This ischemia may be secondary to coronary artery disease, or a result of the previously described changes in microvasculature. Ischemia can result in impaired relaxation of the heart; when myocytes fail to relax appropriately, myosin cross bridges remain intact and generate tension throughout diastole and thus increase stress on the heart. This is termed partial persistent systole. Ischemia may manifest in distinct ways, either as a result of increasing tissue oxygen demand, or diminished ability of the heart to supply oxygen to the tissue. The former is the result of stress, such as exercise, while the latter is the result of reduced coronary flow. Aging
Cardiac senescence, or cellular deterioration that occurs as part of normal aging, closely resembles the manifestations of HFpEF. Specifically, loss of cardiac reserve, diminished vascular compliance, and diastolic dysfunction are characteristic of both processes. It has been suggested that HFpEF merely represents an acceleration of a normal aging process. Senile systemic amyloidosis, resulting from accumulation of aggregated wild-type transthyretin as part of the degenerative aging process, is emerging as an important and underdiagnosed contributor to HFpEF with age. Other
Any condition or process that leads to stiffening of the left ventricle can lead to diastolic dysfunction. Other causes of left ventricular stiffening include:
Aortic stenosis of any cause where the ventricular muscle becomes hypertrophied, and thence stiff, as a result of the increased pressure load placed on it by the stenosis. Diabetes
Age – elderly patients mainly if they have hypertension.Causes of isolated right ventricular diastolic failure are uncommon.
In medicine, bilirubinuria is an abnormality in which conjugated bilirubin is detected in the urine.The term "biliuria" is very similar, but more general. It refers to the presence of any bile pigment in the urine. Conjugated bilirubin is detected in urine at bilirubinemia of approximately 30-34 mmol/L or 2 mg/dL. In this concentration of conjugated bilirubin in the blood appears as yellowness of the mucous membranes and sclera. Causes
The most common cause of bilirubinuria is hepatocellular disease. More rare causes include inherited disorders, such as Dubin–Johnson syndrome and Rotor syndrome.Although Gilberts syndrome and Crigler–Najjar syndrome are characterized by increased bilirubin in the serum, the bilirubin in these inherited disorders is not conjugated and thus not excreted in the urine. The increase of stercobilin (urobilin) in the feces and urine is caused by the enhanced intracellular hemolysis of erythrocytes. Formed an unconjugated bilirubin entering the intestine, gives a large number of stercobilinogen (urobilinogen). Last absorbed into the blood and passes into the urine. Diagnosis
in order To properly

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