…coffee ground vomiting or melaena. Haematochezia can occur in massive upper bleeding with rapid intestinal transit. Coffee ground vomiting is less specific than fresh haematemesis…

Echocardiography Myocardial ischemia and infarction Definition and Pathophysiology Stress echocardiography is a functional cardiac imaging technique used primarily to identify inducible myocardial ischaemia and to…

…Chronic coronary syndromes (CCS) comprise the clinical manifestations of chronic structural and/or functional disease involving the epicardial coronary arteries and/or the coronary microcirculation…

…epicardial lesion rather than its anatomical appearance alone. Coronary angiography provides only an imperfect estimate of functional severity. Angiographic interpretation is affected by interobserver variability…

…failure (HF) is a complex clinical syndrome characterized by symptoms and signs resulting from structural or functional impairment of ventricular filling or ejection of blood…

Conduction defects ECG Left bundle branch block (LBBB) Left bundle branch block (LBBB) results from anatomical or functional impairment of the left bundle branch (LBB)…

…Index Mechanism Advantages Limitations Key evidence Fractional Flow Reserve (FFR) Ratio of distal coronary pressure (Pd) to aortic pressure (Pa) at maximal pharmacologic hyperemia (adenosine…

…defects ECG Right bundle branch block (RBBB) Right bundle branch block (RBBB) is due to an anatomical or functional dysfunction in the right bundle branch…

…biological age, frailty, multimorbidity, cognitive status, functional capacity, orthostatic symptoms, and treatment burden. Although older adults are often defined chronologically, age thresholds are intrinsically arbitrary…

…rehabilitation aims to: Restore and improve functional capacity Reduce disability and rehospitalization Improve quality of life and self efficacy Address modifiable cardiovascular risk factors Support…

…cognition, independence, functional capacity, and quality of life may be equally important therapeutic objectives. Evidence from randomized trials is often less applicable to very frail…

…ostia. It remains the reference standard for defining the extent of coronary artery disease because it provides anatomical information while permitting functional assessment and, when…

…coronary anatomy, myocardial ischaemia, ventricular function and the anticipated benefit–risk balance of revascularization. Coronary angiography remains primarily an anatomical examination, whereas contemporary decision making…

…arteries. Epicardial spasm produces a reversible functional occlusion and usually causes transmural ischaemia. The resulting abnormalities in left ventricular function may lead to myocardial infarction…

…of ≥50%, accompanied by objective evidence of structural and/or functional cardiac abnormalities and/or elevated natriuretic peptides (NPs) [1] [2] . The evolution of HF…

…intraventricular conduction delays (defects), which are caused by functional or anatomical defects in the components of the intraventricular conduction system. Because the conduction system is…

…there is a discrepancy or uncertainty. Intravenous thrombolysis within 4.5 hours improves functional outcome in properly selected patients. Tenecteplase 0.25 mg/kg is…

…question is purely diagnostic and the target heart rate is needed for the test to be conclusive. For assessment of function and prognosis, arrhythmia evaluation…

…outcome TTM2 (2021) 33 °C versus normothermia with active fever prevention (intervention at ≥ 37.8 °C) No difference in 6 month mortality or functional outcome…

…on a central area of block, which encompasses both an anatomical barrier (the inferior vena cava) and a functional component. When the direction of the…

…early disease or after effective treatment. HFrEF is commonly associated with structural and functional ventricular abnormalities and progressive neurohormonal activation. The therapeutic rationale for disease…

…haemodynamic instability or cardiogenic shock. The likelihood of an identifiable IRA. The extent and complexity of coexisting coronary disease. Renal function, bleeding risk, comorbidities, frailty…

…abdominal distension and, in some patients, bendopnea. Congestion may also aggravate functional mitral regurgitation, ventricular dilatation, myocardial wall stress and subendocardial ischemia. Neurohormonal activation and…

…Its principal outputs are: Functional capacity and exercise tolerance Reproduction and characterization of symptoms Heart rate and blood pressure responses to exercise Detection of exercise…

…from a previous value of at least 50%. A patient with persistently mildly reduced systolic function. This dynamic nature makes prior imaging particularly important when…

…fraction (LVEF) ≥50%. Objective evidence of structural or functional cardiac abnormality consistent with left ventricular diastolic dysfunction or increased filling pressures, including raised natriuretic peptides…

…in selected patients, identifying microvascular or vasomotor coronary disorders. The investigation should be undertaken when its diagnostic or therapeutic consequences are likely to outweigh procedural…

…Historically, revascularization was considered capable of improving LV systolic function and prognosis by restoring perfusion to viable dysfunctional myocardium while preventing further ischemic events. However…

…50%. Severe proximal disease of both the proximal left anterior descending and proximal left circumflex arteries may constitute a functional equivalent of left main disease…

…30–50% of men. Microvascular angina (MVA) is myocardial ischaemia caused by structural or functional abnormalities of the coronary microcirculation. These abnormalities may impair coronary…

…tomography (PET) is a radionuclide based method for assessing regional myocardial blood flow, inducible ischaemia, myocardial scar, ventricular function, and, in selected circumstances, myocardial viability…

…arterial disease, heart failure, depression, dementia and osteoporosis. It also improves functional capacity, skeletal health, muscular strength, quality of life and psychological well being. Physical…

…atherosclerosis, endothelial dysfunction, and distinct coronary functional abnormalities may produce ischaemia without an obstructive epicardial lesion. Once conventional anti ischaemic targets have been exhausted, proposed…

…its most severe form, known as no reflow, structural and functional impairments sustain vascular obstruction. Endothelial dysfunction triggers leukocyte and platelet activation, while thrombotic debris…

…termed no reflow, structural and functional microvascular impairment persists despite restoration of epicardial flow. The electrocardiographic appearance depends on several interacting factors: The stage of…

…effects beyond LDL C reduction, including modulation of inflammation, oxidative stress, endothelial function, plaque stability, thrombogenic responses and immune activity. Statin intolerance refers to adverse…

…devoid of CO 2 . Phase II (Rapid Expiration) : Represents the transition of air from anatomical dead space to functional alveolar space. Phase III (Alveolar Plateau…

…fraction (EF) For several decades, ejection fraction (EF) has been the dominating method for assessing left ventricular systolic function. Ejection fraction is simple to calculate…

…parameters that must be evaluated and the final result of the test depends on an integrated assessment of six components: Symptoms Exercise performance (functional capacity…

…energy consumption at rest (sitting). METs may be used to describe the functional capacity during exercise stress testing. Results of treadmill tests are typically described…

…to the posterior and inferior walls of the left ventricle. Anatomical or functional block in the anterior fascicle leads to left anterior fascicular block. Similarly…

…In contrast, modalities like echocardiography and ECG typically identify ischemia at later stages, when functional or electrical alterations are evident. Subjective symptoms (i.e. chest…

…is intensified [1,2]. The evidence that any particular intravenous drug improves mortality or long term functional outcome is limited. A Cochrane review found insufficient…

…factors, ignoring clinical variables such as age, diabetes, and renal function, which significantly impact outcomes. Inconsistent Predictive Value : While effective in PCI treated patients, its…

…and miscellaneous conditions A novel potentially life threatening cardiac arrhythmia syndrome identified with ECG The ECG may be used to diagnose several cardiac genetic disorders…

…chronic coronary syndromes Chronic coronary syndromes (CCS) describe stable period clinical presentations arising from structural or functional abnormalities of the coronary arteries or coronary microcirculation…

…graft; in such cases, clinical manifestations may be less dramatic despite a sudden deterioration in function. The severity of tissue injury depends on the site…

…insufficiency Hypertensive disorders of pregnancy Preeclampsia Preterm delivery Gestational diabetes Small for gestational age delivery Placental abruption Pregnancy loss Polycystic ovary syndrome Functional hypothalamic amenorrhoea…

…compression and a Venturi or “suction” effect have been proposed as mechanisms of inducible ischaemia. The functional impact depends on the bridge’s thickness, length…

…It is particularly useful when the clinical question is whether CAD is present and when an anatomical examination is preferred over an initial functional test…

…Coronary vasomotor disorders may involve epicardial spasm or abnormalities of the coronary microcirculation. Microvascular angina reflects myocardial ischaemia caused by structural or functional microvascular abnormalities…

…adequate end organ perfusion. Dobutamine is a synthetic catecholamine that functions as an agonist of both beta1 and beta2 adrenergic receptors, with variable effects on…

…signature specific to CTOs. Evaluation and physical examination Evaluation should establish: The severity and functional impact of angina or anginal equivalent symptoms. The response to…

…medicine Definition and pathophysiology Peripheral artery disease (PAD) is a clinical disorder caused by stenosis or occlusion of the aorta or arteries supplying the limbs…

…imaging finding; it can refine the decision to test and may identify patients who require preventive therapy even when functional testing is normal. Probability categories…

…or lead dislodgement/fracture. Functional failure to capture occurs when a stimulus is delivered during the myocardial refractory period. A stimulus delivered during the refractory…

…Echocardiography is performed in all patients with suspected CHD. Echocardiography provides detailed morphological and functional information. The vast majority of cases can be characterized by…

…test, exercise stress ECG) Exercise stress testing has been used routinely for over 60 years to evaluate cardiopulmonary function and to diagnose cardiovascular disease. The…

…arrhythmias, and exercise (functional) capacity. Functional capacity is a strong predictor of both cardiovascular and overall mortality, offering incremental prognostic data beyond perfusion imaging and…

Echocardiography Fractional shortening (FS) for estimating systolic function Fractional shortening (FS) is calculated by measuring the percentage change in left ventricular diameter during systole. It…