COMMON CARDIOVASCULAR DISEASES – PROGRESSIVE CLINICAL PRESENTATION
1. Coronary Artery Disease → Angina → Myocardial Infarction
Stage 1: Early Atherosclerosis (No symptoms)
- No complaints
- Fatigue on heavy exertion
- Mild breathlessness
Stage 2: Stable Angina
- Chest tightness with exertion
- Relieved by rest
- Radiation to arm/jaw
- Mild sweating
Stage 3: Worsening (Crescendo) Angina
- Pain with less exertion
- More frequent episodes
- Temporary relief with nitrates
Stage 4: Unstable Angina
- Pain at rest
- Severe squeezing pressure
- Pre-infarction stage
Stage 5: Myocardial Infarction
- Severe crushing pain
- Not relieved by rest/nitrates
- Profuse sweating
- Breathlessness
- Shock in extensive MI
2. Heart Failure (LHF → RHF → CHF)
Stage 1: Early Left-Sided Failure
- Exertional dyspnea
- Fatigue
- Orthopnea
- Palpitations
Stage 2: Pulmonary Congestion
- PND (sudden night breathlessness)
- Pink frothy sputum
- Tachycardia
- Cold extremities
Stage 3: Right-Sided Failure
- Pedal edema
- Hepatomegaly
- Right hypochondriac pain
- Distended neck veins
Stage 4: Congestive Heart Failure
- Ascites
- Anasarca
- Cyanosis
- Low urine output
- Confusion, drowsiness (brain hypoperfusion)
3. Hypertension (Primary) – Silent → Complicated
Stage 1: Early
- Usually asymptomatic
- Occasional headache
- Mild fatigue
Stage 2: Progressive
- Early morning headache
- Palpitations
- Dizziness
- Blurred vision
Stage 3: Target Organ Damage
- Retinopathy → visual changes
- LVH → exertional breathlessness
- CKD → nocturia, swelling
- TIA → transient weakness
Stage 4: Hypertensive Crisis
- Severe headache
- Vomiting
- Seizures
- Chest pain
- Acute pulmonary edema
- Stroke symptoms
4. Rheumatic Heart Disease (Post-RF → Valve Damage)
Stage 1: Post-Strep Infection
- Fever
- Throat infection history
- Migratory joint pains
Stage 2: Acute Rheumatic Carditis
- Tachycardia
- Chest discomfort
- New murmurs
- Breathlessness
Stage 3: Chronic Mitral Valve Disease
Mitral Stenosis
- Progressive dyspnea
- Palpitations (AF)
- Hemoptysis
- Malar flush
Mitral Regurgitation
- Fatigue
- Dyspnea
- Palpitations
- Pansystolic murmur
Stage 4: Advanced RHD
- Congestive heart failure
- Edema
- Ascites
- Thromboembolism
5. Aortic Aneurysm & Dissection
Stage 1: Silent Aneurysm
- Usually asymptomatic
- Mild back discomfort
- Pulsatile abdominal mass (AAA)
Stage 2: Expanding Aneurysm
- Constant deep back pain
- Abdominal bloating
- Early satiety
- Leg pain (nerve compression)
Stage 3: Aortic Dissection – Sudden
- Tearing, ripping chest/back pain
- Radiation between shoulder blades
- Unequal arm BP
- Syncope
Stage 4: Rupture
- Severe pain
- Shock
- Collapse
- High mortality
6. Atrial Fibrillation (AF)
Stage 1: Paroxysmal AF
- Occasional palpitations
- Mild shortness of breath
- Anxiety
- Irregular heartbeat sensation
Stage 2: Persistent AF
- Palpitations more frequent
- Fatigue
- Exertional dyspnea
- Mild ankle swelling
Stage 3: Chronic AF
- Irregularly irregular pulse
- Reduced exercise capacity
- Dizziness
Stage 4: Complications
- Stroke (clots form in left atrium)
- Heart failure
- Syncope
7. Peripheral Arterial Disease (PAD)
Stage 1: Early
- Leg fatigue on walking
- Foot coldness
- Mild numbness
Stage 2: Intermittent Claudication
- Calf pain after walking fixed distance
- Relieved by rest
- Weak dorsalis pedis pulse
Stage 3: Rest Pain
- Pain even at rest
- Worse at night
- Relieved by hanging leg down
Stage 4: Critical Limb Ischemia
- Ulcers
- Black discoloration
- Gangrene
- Limb-threatening stage
8. Deep Vein Thrombosis (DVT)
Stage 1: Early
- Mild calf discomfort
- Tightness in leg
Stage 2: Progressive
- Unilateral leg swelling
- Warmth and redness
- Tender calf
- Homan’s sign +
Stage 3: Severe
- Severe swelling
- Severe pain
- Cyanosis of limb
Stage 4: Complication
- Pulmonary embolism → sudden dyspnea, chest pain, syncope
9. Infective Endocarditis
Stage 1: Early
- Low-grade fever
- Fatigue
- Joint pains
Stage 2: Progressive
- High spiking fever
- Sweating
- New/changed murmur
- Weight loss
Stage 3: Embolic Phenomena
- Splinter hemorrhages
- Osler nodes
- Janeway lesions
- Petechiae
Stage 4: Severe
- Heart failure
- Stroke (emboli)
- Renal failure
- Septic shock
10. Pericarditis → Pericardial Effusion → Tamponade
Stage 1: Acute Pericarditis
- Sharp chest pain
- Worse lying down
- Relieved by sitting forward
- Pericardial friction rub
Stage 2: Effusion Formation
- Reduced chest pain
- Dyspnea
- Feeling of chest heaviness
- Distant heart sounds
Stage 3: Cardiac Tamponade
- Severe breathlessness
- Hypotension
- Tachycardia
- Raised JVP
- Pulsus paradoxus
- Shock
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