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Coronary Artery Disease

(CAD): Considerations in
the Elderly
• Cardiovascular (CV) disease is the most frequent
diagnosis in elderly people and it is the leading
cause of death in both men and women older than
65 years of age
• Cardiovascular disease in the elderly usually is
associated with other medical conditions. Given
that 80% of people over 65 years old have at least
one chronic medical condition, and half have at
least two.
Aging and CAD
• Interactions between age, disease, and lifestyle
• Whether the high prevalence of CAD is due to an
aging process or whether these disorders merely
occur more frequently in elderly persons because
of a longer exposure to risk is not yet established.
• It is reasonable to ascertain, however, that the
capabilities of the cardiovascular system gradually
decline with age.
Aging and CAD
Aging is associated to:
• The walls of the arteries and arterioles become
thicker, and the Elastic tissue within the walls of the
arteries and arterioles is lost  increased arterial
stiffness and increased pulse pressure.
• increase in fibrinogen, coagulation factors, platelet
activity, endothelial dysfunction potentiate the
development of atherosclerosis.
Aging and CAD
Source : http://circres.ahajournals.org/content/110/8/1097
Clinical manifestation in elderly
• After the age of 80, a minority of patients complain of
chest pain.
• Symptoms like angina are less frequent
• Ischaemia is more likely to be silent and pain
description differs from the classic substernal pressure.
• Symptoms may be described primarily as dyspnea,
shoulder or back pain, weakness, fatigue or epigastric
• Some patients describe symptoms with effort, but
others may not, because of limited physical activity,
mental impairment or altered manifestations of pain
caused by diabetes or age changes.
Considerations when prescribing
medications in older patients
• The metabolism of many drugs is reduced
• Renal drug clearance is also compromised with
increasing age. The decline in renal function affects
the drug used.
Considerations when prescribing
medications in older patients
• Knowledge of collateral effects of cardiovascular
medications, specially hypotension, bradicardia
• Knowledge of non cardiac medications its effects and drug
interaction with cardiovascular drugs.
• Loading doses should be reduced.
• Body surface area should be used to estimate dose (loading
and maintenance).
• Estimate glomerular filtration to guide dosing of
• Consider lower doses with hepatically cleared drugs.
• Time between dosages should be adjusted.
• Assess adequate financial coverage.
Physical exercise in elderly with
• A sedentary lifestyle is a risk factor for CAD 
overweight or obese  risk developing CAD.
• Patient goals for physical activity should begin with 10
to 15 minutes a day and gradually work up to a goal of
30 minutes a day of moderate to vigorous exercise, 5-6
• Moderate exercise e.g: brisk walking, light cycling
• The level of activity should be based on the patient’s
baseline condition and other comorbid diseases.
• Patients should always work with their healthcare
provider prior to starting an exercise program.
Physical exercise in elderly with
• The cardiovascular benefits of exercise include a positive
impact on:
• Lipid metabolism
• Blood pressure
• Insulin sensitivity
• Calories burned (AHA, 2014a; McLaughlin, 2014)
• For patients who are just starting an exercise program, it is
important to start slowly and consult a professional, such as
an exercise physiologist, for assistance in developing a plan
that will work for them.
• For high-risk patients with comorbidities who are
deconditioned or have had recent cardiac events, careful
supervision of physical rehabilitation is recommended.
Referral to a physical therapist to evaluate, plan, and
monitor the patient’s progress with his or her exercise
program is an important consideration.
NNN linkages
Acute pain - Comfort level - Pain management
r/t - Pain control - Medication
Cardiac tissue ischemic, management
inflammation, impaired - Emotional support
circulation - Teaching: individual
NNN linkages
Activity Intolerance - Activity tolerance - Activity management
r/t - Energy management
Insufficient oxygenation - Exercise promotion
for ADLs, cardiac tissue - Sleep enhancement
ischemia, prolonged - Mutual goal settings
immobility, narcotics or
NNN linkages
Risk for decreased cardiac - Cardiac pump - Cardiac care: Acute
tissue perfusion effectiveness - Hemodynamic
- Circulation status regulation
Risk factor: - Tissue perfussion: - Bleeding precautions
DM, coronary artery cardiac - Dysrhythmia
spasm, hyperlipidemia, - Tissue perfussion: management
hypertension, insufficient pepripheral - Cardiac care:
knowledge about risk rehabilitative
NNN linkages
Risk for decreased cardiac - Cardiac Pump - Cardiac care
output Effectiveness - Cardiac precautions
- Circulatory Status - Embolus precautions
Risk factors: - Tissue Perfusion: - Dysrhythmia
hypertension, cardiac management
hyperlipidemia, cigarette - Tissue Perfusion: - Vita signs monitoring
smoking, family history of Peripheral - Shock management:
CAD, obesity, lack of - Vital Signs Status cardiac
knowledge of modifiable
risk factors
NNN linkages
Fear/anxiety (individual, - Anxiety level - Anxiety reduction
family) - Coping - Impulse control
r/t - Impulse control training
Unfamiliar situation, - Anticipatory guidance
unpredictable nature of
condition, fear of death,
negative effects on