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CVS - Coggle Diagram

- - - - BP ≥ 140/90
      - daytime average > 135/85
    - - BP > 160/100
      - daytime average > 150/95
    - - BP > 180/120
  - - - ulcers
    - - renal failure
  - - - over 60
    - - younger
  - - - idiopathic
    - - chronic renal disease
      - renal artery stenosis
      - endocrine disease
        
        Cushing's
        
        Conn's
        
        phaeochromocytoma
        
        hyperthyroidism
        
        acromegaly
      - coarctation of aorta
      - sleep apnoea
      - alcohol
      - pregnancy
      - medications
        
        steroids
        
        COCP
      - coarctation of the aorta
      - glomerulonephritis
    - - FH
        
        hereditary defect of smooth muscle lining arterioles
        
        increased reactivity of arterioles
        
        increased peripheral resistance
      - old
      - obesity
      - excess alcohol
      - mental/physical stress
      - low birth weight
      - Afro-Caribbean race
      - excess dietary salt
      - smoking
      - sedentary lifestyle
    - - kidneys can't secrete enough sodium
      - sodium rises
      - BP rises
  - - - referral to specialist
  - - - weight loss
      - exercise
      - reduced alcohol intake
      - reduced salt intake
      - stop smoking
    - - < 80 yrs with one of
        
        end organ damage
        
        pharmacological treatment
        
        more than 55 yrs
        
        of African/Caribbean descent
        
        CCB (vasodilators: amlodipine, felodipine, nifedipine in women of child-bearing age; rate limiting & some vasodilation: verapamil)
        
        CCB contraindications
        
        3 more items...
        
        < 55 yrs
        
        ACEi (ramipril, lisinopril, perindropril) or ARB (losartan, valsartan, candesartan)
        
        add ACEi/ARB or thiazide like diuretic (indapamide)
        
        1 more item...
        
        contraindications for ACEi
        
        5 more items...
        
        type 2 diabetes
        
        prefer ARB 1st line if Afro-caribbean
        
        CV disease
        
        renal disease
        
        DM
        
        10 yr CV risk 10% or more
      - more than 80
        
        same drugs, but BP target of 145/85
- - - - open heart surgery
      - penetrating/blunt force trauma to heart
  - - - muffled heart sounds
      - raised JVP
      - hypotension
    - - raised JVP on inspiration
  - - - electrical alternans
        
        QRS complex alternates appearance
- - - - normal
      - pathology
    - - pathology
        
        partially occluded coronary arteries
        
        subendocardial infarction
    - - elevated
      - pathology
        
        completely occluded coronary artery
        
        transmural infarction
    - - troponin
        
        raised
      - ECG
    - - non-modifiable
        
        male
        
        old age
        
        FH
      - modifiable
        
        smoking
        
        high cholesterol
        
        BG control
    - - retrosternal crushing chest pain/discomfort/pressure
      - present at rest
      - may radiate to neck/jaw/left arm
      - dyspnoea
      - palpitations
      - N&V
      - sympathetic symptoms
        
        pallor
        
        anxiety
        
        sweating
    - - Morphine
      - Oxygen (if SpO2 < 94%)
      - Nitrates (sublingual GTN)
      - Aspirin
        
        and 2nd antiplatelet
        
        prasugrel
        
        ticagrelor
        
        clopidogrel
      - STEMI
        
        symptom onset within 12 hrs & access to PCI within 2 hrs
        
        PCI
        
        thrombolysis
        
        alteplase
    - - cardiac arrest
      - post-MI pericarditis
      - Dressler's syndrome
        
        pathology
        
        autoimmune
        
        presentation
        
        similar to post-MI pericarditis
        
        presents 2–6 wks post-MI
      - heart failure
        
        acute
        
        chronic
      - particularly inferior MI
        
        heart block
        
        arrhythmias
      - mitral regurgitation
        
        pathology
        
        papillary muscle rupture
      - ventricular septal defect
  - - - insufficient blood supply to heart during exercise
    - - exertional pain/discomfort in chest, neck, jaw, shoulders &/or arms
      - symptoms relieved by rest/GTN within 5 minutes
    - - GTN spray PRN
      - beta-blocker
      - CCB (preferably non-dihydropyridine rate limiting, e.g. verapamil, diltiazem)
        
        beta-blocker & dihydropyridine CCB (e.g. amlodipine, nifedipine)
        
        add another medication, or monotherapy if previous meds not tolerated
        
        long acting nitrate (isosorbide mononitrate)
        
        ivabradine
        
        revascularisation
        
        CABG
        
        PCI
        
        nicorandil
        
        ranolazine
- - - - most often aortic stenosis
      - 2nd most often mitral regurgitation
    - - can be a congenital defect
    - - tricuspid regurgitation
  - - - systolic murmur
        
        radiates to carotids
        
        radiates to axilla
    - - mid diastolic
      - heard in 5th ICS LMCL
      - low pitched rumble
        
        heard with bell
      - malar flush
    - - syncope
      - angina
      - dyspnoea
      - crescendo-decrescendo
      - high pitched
        
        heard with diaphragm
      - slow rising pulse
      - narrow pulse pressure
      - ejection systolic
    - - collapsing pulse
      - early diastolic
      - decrescendo
      - lower left sternal edge
      - wide pulse pressure
      - 2nd right ICS, sternal edge
    - - pansystolic
- - - - raised JVP
      - peripheral oedema
      - hepatomegaly
      - ascites
      - fatigue
      - weakness
    - - LHF
      - pulmonary HTN
      - tricuspid stenosis/regurgitation
      - cor pulmonale
        
        COPD
  - - - pulmonary oedema
        
        exertional dyspnoea
        
        orthopnoea
        
        paroxysmal nocturnal dyspnoea (waking up breathless)
        
        cough
        
        pink frothy sputum
        
        bi-basal crackles
      - transudative pleural effusion
      - cardiomegaly
        
        displaced apex beat
      - third heart sound (gallop after S2, heard with bell at apex beat)
      - fatigue
      - weakness
    - - more common than RHF
      - IHD
      - HTN
      - aortic stenosis/regurgitation
      - mitral stenosis/regurgitation
    - - congestive heart failure (CHF)
    - - natriuretic peptide tests
        
        NT-proBNP
        
        elevated
      - ECG
        
        left ventricular hypertrophy
        
        massive QRS complexes (maybe with overlap)
      - echocardiogram
        
        decreased ejection fractions diagnostic
      - CXR
        
        Alveolar oedema
        
        bats' wings opacities
        
        Kerley B lines
        
        lines at 90 degrees to ribs
        
        Cardiomegaly
        
        heart >50% chest width
        
        Dilated upper lobe vessels
        
        pleural Effusion
    - - symptomatic
        
        loop diuretic
        
        furosemide
        
        oral
        
        acute heart failure
        
        IV
        
        fluid restriction
        
        1.5–2L
      - HFrEF (reduced left ventricular EF on echocardiogram)
        
        prognostic
        
        ACEi
        
        ramipril
        
        beta blocker
        
        bisoprolol