Myocardial ischemia and infarction Definition and clinical concept Myocardial infarction with non obstructive coronary arteries (MINOCA) describes a clinical presentation in which the patient has…

Procedurer Spirometry is the only investigation that distinguishes obstructive from restrictive impairment of lung function, and COPD cannot be diagnosed without it . The quality of…

…Objective evidence of myocardial ischaemia. Absence of obstructive coronary artery disease, defined as no stenosis exceeding 50% diameter reduction and/or an FFR 0.80…

…mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac arrest with suspected pulmonary embolism. Urgent bedside echocardiography, looking for right…

…to suspected chronic coronary syndrome, is evaluated by estimating the likelihood of obstructive coronary artery disease (CAD) before diagnostic testing. This pre test probability is…

…months and attributable to established reversible myocardial ischaemia in either of two settings: Obstructive coronary artery disease (CAD) that cannot be controlled despite escalation of…

…is titrated slowly. Caution in acute heart failure and in obstructive airways disease Verapamil or diltiazem When a beta blocker is contraindicated, for example in…

…ScvO₂ : : : : : : : : : Hypovolaemic ↓ ↑ ↓ ↓ Cardiogenic ↓ ↑ ↑ ↓ Distributive (septic) ↑ or normal ↓↓ ↓ or normal ↑ or normal Obstructive (tamponade…

…EMG about 95 %). Contraindications Known hypersensitivity to edrophonium. Mechanical obstruction of the bowel or the urinary tract. Marked bradycardia, sick sinus syndrome or high grade…

…the first second FVC Forced vital capacity FEV₁/FVC The ratio that defines obstruction PEF Peak expiratory flow — variability rather than the absolute value TLC…

…failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus (an opioid can be given for the pain, but the effect on the…

…risk of fluid retention and impaired kidney function). Patients with bronchial asthma, chronic obstructive pulmonary disease, hay fever, or nasal polyps (increased risk of hypersensitivity…

…Peripheral Vascular Disease (PVD) : Indicates systemic atherosclerosis. Chronic Obstructive Pulmonary Disease (COPD) : Associated with higher perioperative risk. Clinical Applications Personalized Decision Making : SYNTAX Score II…

…and cost. The pathophysiological substrate of angina may differ between patients. Myocardial ischaemia may result predominantly from obstructive epicardial coronary disease, coronary vasospasm, microvascular dysfunction…

…Thus, the presence of non obstructive epicardial arteries does not exclude a coronary cause of symptoms. CCS is a clinical syndrome rather than a permanently…

…physiological context. Definition and Pathophysiology Coronary artery disease and obstructive stenosis Anatomically significant epicardial CAD is conventionally defined as stenosis of at least 70%, while…

…no previous diagnosis of CAD, and a low clinical likelihood of obstructive disease when good image quality is expected. It is also an alternative to…

…those achieved during testing. Exercise ECG has become less prominent as a primary diagnostic test for obstructive coronary artery disease (CAD), because coronary computed tomography…

…mechanism of an acute coronary syndrome (ACS), particularly when angiography shows no significant obstructive disease or when the culprit lesion is uncertain. In these settings…

…Non obstructive coronary atherosclerosis not associated with demonstrable ischaemia may therefore remain undetected unless CT based coronary calcium assessment or another anatomical technique is added…

…smoking, diet, physical inactivity, and alcohol consumption. Additional considerations include psychosocial stress, obstructive sleep apnoea, social determinants of health, air pollution, family history, ethnicity, and…

…ST segment elevation caused by spasm. The absence of obstructive disease generally indicates a more favourable course than VA accompanied by severe fixed lesions. Nevertheless…

…to moderate exacerbation of asthma symptoms. Adenosine should be used with caution in patients with obstructive lung disease or asthma. Irregular wide complex tachycardia (absolute…

…2), obesity, smoking, obstructive sleep apnea and chronic obstructive pulmonary disease (COPD). Moreover, certain other tachyarrhythmias predispose to developing atrial fibrillation: atrial flutter, AVNRT and…

…Deasy et al ). A complete airway obstruction results in PEA and cardiac arrest within 8 minutes. Cardiac arrest as a result of asphyxia or hypoxia…

…This type of cardiomyopathy is characterized by pronounced hypertrophy of the myocardium. It may also lead to obstruction of the LVOT (Hypertrophic Obstructive Cardiomyopathy, HOCM)…

…also present in individuals without identifiable cardiac disease. Contributing factors include pulmonary disorders, particularly obstructive pulmonary disease, the use of theophylline, and elevated catecholamine states…

…heart disease), heart failure , cardiomyopathy (dilated cardiomyopathy, hypertrophic obstructive cardiomyopathy), valvular disease . Less common causes are arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/ARVD), Brugada syndrome…

…a rising pCO₂ and respiratory acidosis, or a markedly increased work of breathing with impending exhaustion. Threatened airway obstruction: inhalation injury, anaphylaxis, deep neck infection…

…be taken at the next regular time. Use with caution in patients with asthma/chronic obstructive pulmonary disease (COPD). Dyspnea has been reported in patients…

…dissection. PAU is particularly associated with advanced age, smoking, coronary artery disease, chronic obstructive pulmonary disease, renal insufficiency, systemic hypertension, and concomitant abdominal aortic aneurysm…

…increases myocardial oxygen demand, and may worsen ischemia in patients with obstructive coronary disease. It is also the most prevalent antecedent of heart failure—particularly…

…tissues. 15 Recent evidence clarifies that while the benefits in conditions like osteoarthritis and obstructive sleep apnea primarily reflect the extent of weight loss, the…

…angiography alone. It is particularly useful when ACS occurs without significant obstructive CAD or when more than one potential culprit lesion is present. Clinical Indications…

…of very high risk. They require immediate escalation because the priority is to identify and treat an obstructive coronary lesion without avoidable delay. In contrast…

…systemic inflammation. It is also associated with respiratory disorders, notably obstructive sleep apnoea (OSA) and obesity hypoventilation syndrome, which further increase cardiovascular burden. Obesity may…

…or location of inducible ischaemia. It is particularly appropriate when: The pre test likelihood of obstructive CAD is moderate or high, generally greater than 15…

…dissection Physical disability that precludes safe and adequate testing Relative contraindications Known obstructive left main coronary artery stenosis Moderate to severe aortic stenosis with uncertain…

…Moderate to severe aortic stenosis Insufficiently controlled arrhythmias which may cause hemodynamic compromise Obstructive hypertrophic cardiomyopathy Second degree AV block or third degree AV block …

…sleep ( Dickinson et al ). Pronounced sinus bradycardia is frequently associated with hypoxic episodes caused by obstructive sleep apnea. The following bradyarrhythmias are considered normal findings…

…coronary heart disease) Rheumatic valve disease Endocarditis Congenital mitral regurgitation Amyloidosis SLE Hypertrophic obstructive cardiomyopathy (HOCM) Rupture of papillary muscle Rupture of chordae tendineae Figure…

…Only indices that detect microvascular disease as an independent cause of ischemia, including with non obstructive epicardial arteries (ANOCA/INOCA); CFR has independent prognostic value…

…Definition and pathophysiology A chronic total occlusion (CTO) is a complete or nearly complete coronary arterial obstruction that has persisted for at least 30 days…

…In acute PE, obstruction of pulmonary blood flow increases RV pressure load and may impair RV filling and forward output. The resulting syndrome may progress…

…limiting epicardial coronary stenosis. It is therefore a disorder of coronary microvascular perfusion rather than persistent obstruction of the treated epicardial segment. The phenomenon occurs…

…disease, left sided cardiac disease, chronic lung disease or hypoxia, chronic thromboembolic obstruction, or a range of miscellaneous conditions. Because several mechanisms may coexist, diagnosis…

…myocardial territory through the left anterior descending (LAD) and left circumflex (LCx) arteries (Figure 1). Acute obstruction can lead to rapid hemodynamic deterioration, cardiogenic shock…

…both the cause and the severity [1]. Three questions must be answered immediately: 1. Is there obstruction to urine flow? 2. Is the patient hypovolaemic…

…severe aortic stenosis without symptoms Individual assessment Hypertrophic cardiomyopathy with outflow tract obstruction Caution Tachyarrhythmia or bradyarrhythmia Rate control first Blood pressure 200/110 mmHg…

…obesity or a stiff chest wall. Glottic or subglottic obstruction — the mask sits above the obstruction and solves nothing. A mouth opening below about 2…

…Indications Decompression in ileus, subacute obstruction or gastric retention — the commonest indication on a surgical ward. Decompression in severe vomiting where the stomach does not…

…exercise. The risk of ventricular arrhythmias correlates with the degree of hypertrophy, the extent of ventricular fibrosis, LVOT obstruction, age, and left ventricular function. The…

…recognition, specialist assessment and restoration of perfusion are essential. The abrupt arterial obstruction may result from progression of peripheral arterial disease, cardiac or aortic embolisation…

…coronary calcification. CAC therefore functions primarily as an imaging biomarker of coronary atherosclerotic burden rather than as a direct measure of luminal obstruction. Calcified plaque…

…a modest, dose dependent reduction in triglycerides. The benefit of statins extends beyond angiographic reduction of coronary obstruction. Intensive lipid lowering improves endothelial function, lowers…

…Mechanisms include: Coronary dissection with obstruction of the true lumen Occlusion of a major epicardial artery or bypass graft Side branch occlusion or thrombus Disruption…

…as no reflow, structural and functional impairments sustain vascular obstruction. Endothelial dysfunction triggers leukocyte and platelet activation, while thrombotic debris may worsen the obstruction. Furthermore…

…myocardial infarction as the final diagnosis. The underlying process usually involves acute thrombotic obstruction of an epicardial coronary artery. A vulnerable atherosclerotic plaque and thrombogenic…

…therefore be considered throughout assessment. Coronary disease is most commonly related to atheromatous plaque producing progressive narrowing or obstruction of epicardial coronary arteries. Endothelial dysfunction…