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Diagnosis_flowchart/Acute Coronary Syndrome.json

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+{"diagnostic": {"Suspected ACS": {"Strongly Suspected ACS": {"NSTE-ACS": {"UA": [], "NSTEMI": []}, "STEMI-ACS": []}}}, "knowledge": {"Suspected ACS": {"Risk Factors": "Hyperlipidemia, hypertension, smoking, diabetes, infection, hyperthyroidism, severe arrhythmia, anemia, hypoxemia; etc.", "Symptoms": "Chest pain, sweating, nausea, vomiting, palpitations, dyspnea, arrhythmia with weakness, dizziness or syncope, hypotensive shock, acute left heart failure; etc."}, "Strongly Suspected ACS": "More severe clinical presentations; slight cardiac structural abnormalities;Coronary stenosis", "NSTE-ACS": "non-ST-elevation", "UA": "hs-cTn levels are normal\uff0cNormal ECG", "NSTEMI": "The peak hs-cTn exceeded the 99th percentile of the normal control value; Elevated levels of cardiac biomarkers, especially troponin T or I ", "STEMI-ACS": "ST-elevation; ECG Wide and deep Q waves;T-wave inversion hs-cTn increases at 3-4 hours and peaks at 11-12 hours;Elevated levels of cardiac biomarkers, especially troponin T or I"}}

Diagnosis_flowchart/Adrenal Insufficiency.json

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+{"diagnostic": {"Suspected Adrenal Insufficiency": {"Primary Adrenal Insufficiency": [], "Secondary Adrenal Insufficiency": [], "Congenital Adrenal Hyperplasia": []}}, "knowledge": {"Suspected Adrenal Insufficiency": {"Risk Factors": "Autoimmune diseases; Genetic predisposition; Infections (e.g., tuberculosis, HIV); Adrenal hemorrhage; Anticoagulant therapy; Chronic use of glucocorticoids or other immunosuppressive drugs; Certain medications that affect adrenal function; etc.", "Symptoms": "Fatigue; Muscle weakness; Weight loss; Gastrointestinal symptoms (nausea, vomiting, diarrhea); Low blood sugar; Hyperpigmentation (in primary adrenal insufficiency); Various abnormal manifestations of skin;Changes in serum potassium levels; Salt craving; Dizziness or fainting upon standing; Low blood sugar levels; etc.", "Signs": "Hyperpigmentation (especially in creases of skin, on scars, or gums, in primary adrenal insufficiency); Low blood pressure; especially when standing (orthostatic hypotension); Dehydration; Abdominal tenderness; Electrolyte imbalances (hyponatremia, hyperkalemia); Rapid heart rate; etc."}, "Primary Adrenal Insufficiency": "1. Often there are high ACTH levels because the adrenal glands do not respond to ACTH \n 2. Both PAI and SAI may present with hyporesponsiveness, but in PAI cortisol does not increase even when ACTH is given because the adrenal glands are damaged \n 3. In PAI, imaging studies may show structural abnormalities in the adrenal glands.\n 4. May be associated with significant electrolyte imbalances such as hyponatremia and hyperkalemia \n 5. Aldosterone is usually not involved, so hyperkalemia is unlikely \n 6 have Addison's disease. \n", "Secondary Adrenal Insufficiency": "1. ACTH levels are low or normal because the problem originates from the pituitary gland or hypothalamus, which does not secrete ACTH adequately.\n 2. Cortisol increases when ACTH is given \n 3 For SAI, an MRI or CT scan may be needed to evaluate the structure of the pituitary gland and hypothalamus .\n", "Congenital Adrenal Hyperplasia": "1.Hormone measurements in blood and urine, specifically 17 hydroxyprogesterone (17-OHP), cortisol, androgens, and aldosterone. 2.Patients with CAH often present with abnormally elevated 17-OHP levels. 3.ACTH stimulation test: Measures changes in 17-OHP levels before and after ACTH (adrenocorticotropic hormone) injection to evaluate adrenocortical function.4. Genetic testing can confirm the diagnosis of CAH and identify the specific type of enzyme defect, the most common being 21-hydroxylase deficiency.\n"}}

Diagnosis_flowchart/Alzheimer.json

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+{"diagnostic": {"Suspected Alzheimer": {"Alzheimer": []}}, "knowledge": {"Suspected Alzheimer": {"Risk Factors": "Age; genetic factors; gender; cardiovascular health; head trauma; intellectual activity; lifestyle and diet; other diseases such as diabetes, depression, and sleep disorders.; etc.", "Symptoms": "Cognitive decline, including memory loss and deterioration of other functions; impairment in at least two cognitive areas; progressive decline in memory and cognition without loss of consciousness; typically occurs between ages 40 and 90, with higher frequency after 65; absence of other systemic or brain diseases to explain the decline; specific cognitive functions may deteriorate, such as language, motor skills, and perception; difficulty in daily activities and changes in behavior; family history of similar disorders, especially if confirmed by neuropathology; additional symptoms may include depression, insomnia, incontinence, delusions, hallucinations, outbursts, sexual disorders, and weight loss; some patients may exhibit neurological abnormalities like increased muscle tone, myoclonus, or gait disturbances; seizures may occur in advanced stages.  ; etc."}, "Alzheimer": "1. Clinical Assessment\n    Detailed medical history and neuropsychological tests: Evaluate the patient's cognitive functions, including memory, attention, language abilities, executive functions, and visuospatial skills.\n    Neuropsychological assessment tools: Such as the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).\n2. Imaging Studies\n    Magnetic Resonance Imaging (MRI): Used to check for structural changes in the brain, particularly atrophy in the hippocampus and other memory-related areas.\n    Positron Emission Tomography (PET):\n        FDG-PET: Assesses brain metabolic activity; patients with Alzheimer's disease typically show reduced glucose metabolism in the temporal-parietal lobes.\n        Amyloid PET: Detects amyloid-beta deposits in the brain, a significant biomarker of Alzheimer's disease.\n3. Cerebrospinal Fluid (CSF) Biomarkers\n    Amyloid-beta 42 (A\u03b242): In patients with Alzheimer's, the level of A\u03b242 in the CSF is typically reduced.\n    Total tau and phosphorylated tau proteins: Levels of these markers are usually elevated in the CSF of patients with Alzheimer's.\n4. Genetic Testing\n    APOE \u03b54 allele: This is one of the most significant genetic markers known to be associated with an increased risk of Alzheimer's disease.\n"}}

Diagnosis_flowchart/Aortic Dissection.json

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+{"diagnostic": {"Suspected Aortic Dissection": {"Type A Aortic Dissection": [], "Type B Aortic Dissection": []}}, "knowledge": {"Suspected Aortic Dissection": {"Risk Factors": "Hypertension, Atherosclerosis, Family history, High cholesterol, Smoking, Inherited connective tissue disorders, Previous cardiac surgery, Pregnancy; etc.", "Symptoms": "Intense chest or upper back pain, Sudden severe abdominal pain, Loss of consciousness, Shortness of breath, Weakness or paralysis, Weak pulse in one arm or thigh, Leg pain, Difficulty speaking or loss of vision; etc."}, "Type A Aortic Dissection": "CT, MRI, TEE checking\nType A: Dissection affecting the ascending aorta and possibly extending into the descending aorta\n", "Type B Aortic Dissection": "CT, MRI, TEE checking\nType B: Dissection limited to descending aorta\n"}}

Diagnosis_flowchart/Asthma.json

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+{"diagnostic": {"Suspected Asthma": {"Asthma": {"Severe Asthma": [], "Allergic Asthma": [], "Non-Allergic Asthma": [], "Cough-Variant Asthma": [], "Asthma-COPD": []}}}, "knowledge": {"Suspected Asthma": {"Risk Factors": "Allergies; family history of asthma or allergies; occupational exposures; smoking or exposure to secondhand smoke; air pollution; frequent respiratory infections; etc.", "Symptoms": "Recurrent episodes of wheezing; breathlessness; chest tightness; blood-tinged sputum and coughing; particularly at night or early morning; Sometimes accompanied by hypertension.;etc.", "Signs": "Observable signs during a physical examination might include wheezing on auscultation, especially after exercise or during an acute episode;after giving medicine, patient still has different breathe sound; etc."}, "Asthma": "Spirometry: A significant improvement in FEV1 (Forced Expiratory Volume in 1 second) of more than 12% and 200 ml from baseline after administration of a bronchodilator confirms the reversibility of airflow obstruction.\nFractional Exhaled Nitric Oxide (FeNO): Elevated levels indicate eosinophilic inflammation, supporting the diagnosis of asthma.\nPeak Expiratory Flow Variability: Monitoring over time can show variability in lung function, supporting an asthma diagnosis.\nHyperreactivity tests :An abnormal result in non-specific bronchial hyperreactivity tests (e.g., methacholine challenge test) may also lead to a strong suspicion of asthma.\n", "Severe Asthma": "doesn't respond well to conventional treatments needs stronger treatments;family history can also increase the probability;  acute attack regularly and severe; persistent flow limitation, even after giving enough bronchodilators; often accompanied with obesity or anxiety and depression", "Allergic Asthma": "Triggered by allergens such as pollen, dust mites, or pet dander, etc.", "Non-Allergic Asthma": "Triggered by factors not related to allergies, like stress, exercise, illnesses, or cold air, etc.", "Cough-Variant Asthma": "long-lasting dry cough that is not accompanied by other typical asthma symptoms such as wheezing or difficulty breathing; diurnal variation of peak expiratory flow>20%; often accompanied by a marked irritating cough at night; bronchodilators are effective", "Asthma-COPD": "Features of both asthma and chronic obstructive pulmonary disease (COPD), with symptoms and airflow limitation that aren't fully reversible;lasting airflow limitation; the elder has obvious symptoms"}}

Diagnosis_flowchart/Atrial Fibrillation.json

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+{"diagnostic": {"Suspected Atrial Fibrillation": {"Paroxysmal Atrial Fibrillation": [], "Persistent Atrial Fibrillation": []}}, "knowledge": {"Suspected Atrial Fibrillation": {"Risk Factors": "High blood pressure, Hyperthyroidism, Obesity, Diabetes, Smoking and alcohol consumption, Sleep apnea, Family history, Age, Gender; etc.", "Symptoms": "Palpitations or a feeling that the heart is beating too fast, Fatigue, Shortness of breath, especially during activity, Dizziness or a feeling of fainting, Chest pain, Decreased ability to exercise, Irritability or anxiety, Insomnia; etc."}, "Paroxysmal Atrial Fibrillation": "ECG: Episodes of AF that terminate spontaneously, usually within 7 days, most often within 24 hours. During an episode, the ECG shows absence of P waves, replaced by irregular atrial activity, and irregular R-R intervals\n", "Persistent Atrial Fibrillation": "ECG: AF episodes that last more than 7 days. The ECG features are similar, showing no P waves, irregular atrial activity, and irregular R-R intervals.\n"}}

Diagnosis_flowchart/COPD.json

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+{"diagnostic": {"Suspected COPD": {"COPD": {"Mild COPD": [], "Moderate COPD": [], "Severe COPD": [], "Very Severe COPD": []}}}, "knowledge": {"Suspected COPD": {"Risk Factors": "Long-term exposure to harmful particles or gases (tobacco smoke, occupational dust and chemicals, air pollution) / Genetic predisposition (e.g., alpha-1 antitrypsin deficiency); etc.", "Symptoms": ": Chronic cough, Sputum production, Dyspnea, especially during physical activities, Frequent respiratory infections; etc.", "Signs": "Wheezing\u3001Chest tightness\u3001Prolonged expiratory phase\u3001Decreased breath sounds\u3001Cyanosis (in advanced stages)\u3001Use of accessory muscles for breathing.; etc."}, "COPD": "Post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation.", "Mild COPD": "FEV1 \u2265 80% predicted", "Moderate COPD": "50% \u2264 FEV1 < 80% predicted", "Severe COPD": "30% \u2264 FEV1 < 50% predicted", "Very Severe COPD": "FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic respiratory failure"}}

Diagnosis_flowchart/Cardiomyopathy.json

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+{"diagnostic": {"Suspected Cardiomyopathy": {"Dilated Cardiomyopathy": [], "Hypertrophic Cardiomyopathy": [], "Restrictive Cardiomyopathy": [], "Arrhythmogenic Right Ventricular Cardiomyopathy": []}}, "knowledge": {"Suspected Cardiomyopathy": {"Risk Factors": "Genetic predisposition, Long-standing high blood pressure, Viral infections, Alcohol and toxins, Metabolic disorders and nutritional deficiencie; etc.", "Symptoms": "Fatigue and weakness, Shortness of breath, Swelling of the legs and ankles, Arrhythmias, Chest pain; etc."}, "Dilated Cardiomyopathy": "Echocardiogram: Demonstrates enlargement of the left ventricle or both ventricles and reduced contractile function. Specific values include increased Left Ventricular End-Diastolic Diameter (LVEDD) and a Left Ventricular Ejection Fraction (LVEF) below the normal range (<50%).\nECG: May reveal signs of abnormal rhythms or ventricular enlargement.\nMRI: Can further assess cardiac structure and function, confirming ventricular volume enlargement and myocardial mass increase.\nCardiac catheterization and endomyocardial biopsy: In certain cases, these may be necessary to determine the heart's pressures and pumping efficiency and to directly examine the heart muscle tissue.\n", "Hypertrophic Cardiomyopathy": "Echocardiogram: Increased thickness of the myocardial wall (typically >15mm) without any other cardiac disease that could explain the thickening.\nMRI: Used for a detailed assessment of myocardial thickness and to detect areas of hypertrophy that might not be visible on an echocardiogram\n", "Restrictive Cardiomyopathy": "Echocardiogram: Shows normal or nearly normal ventricular sizes and wall thickness but abnormal ventricular filling and mitral inflow patterns indicative of restrictive filling.\nMRI: Helps assess cardiac structure, particularly for any fibrosis or calcification of the myocardium and pericardium.\nCardiac catheterization: Measures intracardiac pressures, showing elevated pressures during mitral inflow, consistent with a typical restrictive filling pattern.\n", "Arrhythmogenic Right Ventricular Cardiomyopathy": "Echocardiogram: May reveal specific arrhythmias, T-wave inversions in right ventricular leads, and epsilon waves on the ECG\nECG: Shows enlargement and dysfunction of the right ventricle.\nMRI: Visualizes fatty infiltration and/or scarring of the right ventricle.\nCardiac Biopsy: In some cases, can diagnose by detecting fat and fibrous tissue changes in the myocardium.\n"}}

Diagnosis_flowchart/Diabetes.json

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+{"diagnostic": {"Suspected Diabetes": {"Diabetes": {"Type I Diabetes": [], "Type II Diabetes": [], "Specific Types of Diabetes": [], "Gestational Diabetes Mellitus": []}}}, "knowledge": {"Suspected Diabetes": {"Risk Factors": "family history of diabetes; obesity or overweight; physical inactivity; high blood pressure; abnormal cholesterol levels; history of gestational diabetes; polycystic ovary syndrome; age greater than 45 years; certain racial or ethnic backgrounds; etc.", "Symptoms": "increased thirst; frequent urination; unexplained weight loss; increased hunger; blurry vision; numbness or tingling in the feet or hands; sores that do not heal; extreme fatigue; etc.", "Signs": "high fasting plasma glucose levels; elevated 2-hour plasma glucose levels during an oral glucose tolerance test; high A1C levels; presence of ketones in urine; rapid weight loss; acanthosis nigricans; etc."}, "Diabetes": "The definitive diagnosis of diabetes hinges on meeting one of the following criteria: a fasting plasma glucose (FPG) level of \u2265126 mg/dL; a 2-hour glucose value of \u2265200 mg/dL during an OGTT, or a random plasma glucose of \u2265200 mg/dL in the presence of classic symptoms of hyperglycemia or hyperglycemic crisis.", "Type I Diabetes": "Type 1 diabetes often involves an autoimmune process, so the following autoimmune markers can be used to aid diagnosis: anti-islet cell antibodies (ICA) ;anti-glutamate decarboxylase antibodies (GADA); anti-insulin antibodies (IAA) ;anti-tyrosine phosphatase-related Antibodies (IA-2A);These antibodies are positive in most patients with type 1 diabetes but are usually absent in patients with type 2 diabetes. ", "Type II Diabetes": "Type 2 diabetes is often associated with insulin resistance and may involve testing for  Insulin levels and C-peptide levels: The diagnosis of type II diabetes should be determined according to the curve shape of the values of C-peptide release test and insulin release test in different states,for example,fasting,30min,60min,120min,180min. Able-bodied person:fasting basic plasma insulin is 5-20mlU/L,OGTT reached the peak value after 10min,and insulin returns to the basic level after 180 min;fasting C-peptide level was 1.1-4.4ng/ml,the secretion reached the peak which reaches 5-6 times of the basic value. Pre-diabetic patients:often in early stage type II diabetes, insulin levels may be normal or high. Classic type II diabetes:fasting insulin levels are normal or  above the  normal range.the peak is delayed after oral glucose,may reach the peak at 120min,but did not fall to the normal levels at 180min;fasting C-peptide level can be normal,high or low,the release curve rises slowly after taking sugar,the peak is delayed,and the release curve still does not fall back to the fasting level after 180 min. C-peptide testing can help evaluate the function of pancreatic beta cells and their ability to produce insulin.", "Specific Types of Diabetes": "Due to other conditions", "Gestational Diabetes Mellitus": "Diagnosed during pregnancy through glucose testing strategies that may include the OGTT"}}

Diagnosis_flowchart/Epilepsy.json

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+{"diagnostic": {"Suspected Epilepsy": {"Non-epileptic Seizure": [], "Epilepsy": []}}, "knowledge": {"Suspected Epilepsy": {"Risk Factors": "fever, mental or physical stress, certain medications, excessive alcohol or caffeine intake. Brain Malformations, Genetic Abnormalities: Such as intracranial structural abnormalities, genetic neurodevelopmental disorders. Metabolic Abnormalities: Such as electrolyte imbalances, hypoglycemia. Central Nervous System Infections: Meningitis, encephalitis; etc.", "Symptoms": "Patients with epilepsy may experience seizures that vary in frequency from several weeks to several months apart. Some may have seizures more likely to occur under specific conditions, such as lack of sleep, high stress, or exposure to intense light.; etc.", "Signs": "Before, mood changes, unusual sensations (such as strange tastes or sounds), fear, or gastrointestinal discomfort. During a Seizure: Symptoms can include loss of consciousness, muscle twitching, involuntary movements, cessation of activity, staring, chewing, or fumbling movements. After a Seizure (Postictal Symptoms): Post-seizure confusion, fatigue, headache, muscle pain, or memory loss are common., etc."}, "Non-epileptic Seizure": "Maybe related to specific situations, such as emotional stress or psychological trauma, without prodromal symptoms\nEEG shows normal or no typical epileptic discharges\n", "Epilepsy": "EEG typical epileptiform discharges, such as spikes and slow waves, may be recorded;\nVideo EEG-recorded epileptiform discharges, matching clinical seizure symptoms;\nImaging Studies:\n    MRI: Preferred imaging modality for its ability to reveal subtle structural abnormalities such as cavernomas, cerebellar hypoplasia, or heterotopia, which could underlie epilepsy.\t\n    CT Scan: Often used in emergency settings for rapid identification of large-scale abnormalities like tumors, hemorrhage, or significant brain atrophy, particularly when an MRI is not immediately available.\n"}}

Diagnosis_flowchart/Gastro-oesophageal Reflux Disease.json

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+{"diagnostic": {"Suspected Gastro-oesophageal Reflux Disease": {"Gastro-oesophageal Reflux Disease": []}}, "knowledge": {"Suspected Gastro-oesophageal Reflux Disease": {"Risk Factors": "obesity; dietary habits such as eating fatty or spicy foods, chocolate, and coffee; smoking; excessive alcohol consumption; pregnancy; certain medications such as calcium channel blockers, sedatives, and antidepressants; aging; delayed gastric emptying; body posture, like bending over or lying down right after eating; esophageal disorders such as esophageal stricture or motility disorders.; etc.", "Symptoms": "Typical: heartburn, oesophageal chest pain and regurgitation.atypical symptoms: belching, chronic cough, wheezing hoarseness, globus, nausea, abdominal pain and other dyspeptic symptoms; etc."}, "Gastro-oesophageal Reflux Disease": "conclusive evidence for gastro- esophageal reflux disease(off therapy): \nEndoscopy (endoscopy should be performed 2\u20134 weeks after discontinuation of antisecretory therapy ): LA grades B, C and D oesophagitis, biopsy proven Barrett\u2019s oesophagus and peptic stricture are conclusive for a diagnosis of GERD.\nAmbulatory reflux monitor (pH or pH-impendance):AET>6% on at least 2 days of wireless pH monitoring or total AET>6% on pH-impedance monitoring  (Total reflux episodes >80/day and baseline impedance of <1500 ohms  are adjunctive evidence).\nEsophageal Manometry\n  Lower Esophageal Sphincter (LES) Resting Pressure: Normal values: 10-45 mmHg\n  Lower Esophageal Sphincter Relaxation Pressure: During swallowing, the LES should relax completely, approaching the intrathoracic pressure.\n  Esophageal Body Peristaltic Wave Amplitude: Normal values: 30-180 mmHg\n  Esophageal Peristaltic Wave Propagation Speed: Normal values: 2-4 cm/s\n  Complete Peristaltic Waves: Normally, more than 70% of swallowing actions should induce effective peristaltic waves.\n"}}

Diagnosis_flowchart/Heart Failure.json

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+{"diagnostic": {"Suspected Heart Failure": {"Strongly Suspected Heart Failure": {"Heart Failure": {"HFrEF": [], "HFmrEF": [], "HFpEF": []}}}}, "knowledge": {"Suspected Heart Failure": {"Risk Factors": "CAD, Hypertension, Valve disease, Arrhythmias, CMPs, Congenital heart disease, Infective, Drug-induced, Infiltrative, Storage disorders, Endomyocardial disease, Pericardial disease, Metabolic, Neuromuscular disease; etc.", "Symptoms": "Typical: Breathlessness, Orthopnoea, Paroxysmal nocturnal dyspnoea, Reduced exercise tolerance, Fatigue, tiredness, increased time to recover after exercise, Ankle swelling. Less typical: Nocturnal cough, Wheezing, Bloated feeling, Loss of appetite, Confusion (especially in the elderly), Depression, Palpitation, Dizziness, Syncope.; etc.", "Signs": "More specific: Elevated jugular venous pressure, Hepatojugular reflux, Third heart sound (gallop rhythm), Laterally displaced apical impulse. Less specific: Weight gain (>2 kg/week), Weight loss (in advanced HF), Tissue wasting (cachexia), Cardiac murmur, Peripheral edema (ankle, sacral, scrotal), Pulmonary crepitations, Pleural effusion, Tachycardia, Irregular pulse, Tachypnoea, Cheyne-Stokes respiration, Hepatomegaly, Ascites, Cold extremities, Oliguria,  Narrow pulse pressure."}, "Strongly Suspected Heart Failure": "NT-proBNP \u2265 125 pg/mLor BNP \u2265 35 pg/mL\n", "Heart Failure": "Abnormal findings from echocardiography\uff1aLV mass index\u226595 g/m2 (Female), \u2265 115 g/m2 (Male), Relative wall thickness >0.42, LA volume index>34 mL/m2, E/e\u2019 ratio at rest >9, PA systolic pressure >35 mmHg, TR velocity at rest >2.8 m/s, etc.", "HFrEF": "LVEF\u226440%", "HFmrEF": "LVEF41\u201349%", "HFpEF": "LVEF\u226550%"}}

Diagnosis_flowchart/Hyperlipidemia.json

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+{"diagnostic": {"Suspected Hyperlipidemia": {"Hyperlipidemia": []}}, "knowledge": {"Suspected Hyperlipidemia": {"Risk Factors": "Genetics, Diet, Physical inactivity, Weight, Smoking, Age and gender, Alcohol, medical conditions: Including diabetes, hypertension, kidney diseases, and some liver diseases, can be linked to hyperlipidemia, Certain medications: Including some contraceptives, diuretics, \u03b2-blockers, and steroids, can affect blood lipid levels; etc.", "Symptoms": "Xanthomas, Xanthelasmas, Corneal arcus; etc."}, "Hyperlipidemia": "Total Cholesterol\n    Borderline high: 200-239 mg/dL\n    High: 240 mg/dL and above\nLDL Cholesterol (Low-Density Lipoprotein Cholesterol)\n    Borderline high: 130-159 mg/dL\n    High: 160-189 mg/dL\n    Very high: 190 mg/dL and above\nHDL Cholesterol (High-Density Lipoprotein Cholesterol)\n    Low: Less than 40 mg/dL for men and less than 50 mg/dL for women \n    High: 60 mg/dL and above\nTriglycerides\n    Borderline high: 150-199 mg/dL\n    High: 200-499 mg/dL\n    Very high: 500 mg/dL and above\n"}}

Diagnosis_flowchart/Hypertension.json

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+{"diagnostic": {"Suspected Hypertension": {"Hypertension": []}}, "knowledge": {"Suspected Hypertension": {"Risk Factors": "Age, Family history, Race, Being overweight or obese, Unhealthy diet, Lack of physical activity, Smoking and drinking alcohol, Stress, Chronic conditions, Sleep disorders; etc.", "Symptoms": "Headaches, Dizziness or light-headedness, Blurred vision or other visual disturbances, Chest pain, Shortness of breath, Rapid or irregular heartbeat, Tinnitus, Nosebleeds; etc."}, "Hypertension": "an elevation of BP (SBP\u2265140mmHg or DBP\u226590mmHg) confirmed by at least two to three visits is the diagnostic criteria of hypertension\n"}}

Diagnosis_flowchart/Migraine.json

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+{"diagnostic": {"Suspected Migraine": {"Migraine Without Aura": [], "Migraine With Aura": []}}, "knowledge": {"Suspected Epilepsy": {"Risk Factors": "Genetic predispositions, environmental triggers (such as stress, certain foods or drinks, hormonal changes, changes in sleep patterns; etc.", "Symptoms": "headache on one side, pulsating pain, Moderate to severe pain intensity, nausea or vomiting, Sensitivity to light, sound or smell; etc."}, "Migraine Without Aura": "Headache attacks often begin suddenly, with no apparent warning period. \nA: At least 5 attacks.\nB: Each attack lasts from 2 to 72 hours.\nC: The attack has two or more of the following characteristics:\n     Unilateral pain\n     pain of pulsating nature\n     Moderate or severe pain intensity\n     Physical activity (such as walking up and down stairs) can worsen pain\nD: accompanied by at least one of the following symptoms during the attack:\n     Nausea and/or vomiting\n     Sensitivity to light, sound, or smells (photophobia, soundphobia, or odorphobia\n", "Migraine With Aura": "Headache attacks are preceded by a specific set of symptoms of neurological dysfunction. The aura usually lasts from 5 to 60 minutes and is immediately followed or overlapped by a headache attack. These include visual abnormalities (such as flashes of light, loss of visual field), sensory abnormalities (such as tingling or numbness in the hands and feet), and speech or language impairment. In rare cases, aura may include movement disorders.\n"}}

Diagnosis_flowchart/Multiple Sclerosis.json

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+{"diagnostic": {"Suspected Multiple Sclerosis": {"Multiple Sclerosis": {"Relapsing-Remitting Multiple Sclerosis": [], "Primary Progressive Multiple Sclerosis": [], "Secondary Progressive Multiple Sclerosis": [], "Benign Multiple Sclerosis": []}}}, "knowledge": {"Suspected Multiple Sclerosis": {"Risk Factors": "Gender and age: MS is more common in women than men, with the onset usually occurring between the ages of 15 and 50. Location of the lesion: The signs and symptoms of MS depend on the location of the lesion in the central nervous system. Genetic and environmental factors: Although not specifically mentioned in the literature, it is generally believed that genetic and environmental factors (such as viral infections, smoking, vitamin D deficiency) may play a role in the pathogenesis of MS.; etc.", "Symptoms": "Inflammation, demyelination, and axonal damage. Vision loss: usually in one eye and may be painful. Double vision or blurred vision. Lhermitte phenomenon: An electric shock-like sensation when the neck is tilted forward. Motor or sensory impairment: In the central nervous system distribution area.\n; etc."}, "Multiple Sclerosis": "MRI: MRI is one of the most important tools for diagnosing MS, showing areas of damage (called lesions or plaques) in the brain and spinal cord. MRI can detect damage to myelin, a key feature of MS.\nCSF Analysis: A sample of cerebrospinal fluid is obtained through a lumbar puncture (spinal tap) and analyzed for the presence of immune system activity, which is common in people with MS. CSF analysis may show abnormal immunoglobulin G (IgG) levels and oligoclonal bands, which are hallmarks of MS.    \nVisual Evoked Potentials, VEPs: In people with MS, visual pathways may have conduction delays due to damage to myelin sheaths\n             ", "Relapsing-Remitting Multiple Sclerosis": "Clinical Presentation: At least two clinical attacks, each with symptoms indicating involvement of different central nervous system (CNS) areas. The condition has distinct attacks (relapses) and remission periods. During an attack, symptoms suddenly worsen, followed by a remission phase in which symptoms partially or completely subside and the condition remains stable without significant progression.\nMRI:Presence of at least two distinct lesions in different CNS locations consistent with demyelination. Utilization of weighted imaging and contrast enhancement to demonstrate the presence and evolution of new and old lesions.\nCerebrospinal Fluid (CSF):Detection of oligoclonal bands (OCB) or elevated IgG index (value above 0.7).", "Primary Progressive Multiple Sclerosis": "Clinical Presentation: Disease progression from onset without distinct relapses.\nDisease Duration: Progression for at least 1 year.\nMRI:Presence of at least two T2-weighted lesions in the brain and/or spinal cord.\nCerebrospinal Fluid (CSF):Detection of oligoclonal bands or elevated IgG index (value above 0.7).", "Secondary Progressive Multiple Sclerosis": "Clinical Presentation: Initially presents as RRMS, later transitioning to sustained worsening of disease with or without new relapses.\nDisease Duration: Progression to SPMS at least 3 years after RRMS diagnosis.\nMRI:Continued increase in the number of CNS lesions.\nCerebrospinal Fluid (CSF):Confirmation of persistent oligoclonal bands or elevated IgG index.", "Benign Multiple Sclerosis": " Clinical Presentation: After 10 years, maintains good function with minimal disability (EDSS score \u2264 3).\nLong-Term Observation: Approximately 55% of patients maintain low disability status over the next 10 years.\nMRI:May show fewer CNS lesions, with slow lesion progression.\n"}}

Diagnosis_flowchart/Peptic Ulcer Disease.json

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+{"diagnostic": {"Suspected Peptic Ulcer Disease": {"Gastric Ulcers": [], "Duodenal Ulcers": []}}, "knowledge": {"Suspected Peptic Ulcer Disease": {"Risk Factors": "H. pylori Infection; (Nonsteroidal antiinflammatory drugs) NSAIDs Usage; Other  Co-administration of corticosteroids and bisphosphonates with NSAIDs; Neoplasms :gastrinoma, gastric adenocarcinoma, carcinoid syndrome; Other Factors: smoking, age, chronic medical conditions, genetic factors, stress and psychological factors and diet.; etc.", "Symptoms": "exhibit signs is epigastric pain; potentially accompanied by dyspepsia; Pain after meals, weight loss; bloating; abdominal fullness or discomfort; nausea; acid reflux; heratburn;belching,anorexia and early satiety.; etc."}, "Gastric Ulcers": "Upper Endoscopy: Typically located on the lesser curvature of the stomach, especially in the antrum and body of the stomach; May be accompanied by thickening of the stomach wall, and redness or swelling of the mucosa.\n;H. pylori Testing: Urea breath testing, stool antigen testing, rapid urease testing, or histology.\n", "Duodenal Ulcers": "Upper Endoscopy: Most commonly found in the duodenal bulb, the initial part of the duodenum. Duodenal ulcers usually appear round or oval with clearer edges, and the center sometimes shows white scar tissue; Common accompanying features include congestion and swelling of the nearby duodenal mucosa. Less commonly, perforation or bleeding may occur.\nH. ;pylori Testing: Urea breath testing, stool antigen testing, rapid urease testing, or histology.\n"}}

Diagnosis_flowchart/Pituitary Disease.json

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+{"diagnostic": {"Suspected Pituitary Disease": {"Pituitary Microadenomas": [], "Pituitary Macroadenomas": [], "Pituitary  Silent Adenomas ": []}}, "knowledge": {"Suspected Pituitary Disease": {"Risk Factors": "family history; Genetic syndromes (MEN1, MEN4, McCune-Albright syndrome; Carney complex; Familial Isolated Pituitary Adenoma); Age (30s-40s); Ethnic background (Ashkenazi Jewish descent); Sex (women more likely for certain adenomas); etc.", "Symptoms": "Typical: Headaches, Vision problems (blurred vision, double vision, loss of peripheral vision); Unexplained weight changes; Fatigue; Changes in menstrual cycle or sexual function; Increased growth in hands and feet (acromegaly); \n                                          High blood pressure; High or low blood sugar levels; Mood changes. Less typical: Facial numbness or pain; Dizziness; Loss of consciousness; Unexplained lactation; Feeling cold; Erectile dysfunction in men; Growth of breast tissue in men; Decreased interest in sex; etc.", "Signs": "Visual field defects; Features of hormonal excess (e.g., acromegaly signs, Cushingoid appearance); Pituitary apoplexy symptoms (sudden headache, vomiting, visual changes, possibly coma); etc."}, "Pituitary Microadenomas": "Pituitary adenomas that are less than 1 centimeter (10 millimeters) in size are called microadenomas. ; The gold standard diagnosis is through magnetic resonance imaging (MRI), which can accurately show the size and location of adenomas. ", "Pituitary Macroadenomas": "Pituitary adenomas that are 1 cm or larger in size are called macroadenomas. In addition to MRI, giant adenomas may also cause symptoms through their compression of surrounding structures, such as vision problems, in which case visual field testing is also required.", "Pituitary  Silent Adenomas ": "Nonfunctioning adenomas are pituitary adenomas that do not produce physiologically active levels of hormone, and they do not cause the clinical symptoms associated with hormone excess. Often discovered incidentally during MRI examinations, they are so-called incidentalomas"}}

Diagnosis_flowchart/Pneumonia.json

@@ -0,0 +1 @@
+{"diagnostic": {"Suspected Pneumonia": {"Pneumonia": {"Bacterial Pneumonia": [], "Viral Pneumonia": []}}}, "knowledge": {"Suspected Pneumonia": {"Risk Factors": "Exposure to pathogens (e.g., in community, hospitals, or through travel); Smoking and chronic lung diseases (COPD, asthma);OSA; Immunosuppressive conditions (HIV/AIDS, use of immunosuppressive drugs); Elderly age; Comorbidities (diabetes, heart disease); etc.", "Symptoms": "Typical: Cough (dry or productive of sputum), fever, chills, dyspnea (shortness of breath), Less typical: Chest pain, headache, fatigue, myalgia (muscle pain).; etc.", "Signs": "More specific: Crackles and/or wheezing on lung auscultation, tachypnea (increased respiratory rate), fever, cyanosis (bluish skin color due to lack of oxygen). Less specific: Hypotension, tachycardia (increased heart rate), altered mental status in severe cases.; etc."}, "Pneumonia": "Radiological examination: Chest X-rays or CT scans are the most commonly used methods and can show areas of inflammation in the lungs. On X-ray or CT images, inflammation appears as localized shadows or infiltrative lesions.\nMicrobiological tests: Identification of the causative pathogen can be confirmed through microbial cultures and PCR tests of body fluids such as sputum, blood, or bronchoalveolar lavage fluid.\nComplete blood count (CBC): An increased white blood cell count in the CBC is commonly associated with infection but is not a specific indicator.\nBlood gas analysis: For patients with severe pneumonia, blood gas analysis can help assess oxygenation and acid-base balance.\nC-reactive protein and other inflammatory markers: Levels of these markers typically rise during infections, but they also lack specificity.\n", "Bacterial Pneumonia": "Detection of specific bacteria by PCR or other molecular biology methods. Or suppuration caused by bacteria", "Viral Pneumonia": "PCR technology detects the genetic material of a specific virus"}}

Diagnosis_flowchart/Pulmonary Embolism.json

@@ -0,0 +1 @@
+{"diagnostic": {"Suspected Pulmonary Embolism": {"Pulmonary Embolism": {"Massive PE": [], "Submassive PE": [], "Low-risk PE": []}}}, "knowledge": {"Suspected Pulmonary Embolism": {"Risk Factors": "HTN; Previous VTE; Immobility or recent surgery; Cancer; Thrombophilia; Hormonal therapy (e.g., oral contraceptives or hormone replacement therapy); Pregnancy and the postpartum period; Obesity; Smoking; Long travel history.; etc.", "Symptoms": "Sudden onset of dyspnea; Chest pain (sharp and worsened with deep breaths); Hemoptysis; Syncope or dizziness; Tachypnea; Tachycardia; etc.", "Signs": "Tachypnea (rapid breathing); Tachycardia (rapid heart rate); Hypoxia (low oxygen levels in the blood); Cyanosis (blueish coloration of the skin and lips); Fever; Signs of deep vein thrombosis (DVT), such as swelling, redness, or pain in the leg.; etc."}, "Pulmonary Embolism": "Multi-slice spiral CT (CTPA): directly displays thrombus in the pulmonary artery.\nD-dimer test: This is a blood test in which high levels of D-dimer may indicate blood clots, but low levels can be used to rule out pulmonary embolism. Normal values for D-dimer should be lower, using age \u00d7 10 \u03bcg/L as the threshold\nEchocardiography: Assess right ventricular function and hemodynamics, especially important in high-risk patients. \n    Right ventricular dimensions: An enlarged right ventricle (RV) appears as increased width in cross-sectional long-axis view. Tricuspid annular plane \n    systolic excursion (TAPSE): If TAPSE is less than 16 mm, it indicates reduced RV function. \n    Tricuspid annular peak systolic velocity (S'): If the peak systolic velocity of the tricuspid annulus is less than 9.5 cm/sec, it may indicate RV insufficiency. \n    RV/LV diameter ratio: In the emergency setting, an RV to left ventricular (LV) diameter ratio greater than 1.0 can be used as an indicator of RV dysfunction. \n    RV wall thickness: During acute right ventricular pressure overload, echocardiography may detect increased RV wall thickness or tricuspid regurgitation ejection flow velocity exceeding 3.8 m/s or tricuspid peak systolic pressure gradient exceeding 60 mmHg.\nLower extremity venous ultrasound: Checks for the presence of deep vein thrombosis in the lower extremities, which may dislodge and become a pulmonary embolism.\nV/Q lung scan: compares the ventilation (V) and perfusion (Q) of the lungs to detect abnormal areas, which may indicate the presence of blood clots.\n", "Massive PE": "The patient develops hemodynamic instability, such as sustained hypotension, shock, or cardiac arrest. These patients are high-risk PE and require immediate thrombolytic treatment or surgical intervention.", "Submassive PE": "The patient is hemodynamically stable, but there is evidence of RV functional impairment, such as RV enlargement or ventricular septal deviation on echocardiography, and elevated blood biomarkers (such as cardiac troponin). These patients are intermediate-risk PE and require hospitalization and close monitoring to detect potential hemodynamic instability promptly.", "Low-risk PE": "The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels. A low Pulmonary Embolism Severity Index (PESI) or simplified PESI (sPESI) score indicates a low risk of death."}}

Diagnosis_flowchart/Stroke.json

@@ -0,0 +1 @@
+{"diagnostic": {"Suspected Stroke": {"Ischemic Stroke": [], "Hemorrhagic Stroke": []}}, "knowledge": {"Suspected Stroke": {"Risk Factors": "hypertension, diabetes, cardiac history, smoking, hyperlipidemia, family history, atrial fibrillation, sedentary lifestyle, obesity, alcohol abuse, previous stroke or transient ischemic attack (TIA), high cholesterol, poor diet, age, gender, race, and certain medical conditions like sickle cell disease; etc.", "Symptoms": "sudden numbness or weakness in the face, arm, or leg, especially on one side of the body, confusion, trouble speaking or understanding speech, visual disturbances in one or both eyes, difficulty walking, dizziness, loss of balance or coordination, severe headache with no known cause; etc.", "Signs": "facial drooping, arm weakness, speech difficulties, vision problems, severe headache, dizziness or loss of balance, confusion, difficulty walking, numbness or paralysis on one side of the body, sudden behavioral change, and loss of consciousness"}, "Ischemic Stroke": "MRI Scan (especially the DWI sequence):\n    Positive DWI: Indicates ischemic damage to brain tissue at the time of scanning. On DWI, ischemic areas appear as high signal (bright white).\n    ADC Images: Accompanying DWI, this sequence shows low signal (dark areas) representing restricted movement of water molecules, characteristic of early ischemia.\nCT Scan:\n    Early ischemic changes: Within hours of an ischemic stroke, subtle loss of cerebral cortex and narrowing of brain sulci, referred to as \"sulcal effacement\", may be observed.\n    Low-density areas: Low-density areas in the brain parenchyma indicating ischemic tissue.\nCarotid and Intracranial Vessel Imaging:\n    Ultrasound: Carotid intima-media thickness \u22651.0 mm or visible plaque.\n    CTA/MRA: Demonstrating arterial stenosis of \u226550%.\n", "Hemorrhagic Stroke": "Non-contrast CT Scan:\n    High-density areas: Typical manifestation of hemorrhagic stroke on CT is a high-density area representing fresh bleeding. The density usually ranges from 50-80 Hounsfield Units (HU).\n    Hemorrhage volume: The volume and location of the bleed correlate closely with clinical manifestations; larger volumes generally have a poorer prognosis.\nMRI Scan:\n    T1 and T2 Weighted Imaging: Hemorrhage shows different signals on T1 and T2 sequences depending on the age of the bleed. Fresh bleeding may appear isointense or hypointense on T1 and hyperintense on T2.\n    Gradient Echo Sequence (GRE): Especially sensitive to blood breakdown products, such as deoxyhemoglobin and iron, used for detecting microbleeds.\nCerebral Angiography:\n    Detection of vascular abnormalities: Aneurysms, vascular malformations, or stenoses. Diagnosis of an aneurysm typically requires visualization of a typical \"saccular\" dilation.\n"}}

Diagnosis_flowchart/Thyroid Disease.json

@@ -0,0 +1 @@
+{"diagnostic": {"Suspected Thyroid Disease": {"Hypothyroidism": [], "Hyperthyroidism": [], "Thyroiditis": [], "Thyroid Nodules": {"Thyroid Cancer": []}}}, "knowledge": {"Suspected Thyroid Disease": {"Risk Factors": "Gender and Age; Both iodine deficiency and excess; Presence of thyroid autoantibodies ; Exposure to radiation; Family history of thyroid disease; Pregnancy itself alters thyroid function; Smoking; Certain Medications, e.g., Lithium, Amiodarone, Interferons, Rifampin, PTU, MMI, SSRIs", "Symptoms": "Hypothyroidism: Fatigue and sluggishness; Increased sensitivity to cold; Constipation; Dry skin and hair; Weight gain; Puffy face; Hoarseness; Muscle weakness; Elevated blood cholesterol level; Muscle aches, tenderness, and stiffness; Pain, stiffness, or swelling in your joints; Heavier than normal or irregular menstrual periods; Thinning hair; Slowed heart rate; Depression; Impaired memory; bradycardia; decrease in basal body temperature\n                                                        Hyperthyroidism: Sudden weight loss; Rapid heartbeat; Irregular heartbeat; Pounding of your heart; Increased appetite; Nervousness, anxiety, and irritability; Tremor \u2014 usually a fine trembling in your hands and fingers; Sweating; Changes in menstrual patterns; Increased sensitivity to heat; Changes in bowel patterns, especially more frequent bowel movements; An enlarged thyroid gland ; Fatigue, muscle weakness; Difficulty sleeping; Shortness of breath; Eye swelling and increased tearing\n                                                        Thyroiditis: Enlargement of the thyroid gland"}, "Hypothyroidism": {"Criteria": "TSH > 4.0-4.5 mIU/L ; Free T4 (FT4) below the normal range (0.9-1.7 ng/dL); FT3<2.0 pg/ml; T3<80 ng/dL; T4<5.0 ng/dL"}, "Hyperthyroidism": {"Criteria": "Low  TSH (<0.1 mIU/L) ; high levels of T4 (> 12.0 ng/dL) ;Triiodothyronine (T3) (> 180 ng/dL); FT4> 1.7 pg/ml; FT3 > 4.4 pg/ml"}, "Thyroiditis": {"Criteria": "Thyroid function tests and thyroid antibody tests (such as anti-thyroid peroxidase antibodies, TPOAb); ultrasound shows thyroid size and shape may appear enlarged or morphologically altered; Changes in Echogenicity  showing areas of hypoechoicity, indicating tissue heterogeneity; ultrasound imaging may show increased or abnormal blood flow; ultrasound  find thyroid tissue may display structural heterogeneity"}, "Thyroid Nodules": {"Criteria": "Thyroid ultrasound is the preferred method for evaluating thyroid nodules, which can help determine the nature of the nodules (likelihood of benign vs. malignant);\n\nEchogenicity\uff1a\n    Hypoechoic: The nodule appears darkerthan the surrounding thyroid tissue, which may suggest malignancy.\n    Isoechoic or Hyperechoic: The nodule appears similar to or brighter than surrounding tissue, usually indicating benignity.\n\nMargins:\n    Irregular margins: May indicate malignancy. \n    Smooth and well-defined margins: Typically indicate a benign nodule.\n\nShape:\n    Taller-than-wide: Nodules that are taller than they are wide (vertical to the skin) may be malignant.\n    Wider-than-tall: Nodules that are wider than they are tall (horizontal to the skin) are usually benign.\n\nMicrocalcifications:\n    Small calcium deposits within a nodule may suggest malignancy.\n\nBlood flow pattern:\n    Using Doppler ultrasound, increased abnormal blood flow may be associated with malignant nodules. \n\nFor suspicious nodules, fine-needle aspiration biopsy (FNA) is crucial for definitive diagnosis."}, "Thyroid Cancer": {"Criteria": " If FNA results suggest cancer or are suspicious for cancer, surgery, and further histopathological evaluation are usually necessary. Sufficient sample size is needed to make a diagnosis."}}}

Diagnosis_flowchart/Tuberculosis.json

@@ -0,0 +1 @@
+{"diagnostic": {"Suspected Tuberculosis": {"LTBI": [], "Tuberculosis": []}}, "knowledge": {"Suspected Tuberculosis": {"Risk Factors": ": Close contact with someone with infectious TB\u3001HIV infection; Areas with high TB prevalence (geographical risk factors);Immunosuppression (e.g., corticosteroid use, organ transplant); Previous history of TB or inadequately treated TB; Socioeconomic factors: homelessness, incarceration\u3001Substance abuse: tobacco smoking, drug use\u3001Health care workers with exposure to TB.; etc.", "Symptoms": "Typical: Persistent cough for more than three weeks; coughing up blood; chest pain; fever; night sweats; weight loss; fatigue. Less typical: Shortness of breath; lymphadenopathy; anorexia; etc.", "Signs": "More specific: Evidence of weight loss; fever; signs of pleural effusion on physical examination Less specific: Lymphadenopathy; signs of comorbid conditions (e.g., HIV infection signs).; etc."}, "LTBI": "Interferon-gamma release test (IGRA): This is a blood test that can detect whether there is an immune response to Mycobacterium tuberculosis in the body. It is not affected by BCG vaccination, so it is especially suitable in areas where BCG has been vaccinated.    \nTuberculin test (TST): Inject a certain amount of purified protein derivative (PPD) into the skin and observe the reaction of the skin 48 to 72 hours later to determine whether the patient is infected with Mycobacterium tuberculosis. Results need to be judged based on the size of the induration, usually 5 mm or larger is considered a positive reaction, but this also depends on the individual's specific circumstances such as HIV infection or recent exposure to a case of tuberculosis.\n", "Tuberculosis": "Sputum smear microscopy: This is a rapid test that uses a microscope to examine sputum samples for tuberculosis bacteria. Although simple and low-cost, it is less sensitive. \nSputum culture: This is the gold standard for diagnosing tuberculosis. The sputum sample is cultured in a specific medium to see if Mycobacterium tuberculosis is growing. Culture can provide information about resistance but takes a long time (usually weeks to months). \nMolecular biology detection methods: such as PCR technology, which can quickly detect the genetic material of Mycobacterium tuberculosis with high sensitivity and specificity, and is especially suitable for patients with negative sputum smear. \nChest X-ray: Chest X-ray is a commonly used screening tool for patients suspected of having active pulmonary tuberculosis, which can reveal abnormalities in the lungs, such as patchy shadows, cavities, etc.\n"}}

Diagnosis_flowchart/Upper Gastrointestinal Bleeding.json

@@ -0,0 +1 @@
+{"diagnostic": {"Suspected Upper Gastrointestinal Bleeding": {"Upper Gastrointestinal Bleeding": []}}, "knowledge": {"Suspected Upper Gastrointestinal Bleeding": {"Risk Factors": "peptic ulcers; prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs); Helicobacter pylori infection; esophageal varices; alcohol abuse; tumors; anticoagulant medications; stress ulcers; esophagitis or gastritis.; etc.", "Symptoms": "hematemesis (vomiting of red blood or coffee-grounds material); melena (black, tarry stool), or hematochezia (passage of red or maroon material per rec-tum); anemia; Hemorrhagic peripheral circulatory collapse(dizziness, palpitations, fatigue, fainting when standing up suddenly from a flat position, cold sensation of the limbs, increased heart rate, and low blood pressure);fever;zaotemia.; etc."}, "Upper Gastrointestinal Bleeding": "Bleeding outside the digestive tract was excluded: Melena caused by eating and bleeding from the respiratory tract mouth, nose, and throat were excluded.\nGastroscopy: Bleeding is observed or has stopped\n"}}

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

@@ -0,0 +1,69 @@
+{
+    "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"
+}