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Arisman wenge abdul rahman c11108805

HEART DISEASE IN THE ELDERLY


As a person ages, the heart undergoes subtle physiologic changes, even in the absence of
disease, but it can worsen whenever cardiovascular diseases are present. The muscles of the
aged heart may relax less completely between beats; as a result, the pumping chambers
(ventricles) become stiffer and may work less efficiently, especially if specific cardiac
diseases are present.
In old age, the heart also may not pump as vigorously or as effectively as it once did. The
older heart also becomes less responsive to adrenaline and cannot increase the strength or
rate of its contractions during exercise to
the same extent it could in youth. It is
extremely difficult as we get older; the
heart just cant get enough blood out to
muscles to supply them with adequate
oxygen.
The vascular system, too, experiences
gradual changes over the decades. The
walls of the arteries tend to lose their
elasticity and stiffen, even without
internal blockage from fatty deposits
(atherosclerosis). Commonly, this may
lead to a specific kind of high blood
pressure among older people called
isolated systolic hypertension.
Cardiovascular
diseaseincluding
coronary heart disease, hypertension,
heart valve disease, and rhythm disordersbecomes increasingly common with advancing age.
Physiologic changes in the heart and blood vessels make the elderly more prone to certain
types of cardiovascular disease. These include isolated systolic hypertension, orthostatic
hypotension, heart failure, certain valve disorders (particularly of the aortic valve), and
certain rhythm abnormalities, particularly bradycardia or slow rhythms.

References:

1. Article of HEART DISEASE IN THE ELDERLY LAWRENCE H. YOUNG, M.D.


2. USM books, pathomechanism of diseases.
3. Internet, medicine.com

Arisman wenge abdul rahman c11108805

Pathomechanism of cardiovascular disease in elderly:

Blood vessels

heart
Wall less
elastic
Pump blood
out less
efficiently

Muscle
relaxes less
between beat

Less strength
contraction
during
exercise

Wall thicken
Decrease of
resistance

Less
responsive to
stimulation

Drugs HTN

Orthostatic
hypotension

Bone weak

Less supply of:


oxygen
nutrition

muscle

Decrease of
blood flow

Less nutrition
supply to
bone cell

Decrease of CO

brain

Reflex to
maintain BP
upon standing
up slower

Increase
sympathetic
tone

FAL
L

HTN

References:

1. Article of HEART DISEASE IN THE ELDERLY LAWRENCE H. YOUNG, M.D.


2. USM books, pathomechanism of diseases.
3. Internet, medicine.com

Drugs HTN

Arisman wenge abdul rahman c11108805

Unique features of CVD in the elderly


Presentation
AMI

Diagnosis

Treatment

Dyspnea, CHF chest


ECG,serum markers or imaging.
pain,nausea/vomiting,
confusion.

Thrombolysis

Dyspnea, CHF rate


slower than in young.

Apical pulse, ECG

Rate control,
anticoagulation

CAD

Chest discomfort or
dyspnea with
emotion/DOE women
as well as men

TMT test, Nuclear test imaging,


stress echo, smoking sessation,
medicine, PTCA, CABG, lipid
reduction

CHF

Same as young

Diastolic > sistolic

Diuretics,digoxin,+Bblockers/CCB

Htn

Systolic,
asymptomatic

Three readings at > 2 weeks


apart

Diet, exercise, alcohol


withderawal,
medications.

Valvular

Altered physical
findings

Echocardiography

Critical --- surgery.

Atrial
Fibrillation

disease

?Revascularization

Drugs and the elderly


1. Slower metabolism and other physiologic changes in the aging body may cause
drugs to act differently in elderly patients than in younger ones:
High BP medication may produce dizziness and orthostatic hypotension,
especially the vasodilators, diuretics, or some of CCB.
Dizziness from anti-anginal medications (nitroglycerine) is also more common.
Toxicity from digitalis (used in heart failure) may be more common.
References:

1. Article of HEART DISEASE IN THE ELDERLY LAWRENCE H. YOUNG, M.D.


2. USM books, pathomechanism of diseases.
3. Internet, medicine.com

Arisman wenge abdul rahman c11108805

The use of antiocoagulant drugs may result in bleeding more readily and is
dangerous in people who are unsteady and subjects to frequent falls.
B-blockers tend to slow the heart more.
Inravenous lidocaine may cause more confusion.
Anticoagulant is the chief weapon against stroke
2. Treat symptoms with a goal of improving quality of life as well as morbidity :
Control BP ---- systolic and diastolic.
Control atrial fibrillation rate.
Promote physical activity.
Adjust medications for age- and disease- related changes in kinetics and dynamics.
Time between dosage adjustments and evaluation of dosing changes should be
longer in older patients than in younger patients.
Routine use of strategies to avoid drug interactions is essential

The side effects of some medicines can upset your balance and make you fall. Medicines for
depression, sleep problems and high blood pressure often cause falls. Some medicines for
diabetes and heart conditions can also make you unsteady on your feet. You may be more
likely to fall if you are taking four or more medicines. You are also likely to fall if you have
changed your medicine within the past two weeks.

References:

1. Article of HEART DISEASE IN THE ELDERLY LAWRENCE H. YOUNG, M.D.


2. USM books, pathomechanism of diseases.
3. Internet, medicine.com