtained which demonstrated sinus rhythm at a rate of 89 with STE V2-V5 and aVL with reciprocal changed in II and III. He was transferred out of concern for in-stent thrombosis.\n\nUpon arrival, he was taken directly to the cath lab where he underwent coronary angiography via the R radial artery. This demonstrated complete occlusion of the LAD for which he received POBA. \n\nHe was then transferred to the floor where he was complaining of mild dyspnea but improved abdominal pain. He has no fevers or chills. No chest pain or papliations. His ECG showed improved anteroseptal STEs.\n\nOf note, the patient has had an episode of pancreatitis that was thought to be possible due to biliary obstruction but  no stones were seen on EUS. Therefore the etiology was thought to  be from resolved choledocholithiasis vs. idiopathic. The patient states that this abdominal pain is very similar to this episode.\n",
+    "input3": "+HTN\n+HLD\n+CVA c/b R arm and leg weakness\n+DM2\n+Pancreatitis\n",
+    "input4": "HTN in both parents, father with CHF, mother with CABG in her, multiple siblings with HTN. Had myopathy to rosuvastatin \nand cough to lisinopril.\n",
+    "input5": "ADMISSION PHYSICAL EXAMINATION:  \n===============================\nVS: T 98.2 BP 159/98 HR 91 R 18 SpO2 98 ra \nGEN: NAD\nHEENT: Clear OP, no scleral icterus\nRESP: No increased WOB. Mild, end-expiratory crackles R base\nABD: NTND no HSM\nEXT: Warm, no edema. No mass by R radial artery. Bandage c/d/i\nNEURO: CN II-XII intact. Strength ___ LUE and LLE ___ RUE and RLE\n",
+    "input6": "ADMISSION LABS:\n===============\n___ 11:00AM BLOOD WBC-7.6 RBC-4.56* Hgb-13.5* Hct-39.9* MCV-88 MCH-29.6 MCHC-33.8 RDW-13.2 RDWSD-42.2 Plt ___\n___ 11:00AM BLOOD Neuts-86.3* Lymphs-9.6* Monos-3.3* Eos-0.1* Baso-0.3 Im ___ AbsNeut-6.58* AbsLymp-0.73* AbsMono-0.25 AbsEos-0.01* AbsBaso-0.02\n___ 11:00AM BLOOD Glucose-253* UreaN-10 Creat-1.1 Na-140 K-4.0 Cl-101 HCO3-25 AnGap-14\n___ 11:00AM BLOOD ALT-63* AST-304* LD(LDH)-690* AlkPhos-57 Amylase-29 TotBili-0.9\n___ 11:00AM BLOOD Lipase-77*\n___ 11:00AM BLOOD CK-MB-214* cTropnT-6.61*\n___ 08:00PM BLOOD cTropnT-12.62*\n___ 09:52PM BLOOD CK-MB-259* cTropnT-11.69*\n___ 11:00AM BLOOD Albumin-4.2 Calcium-9.1 Phos-4.0 Mg-1.9 Iron-50 Cholest-108\n___ 11:00AM BLOOD calTIBC-325 Ferritn-204 TRF-250\n___ 11:00AM BLOOD Triglyc-28 HDL-44 CHOL/HD-2.5 LDLcalc-58\n\n\nIMAGING/STUDIES:\n================\nCORONARY ANGIOGRAPHY ___:\nFINDINGS:\nHemodynamics: State: Baseline\nDominance: Left\nThe LMCA was short with nearly separate ostia in the LAD and Cx. The LAD was widely patent with no thrombosis in the stent and only mild luminal irregularities. The Cx had mild plaquing. The RCA was nondominant with luminal irregularities as before.\nImpressions:\n1. No change in coronary disease.\n\nCXR:\nThere is a right lower lobe patchy opacity.  No pleural effusion or pneumothorax identified.  The size of the cardiac silhouette is within normal limits. \nIMPRESSION:  \nRight basilar atelectasis and/or consolidation. \n\nLIVER OR GALLBLADDER U/S:\n1. Echogenic liver most likely due to fatty deposition.  Please note, on the basis of this appearance, more advanced forms liver disease not excluded. \n2. Status post cholecystectomy.  No biliary ductal dilation.\n"
+}

Finished/Acute Coronary Syndrome/STEMI/12392100-DS-22.json

@@ -0,0 +1,79 @@
+{
+    "NSTE-ACS$Intermedia_4": {
+        "ST-elevations is a symotom of acs-stemi$Cause_1": {
+            "On arrival, there is observed to be anterior ST elevations.$Input2": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "repeat troponin at 8:20AM day of transfer, 0.25.$Input2": {}
+        },
+        "Cardiac structural abnormalities is a sigh of ACS.$Cause_1": {
+            "Dilated right ventricular cavity with mild global free wall hypokinesis. The aortic sinus is mildly dilated with normal ascending aorta diameter for gender. The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. There is no aortic regurgitation. The mitral valve leaflets appear structurally normal with no mitral valve prolapse. There is trivial mitral regurgitation.$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09 .$Cause_1": {
+            "CK-MB-3 cTropnT-0.10*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain is a symptom of ACS$Cause_1": {
+                "Cardiac ArrestChest Pain$Input1": {}
+            },
+            "alcohol use and heavy smoking are risk factors$Cause_1": {
+                "He is a 58 year old gentleman with a history of significant alcohol use and heavy smoking$Input2": {}
+            },
+            "Hypertension is the risk fact for ACS$Cause_1": {
+                "Hypertension$Input3": {}
+            },
+            "Hyperlipidemia is the risk fact for ACS$Cause_1": {
+                "Hyperlipidemia$Input3": {}
+            },
+            "Chronic low back pain is the risk fact for ACS$Cause_1": {
+                "Chronic low back pain$Input3": {}
+            },
+            "Anxiety is the risk fact for ACS$Cause_1": {
+                "Anxiety$Input3": {}
+            },
+            "family history of coronary artery disease is a risk factor$Cause_1": {
+                "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family.$Input4": {}
+            }
+        },
+        "Strongly suspected ACS$Intermedia_3": {
+            "Changes in the nervous system can be a sigh$Cause_1": {
+                "He's also had erratic behavior including spending all his time naked, being incontinent of urine and sometimes stool, shouting sporadically and playing loud music, and other behavior that is very atypical for him.$Input2": {}
+            },
+            "More severe clinical presentations of acs$Cause_1": {
+                "She found him to have jerking movements of his extremities and not responding to her.$Input2": {}
+            },
+            "Coronary stenosis is a sigh of acs$Cause_1": {
+                "Angiography showed 95% LM ostial stenosis, 90% LAD extending to mid-LAD and 90% stenosis at large diagonal. the circumflex has 80% mid stenosis.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "Cardiac ArrestChest Pain$Input1": {}
+                },
+                "alcohol use and heavy smoking are risk factors$Cause_1": {
+                    "He is a 58 year old gentleman with a history of significant alcohol use and heavy smoking$Input2": {}
+                },
+                "Hypertension is the risk fact for ACS$Cause_1": {
+                    "Hypertension$Input3": {}
+                },
+                "Hyperlipidemia is the risk fact for ACS$Cause_1": {
+                    "Hyperlipidemia$Input3": {}
+                },
+                "Chronic low back pain is the risk fact for ACS$Cause_1": {
+                    "Chronic low back pain$Input3": {}
+                },
+                "Anxiety is the risk fact for ACS$Cause_1": {
+                    "Anxiety$Input3": {}
+                },
+                "family history of coronary artery disease is a risk factor$Cause_1": {
+                    "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family.$Input4": {}
+                }
+            }
+        }
+    },
+    "input1": "Cardiac ArrestChest Pain\n",
+    "input2": "He is a 58 year old gentleman with a history of significant alcohol use and heavy smoking with a recent neurologic decline who presents to the CCU after witnessed cardiac arrest. \n\nHe has had a steep neurologic decline over the past two months. He has been a lifelong heavy drinker and smoker, but he's been drinking far more than usual and at atypical times of day. He's also had erratic behavior including spending all his time naked, being incontinent of urine and sometimes stool, shouting sporadically and playing loud music, and other behavior that is very atypical for him. He was recently hospitalized for a rectal foreign body that was removed successfully. Due to concern for behavioral changes and rapidly progressive dementia, neurology was consulted. They suggested an extensive neurologic workup but the patient left AMA. He has since established with neurology but has also declined a workup there. \n\nHe was having a typical day, and drinking heavily during the day. His wife made him a sandwich and left the room briefly and returned when she heard gurgling sounds. She found him to have jerking movements of his extremities and not responding to her. She called EMS who arrived within minutes and found him to be pulseless VF and delivered a shock, regaining a pulse. He was intubated in the field. He received an amiodarone bolus. He was given 600mg aspirin PR. \n\nOn arrival, there is observed to be anterior ST elevations. Angiography showed 95% LM ostial stenosis, 90% LAD extending to mid-LAD and 90% stenosis at large diagonal. the circumflex has 80% mid stenosis. The RCA had minimal disease. An intra-aortic balloon pump was placed using R femoral access. \n\nOn arrival for to the ICU, he was found to not be following commands and post-arrest was consulted who recommended targeted-temperature management and EEG.He is a gentleman with CAD (known occluded RCA with collaterals s/p PCI's (PTCA and stenting of ostial LCx and PTCA ostial RI c/b instent restenosis at ostium of LCx and restenosis of ramus branch s/p PTCA of LCx ostium and ramus ostium, HTN, HL, chronic low back pain and anxiety who presented to OSH with chest pain. He was found to have an NSTEMI and was transferred to for catheterization.\n  \nAt the time of presentation, patient's pain was in severity. Troponins initially .06, repeat troponin at 8:20AM day of transfer, 0.25. VS on transfer: 136/59, HR 69 SR, 16, 97% 2 liters, afebrile.  Patient arrived and underwent uncomplicated cardiac cath with right femoral access. During procedure DES was placed in the ostial LCx with residual 40-50% distal left main to LAD. Plan per interventional is ASA, plavix, IVF overnight with plan for TTE, consult in the AM. Of note patient received ample versed and Fentanyl  \n\nOn arrival to the floor, patient without complaint. Denies chest pain, shortness of breath, palpitations. Tolerating PO without nausea, vomiting. Chronic back pain is at its baseline. Last BM yesterday.\n",
+    "input3": "+Arthritis (several joints) \n+Erectile dysfunction \n+Rapid onset dementia currently being worked up+CAD s/p MI and multiple PCI's  \n+Hypertension  \n+Hyperlipidemia  \n+Chronic low back pain\n+s/p cholecystectomy  \n+h/o osteomyelitis  \n+Depression  \n+Anxiety  \n+Umbilical hernia\n",
+    "input4": "Sister with lung CA \nFather died of liver disease with no history of alcohol useStrong family history of coronary artery disease in several first degree relatives on his mother's side of family. Thinks his family members have hypercholesterolemia, diabetes, hypertension. + early cardiac death.\n",
+    "input5": "ADMISSION PHYSICAL EXAMINATION:\n\nVS: T98.4, HR 90, BP 132/74, RR 21, O2 100% on 60% FiO2\nGENERAL: Intubated, no apparent distress\nHEENT: Pupils equal and briskly reactive, ETT tube, small abrasion on nasal bridge, no scleral icterus, moist mucous membranes\nNECK: JVP not elevated\nCARDIAC: S1/S2 regular, balloon pump auscultated, no other obvious murmurs\nLUNGS: Rhonchorous bilaterally\nABDOMEN: Soft, non-distended\nEXTREMITIES: No lower extremity edema, hair loss at the lower shins and distally. Balloon pump in R groin with no hematoma. Palpable R pedal pulses.  \nNEURO: Moving both extremities and gagging on tube after arrival, then much less activity subsequently. Not following any commands. Some movement of eyes and eyelids spontaneouslyADMISSION EXAM\nVS T 97.8 102/60 72 14 96%RA  \nGen: Obese M in NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.  \nNeck: Supple with no JVD noted (difficult to assess).  \nCV: RR, normal S1, S2. No m/r/g. No S3 or S4. Distant heart \nsounds.  \nChest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi.  \nAbd: NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. Morphine pump can be felt on the RLQ under the skin.  \nExt: no c/c/e. Right femoral cath site c/d/i under tegaderm.  \nSkin: No stasis dermatitis, ulcers, scars, xanthomas. + tattoos noted  \nRight: 2+ DPs  \nLeft: 2+ DP and radial\n",
+    "input6": "ADMISSION LABS:\n\n___ 07:20PM BLOOD WBC-13.2* RBC-3.80* Hgb-13.1* Hct-39.9* MCV-105* MCH-34.5* MCHC-32.8 RDW-12.0 RDWSD-46.7* Plt ___\n___ 07:20PM BLOOD Neuts-60.9 ___ Monos-10.0 Eos-3.4 Baso-0.6 Im ___ AbsNeut-8.01* AbsLymp-3.00 AbsMono-1.32* AbsEos-0.45 AbsBaso-0.08\n___ 07:20PM BLOOD ___ PTT-27.7 ___\n___ 07:20PM BLOOD Glucose-143* UreaN-10 Creat-0.8 Na-132* K-4.1 Cl-98 HCO3-13* AnGap-21*\n___ 07:20PM BLOOD ALT-33 AST-60* AlkPhos-90 TotBili-0.3\n___ 07:20PM BLOOD Lipase-49\n___ 07:20PM BLOOD cTropnT-<0.01\n___ 07:20PM BLOOD Albumin-3.7 Calcium-8.2* Phos-4.9* Mg-2.3\n___ 07:20PM BLOOD ASA-NEG Ethanol-36* Acetmnp-NEG Tricycl-NEG\n___ 07:46PM BLOOD ___ pO2-42* pCO2-46* pH-7.21* calTCO2-19* Base XS--9 Comment-PERIPHERAL\n\nMICRO:\n___ BLOOD CULTURE x2 - no growth\n___ URINE CULTURE - no growth\n\n\nIMAGING/STUDIES:\n___ EEG\nThis was an abnormal continuous ICU EEG monitoring study due to severe diffuse encephalopathy as demonstrated by diffuse slowing and disorganization. There were no electrographic seizures or epileptiform discharges. \n\n___ CXR\nThe ET tube projects approximately 4 cm from the carina. The NG tube projects to the stomach and is coiled up within the stomach. The aortic balloon pump tip projects over the aortic arch. Lungs are low volume with bibasilar atelectasis. No evidence of pneumonia edema or pneumothorax. No effusions. Old healed fracture involving the right clavicle. \n\n___ CORONARY ANGIOGRAM\nThe left main coronary artery. There is a 95% stenosis calcified ostial stenosis. The left anterior descending coronary artery. There is a 90% stenosis proximal LAD extending to the mid LAD. There was a 90% stenosis of the diagonal branch which was a large vessel. The mid and distal LAD had minor lumen irregularities. The circumflex coronary artery. There was a 50% stenosis in the proximal LAD. There is a 80% stenosis in the mid LCx. The distal LCx supplied the left PDA and PL branches. There was a 90% stenosis of a large bifurcating OMB. The right coronary artery. There is a 20% stenosis. IABP placed for high risk anatomy.\n\n___ EEG\nThis was an abnormal continuous ICU EEG monitoring study due to severe diffuse encephalopathy as demonstrated by diffuse slowing and disorganization. There were no electrographic seizures or epileptiform discharges.  \n\n___ CXR\nET and NG tube is unchanged. The intra aortic balloon pump is also unchanged. Lungs are low volume with worsening pulmonary vascular congestion. Cardiomediastinal silhouette is stable. There is no pleural effusion. No pneumothorax. \n\n___ TTE\nThe left atrium is normal in size. The inferior vena cava is dilated (>2.5 cm). There is mild symmetric left ventricular hypertrophy with a normal cavity size. There is moderate regional left ventricular systolic dysfunction with distal septal, anterior and septal hypokinesis as well as inferior wall and basal to mid inferolateral (see schematic) and preserved/normal contractility of the remaining segments. The visually estimated left ventricular ejection fraction is 35-45%. There is no resting left ventricular outflow tract gradient. Dilated right ventricular cavity with mild global free wall hypokinesis. The aortic sinus is mildly dilated with normal ascending aorta diameter for gender. The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. There is no aortic regurgitation. The mitral valve leaflets appear structurally normal with no mitral valve prolapse. There is trivial mitral regurgitation. The pulmonic valve leaflets are normal. The tricuspid valve leaflets are mildly thickened. There is physiologic tricuspid regurgitation. The pulmonary artery systolic pressure could not be estimated. There is no pericardial effusion.\n\n___ CXR\nModerate pulmonary edema has increased and change distributions. Heart size normal. No appreciable pleural effusion or pneumothorax.  Normal mediastinal and hilar contours.ADMISSION LABS\n--------------------\n___ 02:34AM BLOOD Plt ___\n___ 02:34AM BLOOD UreaN-15 Creat-1.1 Na-140 K-4.8 Cl-104\n___ 02:34AM BLOOD CK(CPK)-78\n___ 02:34AM BLOOD CK-MB-3 cTropnT-0.10*\n"
+}

Finished/Acute Coronary Syndrome/STEMI/13007301-DS-11.json

@@ -0,0 +1,58 @@
+{
+    "NSTE-ACS$Intermedia_4": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "BLOOD cTropnT-<0.01$Input6": {}
+        },
+        "ECG change is a evidence of ACS-STEMI$Cause_1": {
+            "EKG: On arrival to ED, EKG demonstrated normal sinus rhythm with PVC's, ST elevations V1-V6$Input6": {}
+        },
+        "Cardiac structural abnormalities is a diagnostic criteria of ACS-STEMI$Cause_1": {
+            "CARDIAC CATH: Right dominant. Total occlusion of mid-LAD. LCx with moderate disease; 90% lesion in a small ramus and subtotal lesion in a branch of the ramus. No obstructive RCA disease. DES placed in mid-LAD.$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "BLOOD CK-MB-48* MB Indx-5.3 cTropnT-1.59*$Input6": {}
+        },
+        "Suspected ACS$Cause_2": {
+            "Chest pain is a symptom of ACS$Cause_1": {
+                "Chest Pain$Input1": {}
+            },
+            "Risk factors$Cause_1": {
+                "+ Mixed Hyperlipidemia + initally had low HDL levels and \nelevated triglycerides.$Input3": {}
+            },
+            "Chest pain is a symptom of ACS.$Cause_1": {
+                "Two days prior to admission, he had similar pain, which he dismissed (given his previous episodes). It awoke him from sleep,$Input2": {}
+            },
+            "Family history is a risk factor$Cause_1": {
+                "Father with MI$Input4": {}
+            }
+        },
+        "Strongly suspected ACS$Intermedia_3": {
+            "maybe evidence of ACS-STEMI$Cause_1": {
+                "He has a history of similar pain for which he was evaluated with stress test (atypical/non-anginal type symptoms in the absence of ischemic ST segment changes).$Input2": {}
+            },
+            "Occlusion of the coronary artery is a symbol of ACS$Cause_1": {
+                "Coronary Angiography demonstrated a total occlusion of his mid LAD and a 90% occlusion of his ramus intermedius. He had a drug eluting stent placed to his mid LAD.$Input2": {}
+            },
+            "Suspected ACS$Cause_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "Risk factors$Cause_1": {
+                    "+ Mixed Hyperlipidemia + initally had low HDL levels and \nelevated triglycerides.$Input3": {}
+                },
+                "Chest pain is a symptom of ACS.$Cause_1": {
+                    "Two days prior to admission, he had similar pain, which he dismissed (given his previous episodes). It awoke him from sleep,$Input2": {}
+                },
+                "Family history is a risk factor$Cause_1": {
+                    "Father with MI$Input4": {}
+                }
+            }
+        }
+    },
+    "input1": "Chest Pain\n",
+    "input2": "68 y/o man with history of moderate mixed hyperlipidemia, recently diagnosed type II diabetes, presented to the emergency department today with severe chest pain. He has a history of similar pain for which he was evaluated with stress test (atypical/non-anginal type symptoms in the absence of ischemic ST segment changes). Two days prior to admission, he had similar pain, which he dismissed (given his previous episodes). It awoke him from sleep, but again went away on its own. On the day of presentation, it awoke him from sleep, and he was brought emergently to the ED. He denied shortness of breath and nausea but noted diaphoresis. The pain was located over his left chest. He was noted to have ST elevations anteriorly and was taken urgently to the cath lab. \n\nCoronary Angiography demonstrated a total occlusion of his mid LAD and a 90% occlusion of his ramus intermedius. He had a drug eluting stent placed to his mid LAD.\n",
+    "input3": "+ Mixed Hyperlipidemia + initally had low HDL levels and \nelevated triglycerides.\n+ GERD\n",
+    "input4": "Father with MI\n",
+    "input5": "Vitals: T98.5F, 150/99, 83, RR 23, 99%RA\nGeneral: Well-appearing, no acute distress\nHEENT: MMM, OP clear\nNeck: JVP not elevated\nHeart: RRR no m/r/g\nLung: Clear anteriorly\nAbd: Soft, non-tender, non-distended; + bowel sounds\nGroin: Mild fullness over right groin site, moderate tenderness; no obvious hematoma\nExt: no c/c/e; 2+ DP pulses bilaterally\n",
+    "input6": "___ 10:25AM BLOOD WBC-8.1# RBC-5.46 Hgb-15.4 Hct-46.2 MCV-85 MCH-28.2 MCHC-33.4 RDW-13.6 Plt ___\n___ 07:30AM BLOOD WBC-8.0 RBC-4.27* Hgb-12.3* Hct-35.1* MCV-82 MCH-28.9 MCHC-35.1* RDW-13.5 Plt ___\n___ 10:25AM BLOOD Glucose-212* UreaN-26* Creat-1.3* Na-138 K-3.8 Cl-101 HCO3-26 AnGap-15\n___ 07:30AM BLOOD Glucose-119* UreaN-22* Creat-1.4* Na-139 K-4.0 Cl-103 HCO3-27 AnGap-13\n___ 07:30AM BLOOD ALT-38 AST-29 AlkPhos-56 TotBili-0.6\n___ 10:25AM BLOOD CK(CPK)-173\n___ 04:51PM BLOOD CK(CPK)-1286*\n___ 01:42AM BLOOD CK(CPK)-903*\n___ 10:25AM BLOOD cTropnT-<0.01\n___ 04:51PM BLOOD CK-MB-83* MB Indx-6.5 cTropnT-2.05*\n___ 01:42AM BLOOD CK-MB-48* MB Indx-5.3 cTropnT-1.59*\n\nEKG: On arrival to ED, EKG demonstrated normal sinus rhythm with PVC's, ST elevations V1-V6\n\nTELEMETRY: Sinus tachycardia\n\n2D-ECHOCARDIOGRAM: none  \n\nETT: none\n\nCARDIAC CATH: Right dominant. Total occlusion of mid-LAD. LCx with moderate disease; 90% lesion in a small ramus and subtotal lesion in a branch of the ramus. No obstructive RCA disease. DES placed in mid-LAD.\n"
+}

Finished/Acute Coronary Syndrome/STEMI/13288722-DS-12.json

@@ -0,0 +1,61 @@
+{
+    "NSTE-ACS$Intermedia_4": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "BLOOD cTropnT-0.85*$Input6": {}
+        },
+        "ECG change is a evidence of ACS-STEMI$Cause_1": {
+            "Sinus rhythm. Possible prior inferior wall myocardial infarction. Left atrial abnormality. Diffuse non-specific ST-T wave abnormalities. No previous tracing available for comparison.$Input6": {}
+        },
+        "Occlusion of the coronary artery is symbol of acs$Cause_1": {
+            "ESTIMATED blood loss: <60 cc\nHemodynamics (see above):\nCoronary angiography:  right dominant\nLMCA:  No angiographically apparent CAD\nLAD:  Ostial 40%, mild luminal irregularities.  Long 60% diagonal stenosis.\nLCX:  Proximal 30%, Origin OM1 had 60% stenosis and the Cx continuation had thrombotic subtotal occlusion with 95% stenosis\nRCA:  Chronic mid vessel total occlusion with collaterals from the LCA$Input6": {}
+        },
+        "Cardiac structural abnormalities is a diagnostic criteria of ACS-STEMI$Cause_1": {
+            "The left atrium is mildly dilated. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. There is mild regional left ventricular systolic dysfunction with hypokinesis of the basal inferior, inferolateral and lateral walls (LCx disease). The remaining segments contract normally (LVEF = 40-45%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve leaflets are structurally normal. Mild (1+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion.$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09..$Cause_1": {
+            "CK-MB-88* cTropnT-1.33*$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09...$Cause_1": {
+            "cTropnT-0.71*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain is a symptom of ACS$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "symptom of ACS$Cause_1": {
+                "72 year old man with GERD, HTN, no known CAD, presented this am with several hours of retrosternal chest pressure similar but more severe than prior episodes of GERD.$Input2": {}
+            },
+            "risk factors$Cause_1": {
+                "Hyperlipidemia$Input3": {}
+            },
+            "family history is a risk factor$Cause_1": {
+                "Father died by cardiac issue. Mother died of pancreatic ca. Family Hx colon ca. Older brother well.$Input4": {}
+            }
+        },
+        "Strongly suspected ACS$Intermedia_3": {
+            "maybe evidence of ACS-STEMI$Cause_1": {
+                "Found to have inferior STe with reciprocal STd in I, aVL, QW in v4-6. Trop elevated at 0.09 (ref <0.03).$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "symptom of ACS$Cause_1": {
+                    "72 year old man with GERD, HTN, no known CAD, presented this am with several hours of retrosternal chest pressure similar but more severe than prior episodes of GERD.$Input2": {}
+                },
+                "risk factors$Cause_1": {
+                    "Hyperlipidemia$Input3": {}
+                },
+                "family history is a risk factor$Cause_1": {
+                    "Father died by cardiac issue. Mother died of pancreatic ca. Family Hx colon ca. Older brother well.$Input4": {}
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "72 year old man with GERD, HTN, no known CAD, presented this am with several hours of retrosternal chest pressure similar but more severe than prior episodes of GERD. Found to have inferior STe with reciprocal STd in I, aVL, QW in v4-6. Trop elevated at 0.09 (ref <0.03). Received clopidogrel 600mg, ASA 325, Atorva 80. Started on nitro and heparin gtt and transferred cath. \n \nCath showed LCx <100% lesion and received DESx3. Jailed OM was wired and ballooned with good flow following. He was chest pain free following the procedure and EKG changes resolved. \n\nOn arrival to the floor, pt reports resolution of CP. Denies N/V/F/C/SOB. Reports feeling anxious about being in the hospital.\n",
+    "input3": "+Hyperlipidemia\n+chronic GERD\n+OSA\n",
+    "input4": "Father died by cardiac issue. Mother died of pancreatic ca. Family Hx colon ca. Older brother well.\n",
+    "input5": "ADMISSION\nVS: 98.5   147/81   91  16   97%RA\nGeneral: WDWN man laying comfortably in hospital bed\nHEENT: NCAT, PERRL, EOMI\nNeck: supple, no JVD\nCV: regular rhythm, no m/r/g\nLungs: CTAB, no w/r/r\nAbdomen: soft, NT/ND, BS+\nExt: WWP, no c/c/e, 2+ distal pulses bilaterally\nNeuro: AAOx3 moving all extremities grossly\n",
+    "input6": "___ 08:00AM BLOOD WBC-9.1 RBC-4.55* Hgb-15.3 Hct-43.1 MCV-95 MCH-33.6* MCHC-35.5* RDW-13.0 Plt ___\n___ 07:45AM BLOOD WBC-6.6 RBC-4.21* Hgb-14.5 Hct-39.2* MCV-93 MCH-34.5* MCHC-37.0* RDW-13.0 Plt ___\n___ 12:46AM BLOOD Plt ___\n___ 08:00AM BLOOD Plt ___\n___ 07:45AM BLOOD Plt ___\n___ 12:46AM BLOOD Na-140 K-3.8 Cl-105\n___ 08:00AM BLOOD Glucose-115* UreaN-14 Creat-1.0 Na-139 K-3.8 Cl-102 HCO3-25 AnGap-16\n___ 07:45AM BLOOD Glucose-112* UreaN-14 Creat-1.0 Na-140 K-4.2 Cl-103 HCO3-25 AnGap-16\n___ 12:46AM BLOOD cTropnT-0.85*\n___ 08:00AM BLOOD CK-MB-88* cTropnT-1.33*\n___ 07:45AM BLOOD cTropnT-0.71*\n___ 08:00AM BLOOD Calcium-9.1 Phos-3.3 Mg-2.1\n___ 07:45AM BLOOD Calcium-9.1 Phos-3.6 Mg-2.1\n\nSTUDIES\n___ ECG\nSinus rhythm. Possible prior inferior wall myocardial infarction. Left atrial abnormality. Diffuse non-specific ST-T wave abnormalities. No previous tracing available for comparison.  \n\n___ Cardiac Cath\nESTIMATED blood loss: <60 cc\nHemodynamics (see above):\nCoronary angiography:  right dominant\nLMCA:  No angiographically apparent CAD\nLAD:  Ostial 40%, mild luminal irregularities.  Long 60% diagonal stenosis.\nLCX:  Proximal 30%, Origin OM1 had 60% stenosis and the Cx continuation had thrombotic subtotal occlusion with 95% stenosis\nRCA:  Chronic mid vessel total occlusion with collaterals from the LCA\n\n___ ECHO\nThe left atrium is mildly dilated. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. There is mild regional left ventricular systolic dysfunction with hypokinesis of the basal inferior, inferolateral and lateral walls (LCx disease). The remaining segments contract normally (LVEF = 40-45%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve leaflets are structurally normal. Mild (1+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion.\n"
+}

Finished/Acute Coronary Syndrome/STEMI/13696506-DS-8.json

@@ -0,0 +1,58 @@
+{
+    "NSTE-ACS$Intermedia_4": {
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "BLOOD cTropnT-0.02*$Input6": {}
+        },
+        "ECG change is a evidence of NSTE-ACS$Cause_1": {
+            "Sinus arrhythmia with ventricular premature beats. Right bundle-branch block. Since the previous tracing of ST segment depression in lead V2 is more prominent.$Input6": {}
+        },
+        "Occlusion of the coronary artery is symbol of acs$Cause_1": {
+            "1. Selective coronary angiography in this right dominant system revealed \n2 vessel coronary artery disease. The LM had minimal angiographically apparent disease. The LAD had no angiographically apparent changes from last angiogram. The LCx had 100% ostial occlusion and was a small vessel; remained unchanged from previous cath. The RCA had 100% acute thrombus in RPLV branch. \n2. Limited resting hemodynamics revealed normal systemic arterial pressure of 143/76mmHg.$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "BLOOD CK-MB-50* MB Indx-11.6* cTropnT-0.35$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09..$Cause_1": {
+            "BLOOD CK-MB-51* MB Indx-12.1* cTropnT-0.80*$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain is a symptom of ACS$Cause_1": {
+                "Chest Pain$Input1": {}
+            },
+            "symptom of ACS$Cause_1": {
+                "he had been asymptomatic where he had skiied with out any chest pain. Earlier today he was walking with his wife when he noted substernal chest pain that was relieved by rest. He has angina, but he did not have chest pain to this magnitude in the past.$Input2": {}
+            },
+            "risk factors of acs$Cause_1": {
+                "CAD  \nAortic valve replacement- porcine$Input3": {}
+            },
+            "family history is a risk factor$Cause_1": {
+                "Mother with MI,$Input4": {}
+            }
+        },
+        "Strongly suspected ACS$Intermedia_3": {
+            "evidence of acs$Cause_1": {
+                "his last Cath  demonstrated 90% focal mid/distal LAD setnosis of a twin LAD. 90% LCX and serioal stenosis of the RCA. He has not had any stents placed.  He had no intervention from his last Cath.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "symptom of ACS$Cause_1": {
+                    "he had been asymptomatic where he had skiied with out any chest pain. Earlier today he was walking with his wife when he noted substernal chest pain that was relieved by rest. He has angina, but he did not have chest pain to this magnitude in the past.$Input2": {}
+                },
+                "risk factors of acs$Cause_1": {
+                    "CAD  \nAortic valve replacement- porcine$Input3": {}
+                },
+                "family history is a risk factor$Cause_1": {
+                    "Mother with MI,$Input4": {}
+                }
+            }
+        }
+    },
+    "input1": "Chest Pain\n",
+    "input2": "58 y/o gentlemen with recent CATH showing no interveinable CAD, dyslipidemia, AVR, with h/o PE on coumadin who presents with persistent exertional chest pain.  \n\nPer the patient, he had been asymptomatic where he had skiied with out any chest pain. Earlier today he was walking with his wife when he noted substernal chest pain that was relieved by rest. He has angina, but he did not have chest pain to this magnitude in the past. He was able to go home where Nitro SL provided some relief. He reported some nausea, but no jaw pain, shoulder pain, diaphoresis or emesis. The chest pain persisted and he presented to the ED.  \n\nOf note his last Cath  demonstrated 90% focal mid/distal LAD setnosis of a twin LAD. 90% LCX and serioal stenosis of the RCA. He has not had any stents placed.  He had no intervention from his last Cath.  \n\nOn review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative.  \n\nIn the ED, his vital signs were 97.2 71 BP 194/95 14 100% RA. He was given the following medications: ASA 81 mg x 3, SL nitro x 3, strated on nitro gtt, and heparin drip. He was also given IV morphine.  \n\nOn the floor, he had additional chest pain that was relieved when the nitro gtt was uptitrated. At the time of this interview his chest pain was minimal.\n",
+    "input3": "1. CARDIAC RISK FACTORS: (+) Dyslipidemia \n2. CARDIAC HISTORY:\n3. OTHER PAST MEDICAL HISTORY:  \n+BPH  \n+CAD  \n+Aortic valve replacement- porcine\n+Pulmonary embolism \n+Hyperlipidemia  \n+Arthritis  \n+s/p Appendectomy  \n-GERD\n",
+    "input4": "Mother with MI, Brother with early CABG\n",
+    "input5": "GENERAL: Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.  \nNECK: Supple with JVP not appreciated at 30 degrees.  \nCARDIAC: PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.  \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi.  \nABDOMEN: Soft, NTND. No HSM or tenderness.  \nEXTREMITIES: No c/c/e.  \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.\n",
+    "input6": "Admission:\n___ 01:44PM BLOOD WBC-8.2 RBC-4.93 Hgb-15.2 Hct-44.2 MCV-90 MCH-30.8 MCHC-34.4 RDW-13.3 Plt ___\n___ 01:44PM BLOOD ___ PTT-24.3 ___\n___ 01:44PM BLOOD Glucose-109* UreaN-20 Creat-1.1 Na-139 K-4.5 Cl-103 HCO3-28 AnGap-13\n___ 01:44PM BLOOD CK(CPK)-185\n___ 01:44PM BLOOD Calcium-9.5 Phos-2.9 Mg-2.2\n.\nCardiac Enzymes:\n___ 01:44PM BLOOD cTropnT-0.02*\n___ 12:50AM BLOOD CK-MB-50* MB Indx-11.6* cTropnT-0.35*\n___ 02:00AM BLOOD CK-MB-52* MB Indx-12.8* cTropnT-0.49*\n___ 07:00AM BLOOD CK-MB-51* MB Indx-12.1* cTropnT-0.80*\n___ 12:55AM BLOOD CK-MB-25* MB Indx-8.1*\n___ 07:25AM BLOOD CK-MB-35* MB Indx-9.5*\n\nECG:\nSinus arrhythmia with ventricular premature beats. Right bundle-branch block. Since the previous tracing of ST segment depression in lead V2 is more prominent. \n\nCATH:\nCOMMENTS:      \n1. Selective coronary angiography in this right dominant system revealed \n2 vessel coronary artery disease. The LM had minimal angiographically apparent disease. The LAD had no angiographically apparent changes from last angiogram. The LCx had 100% ostial occlusion and was a small vessel; remained unchanged from previous cath. The RCA had 100% acute thrombus in RPLV branch. \n2. Limited resting hemodynamics revealed normal systemic arterial pressure of 143/76mmHg.\n"
+}

Finished/Acute Coronary Syndrome/STEMI/15100941-DS-6.json

@@ -0,0 +1,53 @@
+{
+    "NSTE-ACS$Intermedia_5": {
+        "a sigh of STEMI$Cause_1": {
+            "Grade I/VI systolic ejection murmur at LUSB$Input5": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": {
+            "cTropnT-0.38*$Input6": {}
+        },
+        "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+            "cTropnT-0.33*$Input6": {}
+        },
+        "Strongly suspected ACS$Intermedia_4": {
+            "high hs-cTn is a strong value for ACS$Cause_1": {
+                "Labs were notable for a Trop-T of 0.33$Input2": {}
+            },
+            "Cardiac structural abnormalities is a sigh of ACS$Cause_1": {
+                "Cardiac catheterization demonstrated 80-90% blockage of the proximal RCA, occluded L circumflex, severe LAD disease.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Weakness is a symptom of ACS$Cause_1": {
+                    "Weakness$Input1": {}
+                },
+                "severe weakness is a symptom of ACS$Cause_1": {
+                    "The patient reports that she had a 45 minute to one hour episode of severe weakness earlier today with inability to rise from her chair and called.$Input2": {}
+                },
+                "family history of CHF is a risk factor$Cause_1": {
+                    "Father: deceased (CHF)$Input4": {}
+                },
+                "carotid endarterectomy is the risk fact for ACS$Cause_1": {
+                    "R carotid stenosis s/p carotid endarterectomy$Input3": {}
+                },
+                "CKD is the risk fact for ACS$Cause_1": {
+                    "CKD IV$Input3": {}
+                },
+                "HTN is the risk fact for ACS$Cause_1": {
+                    "HTN$Input3": {}
+                },
+                "CVA is the risk fact for ACS$Cause_1": {
+                    "CVA$Input3": {}
+                },
+                "family history of heart diseas is a risk factor$Cause_1": {
+                    "Mother: deceased (unspecified heart diseas)$Input4": {}
+                }
+            }
+        }
+    },
+    "input1": "Weakness\n",
+    "input2": "She was transfer from outside hospital with elevated troponin level for further evaluation. The patient reports that she had a 45 minute to one hour episode of severe weakness earlier today with inability to rise from her chair and called. She was brought to outside hospital where she had elevated troponins concerning for MI and was sent for cardiac catheterization. Patient was dyspneic in the ED, with coarse breath sounds. \n\nIn the ED, initial vitals were: T 97.1F P43 BP 187/85 RR18 O2 98%. Physical examination was unremarkable. Labs were notable for a Trop-T of 0.33, with CK 63 and MB 4. Chemistries were Na 142, K 5.3, Cl 109, HCO3 18, BUN 53, Cr 2.7, Gluc 97. WBC 8.6 (N 67.3%, L 17.8%), H/H of 11.4/38.2, PLT of 286. 11.2, PTT 136.1, INR 1.0. UA with large leuks, 104 WBC, moderate bacteria, no nitrite, no gluc, no ketones. She complained of L scapular pain, possibly anginal in origin, but denied chest pain and dyspnea. There were reports of dynamic changes on EKG during her symptoms of weakness. \n\nCardiac catheterization demonstrated 80-90% blockage of the proximal RCA, occluded L circumflex, severe LAD disease. Post-procedurally, she developed bleeding from her R femoral access site, pressure maintained for 45+ minutes in cath lab, and continued upon arrival to the floor. Initially surrounding tissue from access site firm, but with improvement after maintaining prolonged pressure.\n\nPatient was given:\n___ 09:10 IV Heparin   1000 units/hr \n___ 11:12 IVF 1000 mL NS  Started 250 mL/hr \n___ 11:12 IV Ciprofloxacin 400 mg  \n___ 11:17 PO Acetaminophen 1000 mg\n",
+    "input3": "+ R carotid stenosis s/p carotid endarterectomy\n+ CVA\n+ HLD\n+ HTN\n+ CKD IV\n+ vitamin D deficiency\n+ bleeding duodenal ulcer (H pylori normal)\n+ urinary incontinence\n+ psoriasis \n+ psoriatic arthritis\n+ tobacco use disorder\n+ essential tremor\n+ shingles\n",
+    "input4": "Father: deceased (CHF)\nMother: deceased (unspecified heart diseas)\n- 1 brother passed away from a fall\n- 1 living sister\n",
+    "input5": "ADMISSION EXAM:\n\nVitals: per metavision\nGen: Oriented to self, anxious, confused, asking repeatedly about her cigarettes and her housekeeper.\nHEENT: No conjunctival pallor. No scleral icterus. MMM. OP clear.  \nNECK: R IJ CVL in place, dressing C/D/I, Neck supple without LAD. JVP low. Normal carotid upstroak without bruits.  \nCV: Bradycardic, regular rhythm, Grade I/VI systolic ejection murmur at LUSB, normal S1 and S2, no rubs, clicks, or gallops\nLUNGS: Clear to anterior auscultation bilaterally, no wheezes, rhonchi, or rales.  \nABD: Hypoactive bowel sounds. Abdomen distended, nontender, no organomegaly. No appreciable abdominal bruits.  \nEXT: R Groin with Femostop in place, no appreciable superficial bleeding, mild tenderness to palpation over R groin and anterior thigh. Full distal pulses bilaterally. Wrist restraints in place bilaterally\nNEURO: Alert, oriented to self only, agitated and confused. Unable to cooperate with full neurologic examination, but does follow ___ setp commands. Gait assessment deferred\nLINES: Foley in place, R IJ CVL in place C/D/I\n",
+    "input6": "ADMISSION LABS:\n___ 08:08PM   GLUCOSE-128* UREA N-50* CREAT-2.5* SODIUM-142 POTASSIUM-5.3* CHLORIDE-114* TOTAL CO2-18* ANION GAP-15\n___ 08:08PM   CK(CPK)-43\n___ 08:08PM   CK-MB-4 cTropnT-0.39*\n___ 08:08PM   CALCIUM-8.4 PHOSPHATE-4.3 MAGNESIUM-1.9\n___ 08:08PM   WBC-14.1*# RBC-3.20* HGB-9.4* HCT-32.1* MCV-100* MCH-29.4 MCHC-29.3* RDW-14.8 RDWSD-55.0*\n___ 08:08PM   PLT COUNT-360\n___ 08:08PM   ___ PTT-28.8 ___\n___ 05:00PM   GLUCOSE-107* UREA N-50* CREAT-2.3* SODIUM-142 POTASSIUM-4.7 CHLORIDE-113* TOTAL CO2-18* ANION GAP-16\n___ 05:00PM   ALT(SGPT)-11 AST(SGOT)-16 ALK PHOS-65 TOT BILI-0.2\n___ 05:00PM   cTropnT-0.38*\n___ 05:00PM   ALBUMIN-3.5\n___ 05:00PM   WBC-8.2 RBC-3.50* HGB-10.1* HCT-33.9* MCV-97 MCH-28.9 MCHC-29.8* RDW-14.8 RDWSD-52.4*\n___ 05:00PM   NEUTS-63.0 ___ MONOS-8.5 EOS-6.5 BASOS-1.7* IM ___ AbsNeut-5.16 AbsLymp-1.61 AbsMono-0.70 AbsEos-0.53 AbsBaso-0.14*\n___ 05:00PM   PLT COUNT-270\n___ 05:00PM   ___\n___ 09:00AM   GLUCOSE-97 UREA N-53* CREAT-2.7*# SODIUM-142 POTASSIUM-5.3* CHLORIDE-109* TOTAL CO2-18* ANION GAP-20\n___ 09:00AM   estGFR-Using this\n___ 09:00AM   CK(CPK)-63\n___ 09:00AM   cTropnT-0.33*\n___ 09:00AM   CK-MB-4\n___ 09:00AM URINE  HOURS-RANDOM\n___ 09:00AM URINE  HOURS-RANDOM\n___ 09:00AM URINE  UHOLD-HOLD\n___ 09:00AM URINE  GR HOLD-HOLD\n___ 09:00AM   WBC-8.6 RBC-3.90 HGB-11.4 HCT-38.2# MCV-98# MCH-29.2 MCHC-29.8*# RDW-15.1 RDWSD-53.9*\n___ 09:00AM   NEUTS-67.3 LYMPHS-17.8* MONOS-7.6 EOS-5.6 BASOS-1.4* IM ___ AbsNeut-5.80 AbsLymp-1.54 AbsMono-0.66 AbsEos-0.48 AbsBaso-0.12*\n___ 09:00AM   PLT COUNT-286\n___ 09:00AM   ___ PTT-136.1* ___\n___ 09:00AM URINE  COLOR-Straw APPEAR-Hazy SP ___\n___ 09:00AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-100 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-LG\n___ 09:00AM URINE  RBC-0 WBC-104* BACTERIA-MOD YEAST-NONE EPI-1\n___ 09:00AM URINE  MUCOUS-RARE\n\n\nIMAGING/STUDIES\nCHEST PORT. LINE PLACEM\nIMPRESSION:  \nIn comparison to radiograph, a right internal jugular central venous catheter is been placed, terminating in the lower superior vena cava, with no visible pneumothorax.  Slight widening of the mediastinum is likely due to accentation of a tortuous thoracic aorta by patient rotation and supine portable technique, but a repeat nonrotated radiograph would be helpful to confirm this impression when the patient's condition permits.  Lungs are clear except for minor atelectasis at the left lung base. \n\nCHEST (PORTABLE AP) \nIMPRESSION: \nAs compared to previous study of 1 day earlier, there has not been a substantial change in the appearance of the chest except for slight \nimprovement in minor left basilar atelectasis. \n\nFEMORAL VASCULAR US RIG\nIMPRESSION: \n1. No evidence of pseudoaneurysm or AV fistula and the right groin. \n2. Organized hematoma in the right groin measuring up to 7 cm. \n3. No drainable fluid collection. \n  \nCT ABD & PELVIS W/O CON\nIMPRESSION:  \n1.   Infrarenal fusiform abdominal aortic aneurysm measuring up to is 4.7 cm in maximum diameter without evidence of aneurysmal leak, impending or contained rupture.  Recommend follow-up CT at 6 month interval. \n2.   Status post LHC complicated by a right arterial groin bleed.  6.7 x 2.3 cm area of increased density in the anteromedial aspect of right thigh with extensive soft tissue stranding and edema, most consistent with a soft tissue hematoma.  No evidence of retroperitoneal hematoma. \n3.  Cholelithiasis without cholecystitis. \n4.  Focal consolidation of the apex of the left upper lobe, likely related to scarring from chronic parenchymal disease. \n\nCHEST (PORTABLE AP) \nFINDINGS:  \nCardiomegaly is a stable.  The patient is rotated, this accentuates the widened mediastinum and tortuous aorta.  Improving left lower lobe atelectasis, otherwise the lungs are clear.  There is no pneumothorax or pleural effusion.  Right IJ catheter tip is in the lower SVC\n"
+}

Finished/Acute Coronary Syndrome/STEMI/15314906-DS-14.json

@@ -0,0 +1,55 @@
+{
+    "NSTE-ACS$Intermedia_4": {
+        "ECG changes are sympyoms of ACS-STEMI$Cause_1": {
+            "Sinus rhythm. Delayed precordial R wave progression. Non-specific anterolateral ST-T wave changes. Compared to the previous tracing of wave changes are new. Cannot rule out myocardial ischemia.$Input6": {}
+        },
+        "Strong evidence proves of acs-stemi$Cause_1": {
+            "Hemodynamics (see above):\nCoronary angiography:  right dominant\nLMCA:  No angiographically apparent CAD\nLAD:  Proximal 40%, mild luminal irregularities\nLCX:  Total occlusion of OM1.  Mild disease.\nRCA:  No angiographically apparent CAD.$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain is a symptom of ACS$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "symptom of acs$Cause_1": {
+                "Patient had episode of 'heart burn' 2 nights ago that self resolved, then last night had repeat episode followed by episode of substernal chest pain, described as 'dull', located at his chest, nonradiating.$Input2": {}
+            },
+            "Possible family history$Cause_1": {
+                "Mother died of cancer.$Input4": {}
+            },
+            "Possible family history.$Cause_1": {
+                "Father had CABG and has type II DM.$Input4": {}
+            }
+        },
+        "Strongly suspected ACS$Intermedia_3": {
+            "Cardiac structural abnormalities is a diagnostic criteria of ACS-STEMI$Cause_1": {
+                "The left atrium is normal in size. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is low normal (LVEF = 50%) secondary to focal hypokinesis of the posterior and lateral walls. Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion.$Input6": {}
+            },
+            "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09\nSTD V2-V4 and less than 0.5mm STE inferiorly maybe is a sign$Cause_1": {
+                "he was found to have elevated troponint to 0.11 and ECG changes w/ STD V2-V4 and less than 0.5mm STE inferiorly which normalized after treatment with nitro.$Input2": {}
+            },
+            "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": {
+                "BLOOD cTropnT-0.17*$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "symptom of acs$Cause_1": {
+                    "Patient had episode of 'heart burn' 2 nights ago that self resolved, then last night had repeat episode followed by episode of substernal chest pain, described as 'dull', located at his chest, nonradiating.$Input2": {}
+                },
+                "Possible family history$Cause_1": {
+                    "Mother died of cancer.$Input4": {}
+                },
+                "Possible family history.$Cause_1": {
+                    "Father had CABG and has type II DM.$Input4": {}
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "66 year old male with no significant PMH presenting with c/o dyspepsia and chest pain, found to have NSTEMI and transferred for cardiac catheterization.  \n \nPatient had episode of 'heart burn' 2 nights ago that self resolved, then last night had repeat episode followed by episode of substernal chest pain, described as 'dull', located at his chest, nonradiating. No associated symptoms. Pain was not positional, not worsened with exertion or taking a deep breath, denies any specific aggravating factors. Initially improved with having a bowel movement. This pain then recurred 1h later and pateint decided to go to the ED. Denies prior hx. chest pain, denies new swelling in his legs, no orthopnea. Is fairly active, denies recent exertional chest pain.  \n \nPatient originally presented with these complaints where where he was found to have elevated troponint to 0.11 and ECG changes w/ STD V2-V4 and less than 0.5mm STE inferiorly which normalized after treatment with nitro. There he was given GI cocktail, full dose aspirin, nitro, and started on a heparin drip after which patient was chest pain free. Patient was also given ASA prior to transfer and eval'ed to BI admission w/ plan for cath. On arrival to ED, patient stated that his discomfort was down from initially.  \n \nIn the ED initial vitals were: 99.4 68 144/90 16 99% RA.  \n - Labs were significant for trop t 0.17, PTT 105 (prior CBC and chem-7 @ unremarkable)  \n - Patient was continued on heparin gtt and nitro gtt, as was given ativan x1.  \nOn the floor patient overall feels well, says having chest pain, much improved from prior. No other complaints.\n",
+    "input3": "None\n",
+    "input4": "No family history of colon or prostate cancer. Mother died of cancer. Father had CABG and has type II DM.\n",
+    "input5": "ADMISSION PHYSICAL EXAM:  \nVitals - 98 119/76 hr 51 18 100% RA  \nGENERAL: alert, NAD sitting on side of bed  \nHEENT: EOMI, PERRLA, OMM no lesions  \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs  \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles  \nABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly  \nEXTREMITIES: moving all extremities well, no cyanosis, clubbing or edema  \nNEURO: CN II-XII intact, moves all fours  \nSKIN: warm and well perfused, no excoriations or lesions, no rashes\n",
+    "input6": "ADMISSION LABS:\n___ 09:35AM BLOOD WBC-7.8 RBC-4.06* Hgb-12.9* Hct-39.1* MCV-96 MCH-31.7 MCHC-32.9 RDW-13.0 Plt ___\n___ 02:00AM BLOOD ___ PTT-105.7* ___\n___ 09:35AM BLOOD Glucose-115* UreaN-10 Creat-0.8 Na-140 K-4.1 Cl-108 HCO3-26 AnGap-10\n___ 09:35AM BLOOD Mg-1.8\n___ 02:00AM BLOOD %HbA1c-5.4 eAG-108\n___ 02:00AM BLOOD cTropnT-0.17*\n___ 09:35AM BLOOD CK-MB-180* cTropnT-4.31*\n___ 03:30PM BLOOD CK-MB-185* cTropnT-4.99*\n___ 08:00AM BLOOD CK-MB-35* cTropnT-2.28*\n\nMICRO: None\n\nSTUDIES:\n\nEKG ___:\nSinus rhythm. Delayed precordial R wave progression. Non-specific anterolateral ST-T wave changes. Compared to the previous tracing of wave changes are new. Cannot rule out myocardial ischemia. \n\nTTE ___\nThe left atrium is normal in size. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is low normal (LVEF = 50%) secondary to focal hypokinesis of the posterior and lateral walls. Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion.  \n\nLeft heart catheterization:\nFindings\nESTIMATED blood loss: <50 cc\nHemodynamics (see above):\nCoronary angiography:  right dominant\nLMCA:  No angiographically apparent CAD\nLAD:  Proximal 40%, mild luminal irregularities\nLCX:  Total occlusion of OM1.  Mild disease.\nRCA:  No angiographically apparent CAD.\n\nInterventional details\nChange for 6 XB3.5 guide.  Crossed with Prowater wire. Deployed a 2.5 x 12 mm Xience drug-eluting stent.  Postdilatedwith a 2.5 mm balloon.  Final angiography revealed normal flow, no dissection and 0% residual stenosis with 10% plaquing distal to the stent.\n"
+}

Finished/Acute Coronary Syndrome/STEMI/15379632-DS-17.json

@@ -0,0 +1,38 @@
+{
+    "STEMI-ACS$Intermedia_4": {
+        "Electrocardiogram showing ST segment depression and ST segment elevation is a key indicator for diagnosing STEMI. This change indicates possible myocardial ischemia or damage.$Cause_1": {
+            "Second EKG: rate 84, NSR, left axis deviation, worsened STD in V2-V3. Third EKG: rate 86, NSR, LAD STD in AVR, V1, V2 with mild ST elevation in V4-V6.$Input2": {}
+        },
+        "Elevated cardiac troponin is a marker of myocardial injury and supports the diagnosis of STEMI$Cause_1": {
+            "Labs were notable for troponin 0.36$Input2": {}
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "This description refers to the characteristic feeling of angina, which is a pressure or heaviness centered in the chest.$Cause_1": {
+                "pain as feeling like someone was pushing their forearm against his mid-chest$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is a common symptom of ACS$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "Acute chest pain is one of the typical symptoms of ACS. Its short duration and sudden onset are key diagnostic clues.$Cause_1": {
+                    "<1 day of acute chest pain$Input2": {}
+                },
+                "Night sweats with chest pain are due to an exaggerated sympathetic response, often seen in severe cardiac events.$Cause_1": {
+                    "pain was associated with diaphoresis and a mild headache$Input2": {}
+                },
+                "Hyperlipidemia is a significant risk factor for coronary artery disease$Cause_1": {
+                    "HLD$Input3": {}
+                },
+                "Tachycardia may be caused by the heart trying to compensate for insufficient blood flow to the coronary arteries and is a common symptom of heart disease.$Cause_1": {
+                    "HR102$Input5": {}
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "He is a man with HLD, who presents with <1 day of acute chest pain.  \nThe chest pain woke him from sleep at 4 AM the day of presentation, and lasted one hour. He describes the pain as feeling like someone was pushing their forearm against his mid-chest. The pain was associated with diaphoresis and a mild headache. The pain is worse with lying flat, improved sitting up. There was no dyspnea, nausea, vomiting, abdominal pain, or radiation, and he has had no recent illnesses or URI symptoms. He took a Zantac and Advil, which improved his symptoms but they did not completely resolve. The chest pain continued throughout the day. He shares that the day before he had lifted weights and had a heavy dinner, and did not have chest pain during either. He has never had chest pain or pressure before. He occasionally has heart burn after eating certain foods, but never has had heart burn with exertion, and his symptoms this time were very distinct.  \nIn the ED initial vitals were: T 97.1 HR 89 BP 138/79 Resp 19 98% RA. Cr 1, Hb 16.2, Platelet 176, INR 1.1, PTT 30.7. Initial EKG: Initial: rate 83, NSR left axis deviation, no ischemic changes. Second EKG: rate 84, NSR, left axis deviation, worsened STD in V2-V3. Third EKG: rate 86, NSR, LAD STD in AVR, V1, V2 with mild ST elevation in V4-V6. CXR showed no acute cardiopulmonary process. He was given a full dose aspirin, SL nitroglycerin, and IV heparin. \nCardiology was consulted and he was taken to the cath lab. A DES was placed in the proximal LCX. He was loaded with Plavix.  \nUpon arrival to the floor, the patient gives the above history. He is currently chest pain free. He reiterates that he has never had symptoms like this before. He exercises a few times per week and always feels well. He has no history of presyncope/syncope,orthopnea, PND, or leg swelling.  \nREVIEW OF SYSTEMS:  \nOn further review of systems, denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. Denies exertional buttock or calf pain. Denies recent fevers, chills or rigors. All of the other review of systems were negative.\n",
+    "input3": "+ HLD  \n+ CABG: None  \n+ PERCUTANEOUS CORONARY INTERVENTIONS: None  \n+ PACING/ICD: None  \n+ Cataracts\n",
+    "input4": "Father: Cancer  \nMother: HTN  \nBrother: potentially had a cardiac condition a few years ago, unsure of details.\n",
+    "input5": "Admission physical exam:\n========================\nVS: T98.5 BP130/80 HR102 RR16 O2 SAT 98 RA  \nGENERAL: Pleasant and well appearing gentleman, NAD.  \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma.  \n\ufeff\nNECK: No JVD. No carotid bruits.  \nCARDIAC: RR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts.  \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi.  \nABDOMEN: Soft, NTND. No HSM or tenderness.  \nEXTREMITIES: No c/c/e. Warm. TR band in place on RUE.  \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.  \nPULSES: Distal pulses palpable and symmetric  \nNEURO: CN intact, BUE and BLE, AOX3.\n",
+    "input6": "Admission labs:\n===============\n10:02AM BLOOD WBC-7.7 RBC-5.19 Hgb-16.2 Hct-47.1 MCV-91 MCH-31.2 MCHC-34.4 RDW-12.3 RDWSD-40.7\n10:02AM BLOOD Neuts-80.9* Lymphs-12.5* Monos-5.5 Eos-0.4* Baso-0.4 AbsNeut-6.24* AbsLymp-0.96* \nAbsMono-0.42 AbsEos-0.03* AbsBaso-0.03\n10:02AM BLOOD Glucose-104* UreaN-19 Creat-1.0 Na-140 K-4.1 Cl-103 HCO3-22 AnGap-19\n07:05AM BLOOD Calcium-8.6 Phos-2.8 Mg-2.3 Cholest-175\n07:05AM BLOOD %HbA1c-5.3 eAG-105\n"
+}

Finished/Acute Coronary Syndrome/STEMI/15402809-DS-20.json

@@ -0,0 +1,41 @@
+{
+    "STEMI-ACS$Intermedia_4": {
+        "The electrocardiogram shows ST segment elevation in leads V2 to V6, I, and aVL, and ST segment depression in leads II, III, and aVF, which is the key basis for diagnosing STEMI.$Cause_1": {
+            "found to have STE in V2-V6, I and aVL, and STD II, III and aVF c/f STEMI$Input2": {}
+        },
+        "From 0.12 to 14.15. Cardiac troponin T is an important marker for the diagnosis of acute myocardial infarction. Its significant increase usually indicates myocardial damage.$Cause_1": {
+            "cTropnT-14.15$Input6": {}
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "This description refers to the characteristic feeling of angina, which is a pressure or heaviness centered in the chest.$Cause_1": {
+                "a central chest pressure radiating to both arms and jaw$Input2": {}
+            },
+            "Coronary angiography showed 100% blockage of the left anterior descending artery (LAD), which was the direct cause of STEMI.$Cause_1": {
+                "coronary angiography revealed 100% occlusion LAD$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "The patient experienced a feeling of pressure behind the sternum, with symptoms radiating to the arms and jaw, and nausea, which are typical symptoms of myocardial infarction.$Cause_1": {
+                    "initially with substernal chest pressure radiating to both arms and jaw with associated nausea$Input2": {}
+                },
+                "The patient developed chest pain shortly after using \"poppers,\" an inhaled street drug that can cause blood vessels to dilate and a sudden drop in blood pressure. This suggests that drug use may have been a trigger for the heart attack.$Cause_1": {
+                    "developed chest pressure shortly after taking \"poppers\"$Input2": {}
+                },
+                "Diabetes is an important risk factor for cardiovascular disease$Cause_1": {
+                    "Diabetes$Input3": {}
+                },
+                "Hypertension is also a major risk factor for cardiovascular disease$Cause_1": {
+                    "Hypertension$Input3": {}
+                },
+                "Family history of myocardial infarction increases an individual's risk of ACS$Cause_1": {
+                    "Uncle with MI\nFather with suspected missed MI at early age$Input4": {}
+                }
+            }
+        }
+    },
+    "input1": "None\n",
+    "input2": "He is a man who initially with substernal chest pressure radiating to both arms and jaw with associated nausea found to have STE in V2-V6, I and aVL, and STD II, III and aVF c/f STEMI  now transferred to hospital for emergent coronary angiography. \n\ufeff\nThe patient states that yesterday evening, he developed chest pressure shortly after taking \"poppers\" and engaging in sexual intercourse with his husband. The pain was sudden in onset and was described as a central chest pressure radiating to both arms and jaw. Had associated nausea. Initially thought it was due to indigestion and tried to drink seltzer water, however, his symptoms persisted and he began to vomit. He decided to go to hospital for further management.\n\ufeff\ncoronary angiography revealed 100% occlusion LAD. No significant right coronary or LCx disease. 2 something were placed without complication. During the procedure, he received tirofoban with plans to transition to ticagrelor. He tolerated the procedure well and was transferred to the CCU for further monitoring.\n \nOn arrival to the CCU:  the patient is awake and alert. He complains of mild chest pressure that is much improved from prior. No SOB, palpitations, lightheadedness, fevers or chills. He denies any history of chest pain or SOB with exertion.\n",
+    "input3": "+ Diabetes (-) \n+ Hypertension (-)  \n+ Dyslipidemia  \n+ No known cardiac history \n+ Hiatal hernia\n+ OSA on BiPAP\n",
+    "input4": "Uncle with MI\nFather with suspected missed MI at early age\n",
+    "input5": "ADMISSION PHYSICAL EXAM:\n====================================\nVS: 99  134/81  102  16  97%RA \nGENERAL: Well developed, well nourished in NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: Normocephalic atraumatic. Sclera anicteric. PERRL. EOMI. Conjunctiva were pink. No pallor \nNECK: Supple. JVP not elevated  \nCARDIAC: RR, no m/r/g \nLUNGS: CTAB no r/r/w.  \nABDOMEN: Soft, non-tender, non-distended. No hepatomegaly. No splenomegaly.  \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or peripheral edema.  \nSKIN: No significant skin lesions or rashes.  \nPULSES: Distal pulses palpable and symmetric.  \nLABS AND MICROBIOLOGY: Reviewed in OMR.\n",
+    "input6": "ADMISSION/IMPORTANT LABS\n04:38AM BLOOD WBC-20.4* RBC-4.99 Hgb-15.3 Hct-42.0 MCV-84 MCH-30.7 MCHC-36.4 RDW-12.0 RDWSD-36.2\n04:38AM BLOOD Glucose-113* UreaN-19 Creat-1.0 Na-138 K-3.1* Cl-103 HCO3-16* AnGap-22*\n04:38AM BLOOD CK(CPK)-316\n05:50PM BLOOD CK(CPK)-3528*\n04:52AM BLOOD ALT-78* AST-245* LD(LDH)-1188* AlkPhos-55 TotBili-1.3\n04:38AM BLOOD CK-MB-19* MB Indx-6.0 cTropnT-0.12*\n11:30AM BLOOD cTropnT-14.15*\n04:38AM BLOOD Calcium-9.6 Phos-2.2* Mg-1.7 Cholest-211*\n04:38AM BLOOD %HbA1c-4.8 eAG-91\n04:38AM BLOOD Triglyc-198* HDL-31 CHOL/HD-6.8 LDLcalc-140*\n"
+}

Finished/Acute Coronary Syndrome/STEMI/15838052-DS-15.json

@@ -0,0 +1,32 @@
+{
+    "STEMI-ACS$Intermedia_4": {
+        "Increased cardiac troponin T is an important marker of myocardial damage$Cause_1": {
+            "a troponin T of 0.915$Input2": {}
+        },
+        "Elevated cTropnT is often a marker of cardiomyocyte damage, especially in myocardial infarction.$Cause_1": {
+            "cTropnT-1.02$Input6": {}
+        },
+        "ST-elevation is the critical for STEMI$Cause_1": {
+            "ST-elevation$Input6": {}
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "Echocardiography showed left atrial enlargement is consistent with coronary artery disease.$Cause_1": {
+                "The left atrial volume is increased.$Input6": {}
+            },
+            "Coronary angiography revealed multivessel disease and severe coronary artery obstruction, which is a typical cause of ACS$Cause_1": {
+                "The LAD had a mid vessel 80% ulcerated plaque$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Myocardial infarction is a manifestation of coronary artery disease, which is one of the main causes of STEMI-ACS. Family history indicates that the patient may have a higher genetic risk.$Cause_1": {
+                    "He maternal uncles both died of MIs.$Input4": {}
+                }
+            }
+        }
+    },
+    "input1": "Elbow pain.\n",
+    "input2": "He is a man with no significant past medical history who presents with elbow pain and positive troponin.  \n.  \nWas in his usual state of health until three days prior to admission when he noted sharp pain in his left elbow. This would, at times, radiate to his hand or armpit. This would occur at rest and particularly at night, but would not worsen with exertion. This pain ocurred on two consecutive evenings. It was not associated with any SOB or diapheresis though he does reports feeling fatigued.  \n.  \nOn the day of admission, he presented to his PCP who then him to an OSH. At the OSH, he was found to have a troponin T of 0.915 with a CK of 293 and an MB of 18.5. He was given lopressor and heparin and transferred for further care.  \n\ufeff\nOn review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative.  \n.  \nCardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n",
+    "input3": "GERD\n",
+    "input4": "He maternal uncles both died of MIs. Otherwise, no early CAD.\n",
+    "input5": "Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect appropriate.  \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.  \n\ufeff\nNeck: Supple with JVD flat.  \nCV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \n \nCHEST: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi.  \nABD: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by \npalpation. No abdominial bruits.  \nEXT: No c/c/e. No femoral bruits.  \nSkin: No stasis dermatitis, ulcers, scars, or xanthomas.\n",
+    "input6": "08:00PM BLOOD WBC-12.1* RBC-4.24* Hgb-13.2* Hct-38.3* MCV-90 MCH-31.1 MCHC-34.4 RDW-13.5\n06:25AM BLOOD WBC-10.1 RBC-3.84* Hgb-12.1* Hct-34.3* MCV-90 MCH-31.6 MCHC-35.3* RDW-12.9\n08:00PM BLOOD Glucose-120* UreaN-20 Creat-1.1 Na-143 K-4.1 Cl-108 HCO3-26 AnGap-13\n06:25AM BLOOD Glucose-101 UreaN-9 Creat-1.0 Na-140 K-4.0 Cl-107 HCO3-26 AnGap-11\n08:00PM BLOOD CK(CPK)-272*\n02:28AM BLOOD CK(CPK)-516*\n11:57PM BLOOD CK(CPK)-243*\n08:00PM BLOOD CK-MB-19* MB Indx-7.0*\n08:00PM BLOOD cTropnT-1.02*\n08:00PM BLOOD Calcium-8.7 Phos-2.8 Mg-2.2\n09:10AM BLOOD Calcium-8.9 Phos-2.8 Mg-1.9 Cholest-160\n09:10AM BLOOD Triglyc-119 HDL-39 CHOL/HD-4.1 LDLcalc-97\n\ufeff\nTTE:\n\ufeff\nThe left atrial volume is increased. There is mild regional left ventricular systolic dysfunction with dyskinesis of the basal to mid inferior and inferolateral segments and hypokinesis of the basal to mid lateral segments and inferior apex . [Intrinsic left ventricular systolic function is likely more depressed given the severity of valvular regurgitation.] Quantitative (biplane) LVEF = 47 %. There is no ventricular septal defect. The right ventricular cavity is mildly dilated with mild global free wall hypokinesis. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. There is no mitral valve prolapse. Moderate (2+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. (4) ST-elevation\n\ufeff\nIMPRESSION: Regional left ventricular systolic dysfunction consistent with coronary artery disease. Mildly dilated and hypokinetic right ventricle. Moderate mitral regurgitation.  \n\ufeff\nCath:\nCOMMENTS: 1. Selective coronary angiography of this right dominant system demonstrated three vessel coronary artery disease. The LMCA had a 20% ostial and distal stenosis. The LAD had a mid vessel 80% ulcerated plaque. The Ramus had a mid 70% stenosis. The RCA has total ostial occulsion with robust left to right collaterals. The LCx had mild luminal irregularities. \n2. Resting hemodynamic measurement demonstrated normal systemic arterial pressure at 112/72 mm Hg. Pullback of the pigtail catheter from the LV to the aorta did not demonstrate a gradient. The left sided filling pressure was elevated with an LVEDP of 25 mmHg. \n3. Successful ptca and stenting of the mid LAD with a 3.5x18 mm cypher stent. Successful ptca and stenting of the mid Ramus with a 2.5x8mm cypher stent. Successful ptca and stenting of the proximal rca with a 3.5x33mm cypher stent. Final angiography revealed 0% residual stenosis, no angiographically apparet dissection and timi 3 flow. The patient left the lab free of angina and in stable condition.\n"
+}

Finished/Acute Coronary Syndrome/STEMI/16137568-DS-5.json

@@ -0,0 +1,44 @@
+{
+    "STEMI-ACS$Intermedia_4": {
+        "Electrocardiogram shows inferior ST segment elevation, which is direct evidence for the diagnosis of inferior STEMI$Cause_1": {
+            "Subsequent EKG showed ST elevations$Input2": {}
+        },
+        "The blood report showed that cardiac troponin was 0.14, which is marked as abnormal. Cardiac troponin is a marker of myocardial damage. Its increase may indicate myocardial damage, which is common in myocardial infarction.$Cause_1": {
+            "cTropnT-0.14$Input6": {}
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "The patient describes recurrent chest discomfort over the past 3 days, which feels like a heavy weight on the chest. This description is common in angina pectoris.$Cause_1": {
+                "For the last 3 days, patient states she was having waxing and waning chest discomfort. She says it \"felt like a car was on my chest\".$Input2": {}
+            },
+            "The presence of moderate calcification and obtuse marginal branch stenosis, which are signs of coronary artery disease$Cause_1": {
+                "alcified with sluggish flow distally$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "chest discomfort is the symptom of ACS$Cause_1": {
+                    "chest discomfort$Input1": {}
+                },
+                "Pain radiating to the jaw and back bilaterally is a typical path of cardiac pain, which increases the possibility of cardiac problems.$Cause_1": {
+                    "radiation to the jaw on both sides, as well as radiation to the back$Input2": {}
+                },
+                "The persistence and non-exertional nature of chest pain suggest possible coronary artery disease$Cause_1": {
+                    "This discomfort was waxing and waning and was not associated with exertion, but became persistent the night prior to presentation$Input2": {}
+                },
+                "Mild shortness of breath, which may indicate that the heart is not pumping enough, a common symptom of heart disease$Cause_1": {
+                    "endorse mild shortness of breath$Input2": {}
+                },
+                "High blood pressure is one of the main risk factors for coronary artery disease$Cause_1": {
+                    "Hypertension$Input3": {}
+                },
+                "Family history of heart disease improve the risk$Cause_1": {
+                    "Father with angina\nMother with CHF, lived to her\nBrother with CABG in his$Input4": {}
+                }
+            }
+        }
+    },
+    "input1": "chest discomfort\n",
+    "input2": "\nFor the last 3 days, patient states she was having waxing and waning chest discomfort. She says it \"felt like a car was on my chest\". She also described radiation to the jaw on both sides, as well as radiation to the back. This discomfort was waxing and waning and was not associated with exertion, but became persistent the night prior to presentation. It was not associated with any nausea, vomiting, diaphoresis. She does endorse mild shortness of breath, and states that last week when she was on vacation she was also feeling short of \nbreath after ambulating long distances. All of the symptoms are totally new for her.\n\ufeff\nGiven the fact that her discomfort became persistent, she decided to present to the emergency room. Labs were notable for a troponin T of 0.14, normal CBC, initial EKG with nonspecific ST changes. She was given sublingual nitro with help with her chest discomfort, as well as full dose aspirin and ticagrelor 180. Subsequent EKG showed ST elevations \n\ufeff\nHer chest pain had improved. Per verbal sign out, in the Cath Lab, she initially underwent right radial approach and had findings consistent with RCA with a subtotal occlusion that appeared chronic and calcified with sluggish flow distally. Her left-sided circulation showed a 60% stenosis of her obtuse marginal, and an LAD with no significant disease but moderate calcifications. Her access had to be switched to right groin because of a short and tortuous aorta. The operator was unable to wire the RCA lesion successfully because of likely chronic nature and calcifications. Given that she was chest pain-free and her EKG had improved, no further intervention was pursued. She was brought to the CCU with a plan to potentially return to the Cath Lab later this morning for CTO procedure.\n\ufeff\nOn arrival to the CCU, She is comfortable, cheerful, and chest pain-free. Her husband is at bedside.\n\ufeff\nROS: Positive per HPI. Remaining 10 point ROS reviewed and negative.\n",
+    "input3": "+ Hypertension\n+ Osteoporosis on Reclast\n+ Meniscus surgery\n+ Hysterectomy\n+ Hypercalcemia status post workup negative for multiple myeloma including bone biopsy\n",
+    "input4": "Father with angina\nMother with CHF, lived to her\nBrother with CABG in his\n",
+    "input5": "ADMISSION PHYSICAL EXAMINATION:  \n===============================\nVS: Reviewed in metavision\nGENERAL: Well developed, well nourished in NAD. Oriented x3.\nMood, affect appropriate.  Appears younger than stated age. \nTanned skin.\nHEENT: Normocephalic, atraumatic. Sclera anicteric. PERRL. EOMI. \n\ufeff\n\ufeff\nCARDIAC: Normal rate, regular rhythm. No murmurs, rubs, or gallops.  \nLUNGS: No chest wall deformities or tenderness. Respiration is unlabored with no accessory muscle use. No adventitious breath sounds.  \nABDOMEN: Soft, non-tender, non-distended. No palpable hepatomegaly or splenomegaly.  \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or peripheral edema.  Right groin with pressure dressing in place, no bruit.  Right wrist with TR band in place, warm hand\nSKIN: No significant lesions or rashes.  \nPULSES: Distal pulses palpable and symmetric.  \nNEURO: ANO x3, moving all extremities, grossly nonfocal\n",
+    "input6": "ADMISSION LABS: \n===============\n12:09AM BLOOD WBC-8.8 RBC-4.17 Hgb-11.0* Hct-35.0 \nMCV-84 MCH-26.4 MCHC-31.4* RDW-16.7* RDWSD-50.7*\n12:09AM BLOOD Neuts-57.0 Monos-9.1 Eos-2.0 \nBaso-0.6 AbsNeut-5.02 AbsLymp-2.70 AbsMono-0.80 \nAbsEos-0.18 AbsBaso-0.05\n12:09AM BLOOD Glucose-154* UreaN-20 Creat-0.7 Na-142 K-4.0 Cl-105 HCO3-23 AnGap-14\n12:09AM BLOOD cTropnT-0.14*\n12:09AM BLOOD Calcium-10.9* Phos-2.9 Mg-1.8 Cholest-167\n05:03AM BLOOD %HbA1c-5.3 eAG-105\n12:09AM BLOOD Triglyc-95 HDL-52 CHOL/HD-3.2 LDLcalc-96\n\n"
+}

Finished/Acute Coronary Syndrome/STEMI/16250904-DS-15.json

@@ -0,0 +1,32 @@
+{
+    "STEMI-ACS$Intermedia_4": {
+        "The electrocardiogram shows ST segment elevation in leads II, III, and aVF and ST segment depression in leads V1-2, which are key electrocardiogram manifestations for diagnosing STEMI.$Cause_1": {
+            "EKG showed ST elevations in leads II, III, aVF, ST depressions in leads V1-2.$Input2": {}
+        },
+        "Cardiac troponin T is an important biomarker of myocardial injury. Although this value is within the normal range, any sign of myocardial injury needs attention, as myocardial infarction can cause this indicator to increase.$Cause_1": {
+            "cTropnT-0.10$Input6": {}
+        },
+        "Strongly Suspected ACS$Intermedia_3": {
+            "Increased pain, sweating, and dyspnea are common symptoms in STEMI, indicating that the heart is overloaded and heart function may be declining sharply.$Cause_1": {
+                "worsening pain, diaphoresis, dyspnea$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest Pain is the symptom of ACS$Cause_1": {
+                    "chest pain$Input1": {}
+                },
+                "Sharp pain behind the sternum that radiates into the arms is a classic symptom of angina or myocardial infarction, reflecting ischemia in the heart area.$Cause_1": {
+                    "developed stabbing retrosternal chest pain radiating to the arm$Input2": {}
+                },
+                "High blood pressure is a major risk factor for heart disease, especially acute coronary syndrome$Cause_1": {
+                    "Hypertension$Input3": {}
+                }
+            }
+        }
+    },
+    "input1": "chest pain\n",
+    "input2": "He is a year old man w now s/p DES to the left circumflex.  \nPatient is generally healthy and active with frequent exercise. Only medical comorbidity to this point is hypertension. He was exercising in the gym (weight lifting and running) around 7pm, and near the end of the work-out developed stabbing retrosternal chest pain radiating to the arm. He returned home, and with rest and a shower felt a little improvement in his chest pain. He went to sleep still having chest pain, but around 1130 woke with worsening pain, diaphoresis, dyspnea, and decided to come to the ED.  \nIn the ED, initial vitals were: T 97.9, HR 89, BP 167/90, RR 18, SPO2 100% on RA.  \nEKG showed ST elevations in leads II, III, aVF, ST depressions in leads V1-2.  \n\n",
+    "input3": "+ Hypertension  \n+ Appendectomy\n",
+    "input4": "father with hypertension\n",
+    "input5": "VS: T98, BP 121/73, HR 62, RR 18, O2 96% on RA   \nTele: no alarms  \nGeneral: Alert, oriented, no acute distress  \nHEENT: Sclerae anicteric\nNeck: Supple \nCV: RRR, nl S1 S2, no m/r/g \nLungs: CTA b/l, no wheezes, rales, rhonchi  \nAbdomen: Soft, non-tender, non-distended\nGU: No foley  \nExt: WWP, DP 2+ bilaterally  \nNeuro: CNII-XII intact\n",
+    "input6": "admissions labs:\n05:46AM   GLUCOSE-93 UREA N-14 CREAT-0.9 SODIUM-138 POTASSIUM-4.1 CHLORIDE-104 TOTAL CO2-20* ANION GAP-18\n05:46AM   CALCIUM-9.1 PHOSPHATE-3.6 MAGNESIUM-2.7* CHOLEST-173\n05:46AM   %HbA1c-5.6 eAG-114\n05:46AM   TRIGLYCER-126 HDL CHOL-36 CHOL/HDL-4.8 LDL(CALC)-112\n05:46AM   WBC-5.8 RBC-5.28 HGB-15.9 HCT-46.9 MCV-89 MCH-30.1 MCHC-33.9 RDW-12.4 RDWSD-40.7\n05:46AM   PLT COUNT-285\n01:39AM   TYPE-ART PH-7.35 INTUBATED-NOT INTUBA\n01:39AM   GLUCOSE-104 NA+-131* K+-3.5 CL--97 TCO2-24\n01:39AM   freeCa-1.13\n12:45AM   GLUCOSE-117* UREA N-15 CREAT-1.0 SODIUM-138 POTASSIUM-3.9 CHLORIDE-98 TOTAL CO2-26 ANION GAP-18\n12:45AM   estGFR-Using this\n12:45AM   cTropnT-0.10*\n12:45AM   WBC-7.7# RBC-5.50 HGB-16.5 HCT-49.0 MCV-89 MCH-30.0 MCHC-33.7 RDW-12.4 RDWSD-40.6\n12:45AM   NEUTS-23.2* LYMPHS-60.9* MONOS-10.5 EOS-3.5 \nBASOS-1.8* IM AbsNeut-1.80 AbsLymp-4.71* AbsMono-0.81* \nAbsEos-0.27 AbsBaso-0.14*\n___ 12:45AM   HYPOCHROM-NORMAL ANISOCYT-NORMAL \nPOIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL \nPOLYCHROM-NORMAL\n___ 12:45AM   PLT COUNT-296\n"
+}

Finished/Acute Coronary Syndrome/UA/11657791-DS-21.json

@@ -0,0 +1,105 @@
+{
+    "UA$Intermedia_5": {
+        "Severe chest pain is symbol of ACS-UA$Cause_1": {
+            "He reports that the pain seemed to radiate to the back b/w the scapulae and worsened with breathing but denies other assoc symptoms other than slight dyspnea. Pain lasted for approx 30 min- pt reports \"nearly passing out\" when taking sublingual nitroglycerin.$Input2": {}
+        },
+        "nomal(<0.2 \u03bcg/L)$Cause_1": {
+            "BLOOD cTropnT-<0.01$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain is a symptom of ACS$Cause_1": {
+                "Chest Pain$Input1": {}
+            },
+            "HTN is the risk fact for ACS$Cause_1": {
+                "HTN,$Input3": {}
+            },
+            "HLD is the risk fact for ACS$Cause_1": {
+                "HLD$Input3": {}
+            },
+            "former smoker is the risk fact for ACS$Cause_1": {
+                "former smoker$Input3": {}
+            },
+            "Obesity is the risk fact for ACS$Cause_1": {
+                "Obesity$Input3": {}
+            }
+        },
+        "Strongly suspected ACS$Intermedia_3": {
+            "PCIs (following MI, RCA stent are the risk facts for ACS$Cause_1": {
+                "He is a 66 yr old male with known CAD s/p multiple PCIs (following MI, RCA stent, 2 RCA stents on.$Input2": {}
+            },
+            "Chest pain is a symptom of ACS.$Cause_1": {
+                "He reports an episode of dull substernal chest pain 2 days ago when he was out shopping with his wife.$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "HTN is the risk fact for ACS$Cause_1": {
+                    "HTN,$Input3": {}
+                },
+                "HLD is the risk fact for ACS$Cause_1": {
+                    "HLD$Input3": {}
+                },
+                "former smoker is the risk fact for ACS$Cause_1": {
+                    "former smoker$Input3": {}
+                },
+                "Obesity is the risk fact for ACS$Cause_1": {
+                    "Obesity$Input3": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "ECG\uff1anon-ST-elevation$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "Chest Pain$Input1": {}
+                },
+                "HTN is the risk fact for ACS$Cause_1": {
+                    "HTN,$Input3": {}
+                },
+                "HLD is the risk fact for ACS$Cause_1": {
+                    "HLD$Input3": {}
+                },
+                "former smoker is the risk fact for ACS$Cause_1": {
+                    "former smoker$Input3": {}
+                },
+                "Obesity is the risk fact for ACS$Cause_1": {
+                    "Obesity$Input3": {}
+                }
+            },
+            "Strongly suspected ACS$Intermedia_3": {
+                "PCIs (following MI, RCA stent are the risk facts for ACS$Cause_1": {
+                    "He is a 66 yr old male with known CAD s/p multiple PCIs (following MI, RCA stent, 2 RCA stents on.$Input2": {}
+                },
+                "Chest pain is a symptom of ACS.$Cause_1": {
+                    "He reports an episode of dull substernal chest pain 2 days ago when he was out shopping with his wife.$Input2": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest pain is a symptom of ACS$Cause_1": {
+                        "Chest Pain$Input1": {}
+                    },
+                    "HTN is the risk fact for ACS$Cause_1": {
+                        "HTN,$Input3": {}
+                    },
+                    "HLD is the risk fact for ACS$Cause_1": {
+                        "HLD$Input3": {}
+                    },
+                    "former smoker is the risk fact for ACS$Cause_1": {
+                        "former smoker$Input3": {}
+                    },
+                    "Obesity is the risk fact for ACS$Cause_1": {
+                        "Obesity$Input3": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest Pain\n",
+    "input2": "He is a 66 yr old male with known CAD s/p multiple PCIs (following MI, RCA stent, 2 RCA stents on. Of note, pt is s/p negative nuclear stress testing and coronary angiography. He reports an episode of dull substernal chest pain 2 days ago when he was out shopping with his wife. He reports that the pain seemed to radiate to the back b/w the scapulae and worsened with breathing but denies other assoc symptoms other than slight dyspnea. Pain lasted for approx 30 min- pt reports \"nearly passing out\" when taking sublingual nitroglycerin. Of note, at baseline pt reports substernal chest pain at its worst lasting min- he notes that this baseline pain occasionally occurs at rest and has been present since discharge from last month; he feels that he has had approximately 6 episodes in the last day. \n\nPt saw his PCP yesterday and reported his chest pain from the day before along w/hx of baseline symptoms, and was subsequently referred. Pt was afebrile, BP 158/80, HR 56, RR 18, SaO2 98% RA. Work-up yielded Troponin I x3 <0.015 (<0.046 ng/mL), CPK-MB 2.6 (0.5-3.6 ng/mL), EKG showed normal sinus rhythm, CXR showed no acute cardiopulmonary process.\n",
+    "input3": "+Cardiac Risk Factors: \n+HTN, \n+HLD, \n+former smoker \n+CAD s/p multiple PCIs: following MI, RCA stent, 2 RCA stents.\n+Pulmonary hypertension\n+Mitral valve regurgitation\n+psoriatic arthritis (denies any medical management)\n+Obesity\n+Scarlet fever as a child\n+Bilateral cataracts s/p cataract surgery\n+Bladder cancer , s/p surgery + chemotherapy\n+S/P hernia repair\n+s/p fracture left shoulder, s/p ORIF\n+Persistent hip pain, left\n",
+    "input4": "-Father died, hx of ETOH overconsumption\n-Mother died when pt was young, reportedly from complications assoc w/gestational diabetes\n-No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death\n",
+    "input5": "ADMISSION\nT 97.8F, BP 124/68, HR 50, RR 18, SaO2 99% RA. \nPleasant elderly man resting comfortably in bed, no acute distress\nHEENT: NCAT. Pupils slightly asymmetric, pupillary light reflex not appreciable prior cataract surgery); pt wearing blue-colored contact lenses. Conjunctiva pink, sclera anicteric, moist mucous membranes. Patient wearing partial upper and lower dentures.\nNeck: supple, no JVD\nCV: RRR, HS 1 and 2 audible on auscultation, no m/r/g\nLungs: CTAB \nAbdomen: soft, nontender, non-distended, BS+\nExt: 2+ distal pulses in upper and lower extremities \nbilaterally. Scars on ulnar aspect L forearm (reported to be psoriasis)\nNeuro: A&O x3, cranial nerves II to XII grossly intact. strength in upper and lower extremities bilaterally\n",
+    "input6": "___ 07:45AM BLOOD ___\n___ 04:30PM BLOOD Plt ___\n___ 07:45AM BLOOD Glucose-100 UreaN-17 Creat-1.0 Na-139 K-4.1 Cl-104 HCO3-28 AnGap-11\n___ 04:30PM BLOOD Na-140 K-4.1 Cl-105\n___ 04:30PM BLOOD cTropnT-<0.01\n\nECG\uff1anon-ST-elevation\n"
+}

Finished/Acute Coronary Syndrome/UA/11677801-DS-33.json

@@ -0,0 +1,105 @@
+{
+    "UA$Intermedia_5": {
+        "Severe chest pain is symbol of ACS-UA$Cause_1": {
+            "Reports pain during the last month which starts in left parasternal region, radiates to the left elbow. For the past week the patient has had worsening left-sided chest pressure with any exertional activities. This is associated with dyspnea and recovers after a couple of minutes of rest$Input2": {}
+        },
+        "Severe chest pain is symbol of ACS-UA.$Cause_1": {
+            "He states this felt unlike his prior episodes of angina. It lasted for about 25 min and resolved en route.$Input2": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain is a symptom of ACS$Cause_1": {
+                "chest pain$Input1": {}
+            },
+            "CAD c/b MI s/p 3v CABG and BMS can be risk factors$Cause_1": {
+                "CAD c/b MI s/p 3v CABG and BMS$Input3": {}
+            },
+            "family history can be risk fact$Cause_1": {
+                "Mother CAD, CHF, Tremor$Input4": {}
+            },
+            "family history can be risk fact.$Cause_1": {
+                "Father CAD$Input4": {}
+            },
+            "family history can be risk fact..$Cause_1": {
+                "Brother CAD$Input4": {}
+            }
+        },
+        "Strongly suspected ACS$Intermedia_3": {
+            "ECG changes can be sign of acs-ua$Cause_1": {
+                "EKG showed SR @ 58, old TWI in lead III, LAD. Currently reports continued left arm discomfort$Input2": {}
+            },
+            "Coronary stenosis can strongly be a sign of acs$Cause_1": {
+                "LMCA:  distal 60%\nLAD:  proximally occluded, distal vessel fills via LIMA\nLCX:  proximal 80% lesion with small distal vessel\nRCA:  diffuse proximal/mid disease with mid occlusion;$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "chest pain$Input1": {}
+                },
+                "CAD c/b MI s/p 3v CABG and BMS can be risk factors$Cause_1": {
+                    "CAD c/b MI s/p 3v CABG and BMS$Input3": {}
+                },
+                "family history can be risk fact$Cause_1": {
+                    "Mother CAD, CHF, Tremor$Input4": {}
+                },
+                "family history can be risk fact.$Cause_1": {
+                    "Father CAD$Input4": {}
+                },
+                "family history can be risk fact..$Cause_1": {
+                    "Brother CAD$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "ECG:non-ST-elevation$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "chest pain$Input1": {}
+                },
+                "CAD c/b MI s/p 3v CABG and BMS can be risk factors$Cause_1": {
+                    "CAD c/b MI s/p 3v CABG and BMS$Input3": {}
+                },
+                "family history can be risk fact$Cause_1": {
+                    "Mother CAD, CHF, Tremor$Input4": {}
+                },
+                "family history can be risk fact.$Cause_1": {
+                    "Father CAD$Input4": {}
+                },
+                "family history can be risk fact..$Cause_1": {
+                    "Brother CAD$Input4": {}
+                }
+            },
+            "Strongly suspected ACS$Intermedia_3": {
+                "ECG changes can be sign of acs-ua$Cause_1": {
+                    "EKG showed SR @ 58, old TWI in lead III, LAD. Currently reports continued left arm discomfort$Input2": {}
+                },
+                "Coronary stenosis can strongly be a sign of acs$Cause_1": {
+                    "LMCA:  distal 60%\nLAD:  proximally occluded, distal vessel fills via LIMA\nLCX:  proximal 80% lesion with small distal vessel\nRCA:  diffuse proximal/mid disease with mid occlusion;$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest pain is a symptom of ACS$Cause_1": {
+                        "chest pain$Input1": {}
+                    },
+                    "CAD c/b MI s/p 3v CABG and BMS can be risk factors$Cause_1": {
+                        "CAD c/b MI s/p 3v CABG and BMS$Input3": {}
+                    },
+                    "family history can be risk fact$Cause_1": {
+                        "Mother CAD, CHF, Tremor$Input4": {}
+                    },
+                    "family history can be risk fact.$Cause_1": {
+                        "Father CAD$Input4": {}
+                    },
+                    "family history can be risk fact..$Cause_1": {
+                        "Brother CAD$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "chest pain\n",
+    "input2": "He with h/o CAD s/p CABG and BM stent location, muscle invasive urothelial bladder ca s/p cystectomy and creating of neobladder, intraductal papillary mucinous neoplasm s/p Whipple procedure, who presents with chest pain. Reports pain during the last month which starts in left parasternal region, radiates to the left elbow. For the past week the patient has had worsening left-sided chest pressure with any exertional activities. This is associated with dyspnea and recovers after a couple of minutes of rest. \n\nThis morning at 4am he awoke with throbbing chest pain in the middle of his chest that radiated to his shoulders and his left arm. This was associated with nausea and palpitations, but not shortness of breath or diaphoresis. He states this felt unlike his prior episodes of angina. It lasted for about 25 min and resolved en route.\n\nWas seen where vitals were 97.8 63 126/58 15 96%. Initial ECG did not show evidence of STEMI/NSTEMI and troponin was negative. Received morphine and NTG with improvement in discomfort. He was transferred for possible cath.\n\nIn the ED, initial vitals were 97.4 60 146/54 16 100%. EKG showed SR @ 58, old TWI in lead III, LAD. Currently reports continued left arm discomfort, though no chest pain or shortness of breath. He denies cough, fever, pleuritic chest pain, orthopnea, syncope, leg swelling.ECG:non-ST-elevation\n",
+    "input3": "+muscle invasive urothelial bladder ca s/p cystectomy and creating of neobladder\n-intraductal papillary mucinous neoplasm s/p Whipple procedure \n+ventral hernia s/p repair\n+Ulcer s/p cautery\n+pulmonary embolus (was on coumadin for 6 mo)\n+CAD c/b MI s/p 3v CABG and BMS\n",
+    "input4": "Mother CAD, CHF, Tremor\nFather CAD\nBrother CAD, EtOH abuse\nBrother Living TREMOR, CAD   \nAunt LUNG CANCER\n",
+    "input5": "ADMISSION EXAM\n\n\nVS: Wt=215lbs T=97.8 BP=132/82 HR=67 RR=16 O2 sat=96% on RA \nGeneral: well-appearing man in NAD \nHEENT:  EOMI, anicteric sclera, mucus membranes moist\nNeck: supple JVD 6cm \nCV:  regular rate and rhythm, no murmurs, rubs, or gallops\nLungs:  breathing comfortably on room air, CTAB\nAbdomen:  +BS, S NT ND\nGU:  no foley\nExt:  warm and well perfused, no edema\nNeuro:  A&Ox3, CN2-12 intact, moving all extremities\nSkin:  no rashes\nPULSES:  2+\n",
+    "input6": "ADMISSION LABS\n\n___ 08:56AM BLOOD WBC-8.0# RBC-4.74 Hgb-15.3 Hct-47.2 MCV-99* MCH-32.3* MCHC-32.5 RDW-13.6 Plt ___\n___ 08:56AM BLOOD Neuts-69.9 ___ Monos-5.7 Eos-2.4 Baso-1.1\n___ 02:56PM BLOOD ___\n___ 08:56AM BLOOD Glucose-109* UreaN-21* Creat-1.3* Na-139 K-4.9 Cl-107 HCO3-21* AnGap-16\n___ 08:56AM BLOOD CK-MB-3\n\nSTUDIES\n\n___: Findings\nESTIMATED blood loss: 20 cc\nHemodynamics (see above):Coronary angiography:  right dominant\nLMCA:  distal 60%\nLAD:  proximally occluded, distal vessel fills via LIMA\nLCX:  proximal 80% lesion with small distal vessel\nRCA:  diffuse proximal/mid disease with mid occlusion; distal PLand PDA branches fill via SVG with no significant diseaseSVG sequentially to PL and PDA branches:  prior stent patent; 90%lesion proximal to proximal PL anastomosis LIMA- diagonal:  normal; retrograde filling of distal LAD which is a small vessel\n\nInterventional details\nChange for Fr AL 0.75 guide.  Using Spider distal protection,mid graft lersion crossed with Prowater wire , dilated with 2.5 balloon and stented with 3.5x12 Premier to 3.75 mm at 18 atm.  No residual, normal flow.  Angioseal femoral closure.\n"
+}

Finished/Acute Coronary Syndrome/UA/11677801-DS-34.json

@@ -0,0 +1,58 @@
+{
+    "UA$Intermedia_4": {
+        "Severe chest pain is symbol of ACS-UA$Cause_1": {
+            "Patient reports exertional chest pain and shortness of breath over the last few days.$Input2": {}
+        },
+        "Severe chest pain is symbol of ACS-UA.$Cause_1": {
+            "Chest pain described as midsternal chest pain with radiation to the left arm that feels similar to his previous cardiac chest pain. He experienced left jaw pain for the first time.$Input2": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain is a symptom of ACS$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "CAD is risk fact of acs$Cause_1": {
+                "He is with h/o CAD s/p CABG and BM$Input2": {}
+            },
+            "CAD of family history can be risk fact$Cause_1": {
+                "Mother CAD, CHF, Tremor$Input4": {}
+            },
+            "CAD of family history can be risk fact.$Cause_1": {
+                "Father CAD$Input4": {}
+            },
+            "CAD of family history can be risk fact..$Cause_1": {
+                "Brother CAD,$Input4": {}
+            }
+        },
+        "NSTE-ACS$Intermedia_3": {
+            "Severe chest pain is symbol of ACS-UA..$Cause_1": {
+                "Patient notes chest pain has been worse with walking for a distance more than yards. Had difficulty walking from parking lot to hospital the other day when visiting a friend.$Input2": {}
+            },
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "EKG - sinus, NANI, no STEMI non-ST-elevation$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "CAD is risk fact of acs$Cause_1": {
+                    "He is with h/o CAD s/p CABG and BM$Input2": {}
+                },
+                "CAD of family history can be risk fact$Cause_1": {
+                    "Mother CAD, CHF, Tremor$Input4": {}
+                },
+                "CAD of family history can be risk fact.$Cause_1": {
+                    "Father CAD$Input4": {}
+                },
+                "CAD of family history can be risk fact..$Cause_1": {
+                    "Brother CAD,$Input4": {}
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "He is with h/o CAD s/p CABG and BM, DES in SVG-PDA with restenosis, muscle invasive urothelial bladder ca s/p cystectomy and neobladder, intraductal papillary mucinous neoplasm s/p Whipple procedure, who presents with chest pain. Patient reports exertional chest pain and shortness of breath over the last few days. Chest pain described as midsternal chest pain with radiation to the left arm that feels similar to his previous cardiac chest pain. He experienced left jaw pain for the first time. Patient notes chest pain has been worse with walking for a distance more than yards. Had difficulty walking from parking lot to hospital the other day when visiting a friend. Reports increased chest discomfort and SOB when walking up slight inclines. Pain and dyspnea only associated with exertion. Improved with couple mintues of rest and deep breathing. Denies any symptoms at rest. Notes associated lightheadedness. \n\nPatient was concerned and presented to the ED. In the ED, initial vitals were 98.2 63 141/88 18 94% 2L. Denies any active chest pain or SOB. Exam notable for : mild crackle to right lung\n\nChest Xray- No acute cardiopulmonary process.\nEKG - sinus, NANI, no STEMI non-ST-elevation\n\nOn arrival to the floor patient is stable. Denies any active chest pain or SOB. Currently asymptomatic.  \n\nREVIEW OF SYSTEMS: + as per HPI. Denies nausea, vomiting. \nDiarrhea for past 7 days but reports this is common due to his Whipple. No associated fevers or chills. \n\nCardiac review of systems is notable for chest pain, dyspnea on exertion, negative for paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n",
+    "input3": "+muscle invasive urothelial bladder ca s/p cystectomy and creating of neobladder \n+intraductal papillary mucinous neoplasm s/p Whipple procedure \n+ventral hernia s/p repair\n+Ulcer s/p cautery \n+pulmonary embolus (was on coumadin for 6 mo)\n",
+    "input4": "Mother CAD, CHF, Tremor\nFather CAD\nBrother CAD, EtOH abuse\nBrother Living 72 TREMOR, CAD   \nAunt LUNG CANCER\n",
+    "input5": "ADMISSION PHYSICAL EXAMINATION:\nVitals: 98.0 123/80 70 18 98%RA\nGeneral: well-appearing man in NAD \nHEENT:  EOMI, anicteric sclera, mucus membranes moist\nNeck: supple, level of clavicle sitting upright\nCV:  regular rate and rhythm, no murmurs, rubs, or gallops\nLungs:  breathing comfortably on room air, CTAB\nAbdomen:  +BS, soft, nontender, nondistended, multiple well healed scars.\nGU: No foley\nExt:  warm and well perfused, no edema. Peripheral pulses \nintact.\nNeuro:  A&Ox3, CN2-12 intact, moving all extremities\nSkin:  no rashes\n",
+    "input6": "ADMISSION LABS\n==================\n___ 07:10AM BLOOD WBC-6.1 RBC-4.52* Hgb-13.9 Hct-43.5 MCV-96 MCH-30.8 MCHC-32.0 RDW-13.6 RDWSD-48.6* Plt\n___ 07:10AM BLOOD Neuts-64.4 Monos-10.2 Eos-2.5 Baso-0.7 AbsNeut-3.94 AbsLymp-1.34 AbsMono-0.62 AbsEos-0.15 AbsBaso-0.04\n___ 07:10AM BLOOD\n___ 07:10AM BLOOD Glucose-117* UreaN-17 Creat-1.4* Na-142 K-4.6 Cl-109* HCO3-21* AnGap-17\n___ 07:10AM BLOOD CK-MB-1 cTropnT-<0.01\n___ 01:12PM BLOOD CK-MB-1 cTropnT-<0.01\n___ 07:10AM BLOOD Calcium-9.2 Phos-3.1 Mg-2.0\n\nIMAGING\n==================\nCHEST (PA & LAT)\nThere are slightly low lung volumes, which results in bronchovascular crowding.  The cardiomediastinal and hilar contours are unchanged.  The aorta is tortuous.  The patient is status post CABG.  There is no pneumothorax, pleural effusion, or consolidation. \n  \nIMPRESSION: No acute cardiopulmonary process.\n"
+}

Finished/Acute Coronary Syndrome/UA/11706286-DS-17.json

@@ -0,0 +1,60 @@
+{
+    "UA$Intermedia_5": {
+        "Severe chest pain is symbol of ACS-UA$Cause_1": {
+            "He was walking up the stairs today when he experienced chest pain for two minutes associated with palpitations. The pain lasted for 10 minutes. He has had a few other episodes with exertion this week.$Input2": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Hyperkalemia is a symptom of ACS$Cause_1": {
+                "Hyperkalemia$Input1": {}
+            },
+            "+Dyslipidemia   can be risk fact$Cause_1": {
+                "+Dyslipidemia$Input3": {}
+            }
+        },
+        "Strongly suspected ACS$Intermedia_3": {
+            "ECG changes can be sign of acs$Cause_1": {
+                "EKG: sinus rhythm with subtle ST depression in lateral leads withpoor R wave progression$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Hyperkalemia is a symptom of ACS$Cause_1": {
+                    "Hyperkalemia$Input1": {}
+                },
+                "+Dyslipidemia   can be risk fact$Cause_1": {
+                    "+Dyslipidemia$Input3": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "and non-ST-elevation$Input2": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Hyperkalemia is a symptom of ACS$Cause_1": {
+                    "Hyperkalemia$Input1": {}
+                },
+                "+Dyslipidemia   can be risk fact$Cause_1": {
+                    "+Dyslipidemia$Input3": {}
+                }
+            },
+            "Strongly suspected ACS$Intermedia_3": {
+                "ECG changes can be sign of acs$Cause_1": {
+                    "EKG: sinus rhythm with subtle ST depression in lateral leads withpoor R wave progression$Input2": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Hyperkalemia is a symptom of ACS$Cause_1": {
+                        "Hyperkalemia$Input1": {}
+                    },
+                    "+Dyslipidemia   can be risk fact$Cause_1": {
+                        "+Dyslipidemia$Input3": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Hyperkalemia\n",
+    "input2": "He is a 69 year old male with history of hypothyroidism who presents to the ED after an episode of exertional chest pain.\n\nHe was walking up the stairs today when he experienced chest pain for two minutes associated with palpitations. The pain lasted for 10 minutes. He has had a few other episodes with exertion this week. He denies n/v, diaphoresis, radiation of the pain to either arm or to his jaw. He denies any prior issues with bleeding, has no upcoming planned surgeries. \n\nIn the ED initial vitals were:  T: 97.4  HR: 95  BP: 136/54  RR: 18  SPO2: 100% RA \n\nEKG: sinus rhythm with subtle ST depression in lateral leads withpoor R wave progression and non-ST-elevation\n \nPatient was given:  PO Aspirin 324 mg \n\nOn the floor, patient denies any recurrent chest pain but does note some mild indigestion which he is quick to point out is quite different from his prior chest pain.\n",
+    "input3": "+Dyslipidemia  \n+Rhythm: NSR\n",
+    "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death.\n",
+    "input5": "Vitals: 97.6 139 / 90 71 18 97 RA \nTelemetry:  no events\nGeneral:  laying comfortably in bed\nLungs: breathing comfortably, CTA b/l\nCV: rrr, no mrg, JVP not elevated\nAbdomen: soft, ntnd\nExt: no peripheral edema\n",
+    "input6": "___ 07:30AM BLOOD WBC-8.0 RBC-4.95 Hgb-14.9 Hct-44.7 MCV-90 MCH-30.1 MCHC-33.3 RDW-13.5 RDWSD-44.5 Plt ___\n___ 07:30AM BLOOD Plt ___\n___ 07:30AM BLOOD Glucose-99 UreaN-13 Creat-0.9 Na-141 K-4.5 Cl-102 HCO3-29 AnGap-10\n___ 08:45AM BLOOD CK(CPK)-45*\n___ 09:03AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 03:02AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 08:45AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 07:30AM BLOOD Calcium-9.0 Phos-3.1 Mg-2.2\n___ 03:20AM BLOOD RedHold-HOLD\n"
+}

Finished/Acute Coronary Syndrome/UA/11959580-DS-12.json

@@ -0,0 +1,87 @@
+{
+    "UA$Intermedia_5": {
+        "Chest pain is a symptom of ACS.$Cause_1": {
+            "who presents chest pain this am at 0850 while walking across a parking a lot, that lasted about about 8 mins pain radiated left arm, no nausea, no diaphoresis during event.$Input2": {}
+        },
+        "Severe chest pain is symbol of ACS-UA.$Cause_1": {
+            "She complained of mild mid-sternal to left shoulder pressure at peak exercise, which resolved almost completely by 5 minutes of recovery with the remaining discomfort only occuring with palpation.$Input6": {}
+        },
+        "Suspected ACS$Intermedia_2": {
+            "Chest pain is a symptom of ACS$Cause_1": {
+                "Chest pain$Input1": {}
+            },
+            "+STEMI is a risk fact$Cause_1": {
+                "+STEMI$Input3": {}
+            },
+            "HLD is a risk fact$Cause_1": {
+                "+HLD$Input3": {}
+            },
+            "family history can be risk fact$Cause_1": {
+                "Mother father with CAD and CHF.$Input4": {}
+            }
+        },
+        "Strongly suspected ACS$Intermedia_3": {
+            "slight cardiac structural abnormalities can be sign of acs$Cause_1": {
+                "The right ventricular cavity is mildly dilated with focal hypokinesis of the apical free wall. There is abnormal septal motion/position. The aortic root is mildly dilated at the sinus level.$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "+STEMI is a risk fact$Cause_1": {
+                    "+STEMI$Input3": {}
+                },
+                "HLD is a risk fact$Cause_1": {
+                    "+HLD$Input3": {}
+                },
+                "family history can be risk fact$Cause_1": {
+                    "Mother father with CAD and CHF.$Input4": {}
+                }
+            }
+        },
+        "NSTE-ACS$Intermedia_4": {
+            "non-ST-elevation is a sign of NSTE-ACS$Cause_1": {
+                "ECG:\nnon-ST-elevation$Input6": {}
+            },
+            "Suspected ACS$Intermedia_2": {
+                "Chest pain is a symptom of ACS$Cause_1": {
+                    "Chest pain$Input1": {}
+                },
+                "+STEMI is a risk fact$Cause_1": {
+                    "+STEMI$Input3": {}
+                },
+                "HLD is a risk fact$Cause_1": {
+                    "+HLD$Input3": {}
+                },
+                "family history can be risk fact$Cause_1": {
+                    "Mother father with CAD and CHF.$Input4": {}
+                }
+            },
+            "Strongly suspected ACS$Intermedia_3": {
+                "slight cardiac structural abnormalities can be sign of acs$Cause_1": {
+                    "The right ventricular cavity is mildly dilated with focal hypokinesis of the apical free wall. There is abnormal septal motion/position. The aortic root is mildly dilated at the sinus level.$Input6": {}
+                },
+                "Suspected ACS$Intermedia_2": {
+                    "Chest pain is a symptom of ACS$Cause_1": {
+                        "Chest pain$Input1": {}
+                    },
+                    "+STEMI is a risk fact$Cause_1": {
+                        "+STEMI$Input3": {}
+                    },
+                    "HLD is a risk fact$Cause_1": {
+                        "+HLD$Input3": {}
+                    },
+                    "family history can be risk fact$Cause_1": {
+                        "Mother father with CAD and CHF.$Input4": {}
+                    }
+                }
+            }
+        }
+    },
+    "input1": "Chest pain\n",
+    "input2": "Male-to-female transgender pt (on estrogen and spironolactone), h/o CAD (STEMI and cabg who presents chest pain this am at 0850 while walking across a parking a lot, that lasted about about 8 mins pain radiated left arm, no nausea, no diaphoresis during event. She originally was seen, EKG unchanged compared to prior, trop neg, pt continued to have CP and was given nitro SL and paste x 2, morphine, and ASA lovenox cs, metop tartrate 5,g IV, before transfer.  In the ED intial vitals were:97.9 88 110/64 16 96% 2L pt became hypotensive to 77/44 while on nitro patch this resolved when removing the nitro patch adn BPs went up to the 100s  \n\nLabs were significant for Ddimer <150, trop neg x1 wbc 11  cardiology was consulted and felt there were no frank abnormalities on echo though difficult views, systolic function appeared low normal, ecg unchanged from prior.\n",
+    "input3": "+STEMI\n+CABG\n+HLD  \n+transgender M-->F\n",
+    "input4": "Mother father with CAD and CHF.\n",
+    "input5": "ADMISSION:\nVitals - 98.3 126/73 73 18 98%ra  \nGENERAL: NAD  \nHEENT: no elev JVP  \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs  \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles  \nABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly  \nEXTREMITIES: no edema\n",
+    "input6": "ADMISSION LABS:\n___ 04:00PM BLOOD WBC-11.1* RBC-4.10* Hgb-13.8 Hct-39.1 MCV-96 MCH-33.6* MCHC-35.2* RDW-12.0 Plt ___\n___ 04:00PM BLOOD Neuts-67.7 ___ Monos-5.3 Eos-1.5 Baso-0.9\n___ 04:00PM BLOOD ___ PTT-40.8* ___\n___ 04:00PM BLOOD Glucose-89 UreaN-15 Creat-1.0 Na-136 K-4.5 Cl-102 HCO3-25 AnGap-14\n___ 04:00PM BLOOD Calcium-9.9 Phos-4.1 Mg-2.1\n___ 04:00PM BLOOD cTropnT-<0.01\n___ 04:14PM BLOOD Lactate-1.8\n\nIMAGING AND STUDIES:\n\nExercise Stress MIBI:\nINTERPRETATION: THis was an active 61 year old transgender (M to \nF) woman with CAD (MI/cabg, HLD and CHF, who was referred to the lab from the inpatient floor for an evaluation of chest discomfort. She exercised for 6.5 minutes of protocol METs) and stopped due to fatigue. This represents a fair functional capacity for her age. She complained of mild mid-sternal to left shoulder pressure at peak exercise, which resolved almost completely by 5 minutes of recovery with the remaining discomfort only occuring with palpation. In the presence of RBBB on baseline ECG, there were no changes in ST segment or T wave morphology noted during exercise or in recovery. The rhythm was sinus with one isolated PVC seen during exercise and one ventricular couplet seen in immediate recovery. The heart rate and blood pressure responses were mildly blunted (beta blockade). \n  \n___ CXR:\nNo acute cardiopulmonary abnormality. \n  \n___ ECHO bedside:\nThe left atrium is normal in size. Left ventricular wall thicknesses and cavity size are normal. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded - it appears that the inferior wall may be hypokinetic. Overall left ventricular systolic function is low normal (LVEF 50-55%). The right ventricular cavity is mildly dilated with focal hypokinesis of the apical free wall. There is abnormal septal motion/position. The aortic root is mildly dilated at the sinus level. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve leaflets are structurally normal. Trivial mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. If clinically indicated, a complete transthoracic examination with Doppler is recommended. \n\nCompared with the prior study (images reviewed), right ventricle is slightly larger. Regional left ventricular function cannot be reliably assessed on this emergency study.\n\nECG:\nnon-ST-elevation\n"
+}