💎 Class I

• No limitation of physical activity
• Ordinary physical activity does not cause undue fatigue, palpitation or shortness of breath

💎 Class II

• Slight limitation of physical activity
• Comfortable at rest
• Ordinary physical activity results in fatigue, palpitation, shortness of breath or chest pain.

💎 Class III

• Marked limitation of physical activity
• Comfortable at rest
• Less than ordinary activity causes fatigue, palpitation, shortness of breath or chest pain

💎 Class IV

• Symptoms of heart failure at rest
• Any physical activity causes further discomfort

Examples of ordinary physical activities:

• walking at moderate pace, light housework (e.g. sweeping floors), climbing a few flights of stairs,

Examples of less than ordinary physical activities:

• walking at slower pace, showering

OGDS report of patient X (he was sent back from scope room to the ward): “Forrest 3 clean base ulcer at antrum and fundus…” — What is Forrest 3 ulcer? Is it dangerous?

Forrest I
• Ia: Spurting (rebleed risk without treatment = 85 – 100%)
• Ib: Oozing (rebleed risk without treatment = 10 – 30%)

Forrest II
• IIa: Visible vessel (rebleed risk without treatment = 50 – 60%)
• IIb: Adherent clot (rebleed risk without treatment = 25 – 35%)
• IIc: Pigmented spot (rebleed risk without treatment = <8%)

Forrest III
• III: Clean base (rebleed risk without treatment = <5%)

Killip 1:

• No clinical signs of heart failure

Killip II: Mild heart failure

• Crepitations heard at lower third / less of the lungs
• Elevated JVP
• S3 heart sound

Killip III

• Frank acute pulmonary oedema: crepitations heard more than one-third of the chest

Killip IV Cardiogenic shock + pulmonary oedema

• Hypotension (SBP <90 mmHg)
• Evidence of peripheral vasoconstriction (oliguria, cyanosis, sweating)