\tikzsetnextfilename{Pathogenese-des-VHF}

    \begin{tikzpicture}[node distance=2cm]
    
    \node (extfac) [important, text width=4.5cm] {\textbf{extrakardiale Faktoren}
    \begin{itemize}[noitemsep,nolistsep,leftmargin=6mm]
      \item Hypertension
      \item Übergewicht
      \item Schlafapnoe
      \item Hyperthyreose
      \item Alkohol/Drogen
    \end{itemize}};
    \node (atrstrabn) [important, right of=extfac, xshift=4.25cm, yshift=-2.5cm, text width=6cm] {\textbf{atriale Strukturabnormitäten}
    \begin{itemize}[noitemsep,nolistsep,leftmargin=6mm]
      \item Fibrose
      \item Dilatation
      \item Ischämie
      \item Infiltration
      \item Hypertrophie
    \end{itemize}};
    \node (infoxistr) [more, right of=atrstrabn, xshift=3.5cm, text width=2.cm] {Entzündung und oxi\-da\-ti\-ver Stress};
    
    \node (karfac) [important, below of=extfac, yshift=-2.5cm, text width=4cm] {\textbf{kardiale Faktoren}
    \begin{itemize}[noitemsep,nolistsep,leftmargin=6mm]
      \item Herzinfarkt
      \item rheumatische Herzerkrankungen
      \item Myokarditis
      \item Herzklappener-krankungen
    \end{itemize}};
    
    \node (atrtacrem) [more, below of=karfac, yshift=-3cm, text width=2.5cm] {Ta\-chy\-kar\-die-be\-ding\-tes at\-ri\-a\-les Re\-mo\-del\-ling};
    \node (raasakt) [more, below of=infoxistr, yshift=-2.5cm, text width=2.5cm] {Aktivierung des Renin-Angiotensin-Aldosteron-Systems};
    \node (vorflim) [target, below of=atrstrabn, yshift=-2.5cm, text width=3cm] {\textbf{\gls{vhf}}};
    
    \node (genvar) [important, below of=atrtacrem, yshift=-2cm, text width=4cm] {\textbf{genetische Varianten}
    \begin{itemize}[noitemsep,nolistsep,leftmargin=6mm]
      \item Ionenkanalerkran-kungen
      \item Kardiomyopathie
      \item Herzfehler
    \end{itemize}};
    \node (atreleabn) [important, below of=atrstrabn, yshift=-7cm, text width=6.5cm] {\textbf{atriale elektrische Abnormitäten}
    \begin{itemize}[noitemsep,nolistsep,leftmargin=6mm]
      \item erhöhte Heterogenität
      \item verlangsamte Leitung
      \item Verkürzung des Aktionspotentials
      \item erhöhte Automatie
      \item abnormales intrazelluläres Ca\textsuperscript{2+}-Handling
    \end{itemize}};
    \node (ansa) [more, below of=raasakt, yshift=-2.5cm, text width=2.5cm] {Aktivierung des ve\-ge\-ta\-ti\-ven Nervensystems};
    
    \draw [arrow] (extfac) -- (atrstrabn);
    
    \draw [arrow] (karfac) -- (atrstrabn);
    
    \draw [arrow] (infoxistr) -- (atrstrabn);
    
    \draw [arrow] (atrtacrem) -- (atrstrabn);
    \draw [arrow] (atrtacrem) -- (atreleabn);
    
    \draw [arrow] (raasakt) -- (atrstrabn);
    \draw [arrow] (raasakt) -- (atreleabn);
    
    \draw [arrow] (genvar) -- (atrstrabn);
    \draw [arrow] (genvar) -- (atreleabn);
    
    \draw [arrow] (ansa) -- (atreleabn);
    
    \draw [arrow] (atrstrabn) -- (vorflim);
    \draw [arrow] (atreleabn) -- (vorflim);
    
    \end{tikzpicture}