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Questions and Answers
What effect does ACE inhibitors have on the body?
What effect does ACE inhibitors have on the body?
Which factor is not typically associated with the development of primary hypertension?
Which factor is not typically associated with the development of primary hypertension?
Which of the following statements is true regarding pulmonary hydrostatic pressures?
Which of the following statements is true regarding pulmonary hydrostatic pressures?
What is the main consequence of increased arterial stiffness with aging?
What is the main consequence of increased arterial stiffness with aging?
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How does heart failure relate to the use of nitrates?
How does heart failure relate to the use of nitrates?
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What structural change occurs in the heart's left ventricular wall as one ages?
What structural change occurs in the heart's left ventricular wall as one ages?
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Which change in heart function is associated with aging?
Which change in heart function is associated with aging?
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What effect does valve calcification have on the heart?
What effect does valve calcification have on the heart?
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What is a consequence of reduced pacemaker cells in the heart's conduction system?
What is a consequence of reduced pacemaker cells in the heart's conduction system?
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What is excitation-contraction coupling?
What is excitation-contraction coupling?
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Which condition contributes to fluid imbalance leading to oedema in heart failure patients?
Which condition contributes to fluid imbalance leading to oedema in heart failure patients?
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What happens to cardiac output in heart failure patients?
What happens to cardiac output in heart failure patients?
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What is the effect of increased collagen and decreased elastin on heart muscle efficiency?
What is the effect of increased collagen and decreased elastin on heart muscle efficiency?
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Which of the following statements about physical changes related to aging is accurate?
Which of the following statements about physical changes related to aging is accurate?
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How does Botox function in the body?
How does Botox function in the body?
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What is a common skin change associated with aging?
What is a common skin change associated with aging?
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Which drug mechanism is associated with minoxidil?
Which drug mechanism is associated with minoxidil?
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What factor can influence the effects and side effects of drugs in aging patients?
What factor can influence the effects and side effects of drugs in aging patients?
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Which of the following is a cosmetic change that often occurs with aging?
Which of the following is a cosmetic change that often occurs with aging?
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Which statement about the relationship between aging and cardiovascular changes is correct?
Which statement about the relationship between aging and cardiovascular changes is correct?
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What is a possible side effect of using Minoxidil?
What is a possible side effect of using Minoxidil?
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Study Notes
Drugs and Aging (Cardiovascular System)
- Physical changes related to aging are not diseases.
- Changes in the body associated with aging are often subtle and not immediately problematic.
- Lifestyle choices (diet, exercise, smoking, alcohol) significantly influence the aging process.
- Drugs' effects and side effects can be impacted by age.
Aging Theories
- Wear-and-tear theory: The body wears out like any other object.
- Cellular theory: Cells are born with a limited capacity for replication.
- Genetic mutation theory: A rise in abnormal cells' characteristics with age.
- Autoimmune theory: A decline in the body's immune system's functioning.
Not All Diseases Increase with Age
- The prevalence of some conditions, like sinusitis and heart disease, increases with age.
- Prevalence of other conditions, like asthma and some cancers, does not necessarily increase as age increases.
Some Cosmetic Changes
- Skin wrinkles and sags due to decreased collagen and elastin.
- Thinning of the dermal layer.
- Reduced function of glands affects skin dryness.
- Smaller fat cells contribute to noticeable wrinkles and sagging skin.
Skin Changes (Examples)
- Images of different ages show changes in skin tone and texture.
How Botox Works
- Botox binds to the surface of nerve cells.
- Internalized into small vesicles.
- Affects proteins needed for acetylcholine release.
Hair Changes
- Pattern baldness is common in men (and occasionally in women).
- Increased hair growth in some areas (ears, etc.).
- Loss of body hair in other areas.
- Hair transplants and Minoxidil.
Minoxidil and Hypertension
- Minoxidil opens K channels, hyperpolarizing vascular smooth muscle.
- Vasodilation, reducing constriction sensitivity.
- Not a standard hypertension treatment.
- Hypertrichosis is a side effect, beneficial for cosmetics.
Aging & the Cardiovascular System
- Differentiating age-related changes from lifestyle-related issues can be difficult.
- Normal 'wear and tear' may be confused with cardiovascular disease.
Normal Heart Muscle Changes
- Left ventricle wall thickening.
- Collagen and elastin's efficiency lessens.
- Reduced oxygen supply to the body.
- Lower exercise tolerance and fatigue.
Normal Heart Rate Changes
- Cardiac responsiveness and rate with exercise change.
- Heart takes longer to return to baseline rate.
Valve Changes
- Increased thickness of heart valves.
- Less flexibility of heart valves.
- Aortic and mitral valve calcification.
- Heart murmurs can result from valve changes.
- Treatment involves valve replacement.
Changes to the Conduction System
- Reduced number of pacemaker cells.
- Fibrous tissue infiltrates the conducting system.
- Conduction abnormalities (arrhythmias) can result.
- Increased risk of arrhythmias after a cardiac event.
Normal SA Node & Intranodal Atrial Tract Changes
- Myocardium irritability may cause extrasystoles and sinus arrhythmias/bradycardia.
Changes to Heart Contraction
- Excitation-contraction coupling powers heart contraction.
- Depolarization of cardiac muscle/cardiomyocytes is crucial.
- Calcium aids contraction.
- Heart rate and contraction force decline with old age.
- This can lead to heart failure.
Heart Failure and Treatment
- Reduced cardiac output leads to fatigue, cyanosis, oedema, and other symptoms.
- Treatment aims to either boost heart function or reduce work load (e.g. hypertension).
- Methods include blocking constrictor agents, regulating blood return.
What Causes Oedema in HF Patients?
- Determined by Starling's Forces (hydrostatic and osmotic pressures).
- Hydrostatic pressure pushes fluid into tissues.
- Osmotic pressure retains fluid in capillaries.
- Imbalance leads to fluid buildup (oedema).
Arterial Capillary Venous End Pressures
- Pressures differ in the arterial, capillary and venous ends of the system.
Pulmonary Hydrostatic Pressures
- Much lower than systemic pressure.
- Net fluid transfer at both ends equals oedema prevention.
Heart Failure Drugs
- Nitrates (e.g., nitric oxide): dilate veins reducing blood return to the heart.
- Positive inotropic agents: increase calcium in heart muscle cells for stronger contractions.
- ACE inhibitors: block Angiotensin II to reduce blood pressure and water retention.
Normal Blood Pressure Changes
- Systolic blood pressure (when the heart beats) often increases disproportionately more than diastolic blood pressure (when the heart relaxes).
Blood Pressure and Aging
- Blood pressure usually rises gradually with age.
- Linked to artery stiffness and structural changes.
- Isolated systolic hypertension is frequently found in older adults.
- Increased risk of cardiovascular issues.
WHO Global Risk Factors (2012)
- Visual report showing global trends in attributable deaths and their association with different known risk factors.
Medic's Warning (Silent Killer)
- High blood pressure often goes undiagnosed (silent killer).
- Only 4 out of 10 people with the condition know they've got it.
Defining Hypertension (British Hypertension Society 2003)
- A set of blood pressure measurements define various stages or grades of high blood pressure, from optimal pressure to severe hypertension.
Causes of Hypertension
- Primary (90%): multifactorial, often associated with factors like smoking, obesity, diet, lack of exercise, and genetics.
- Secondary (<10%): due to specific conditions such as kidney issues or a tumour (e.g., pheochromocytoma).
Aging Changes in Blood Vessels
- Large arteries become stiffer and less elastic with age.
- They can calcify (become bony).
Coronary Artery & Aging
- Coronary arteries supply blood to heart muscle.
- Blood flow through the arteries declines with age.
- Reduced ability to increase heart activity
- Coronary artery narrowing may cause angina (pain).
Aging Changes In The Aorta
- Aorta can dilate, elongate and become more rigid with age.
- May exhibit calcification.
- Changes in elasticity, collagen, and elastin can cause weakness and aneurysms.
Treating High Blood Pressure
- Guidelines suggest target blood pressure levels for different age groups and health conditions.
- Lifestyle interventions, drug classes (beta blockers, centrally acting drugs, hormone antagonists, ACE inhibitors, ATII blockers etc.), vessel-affecting drugs, blood volume controllers (diuretics), and other medications can be part of the treatment strategy.
Beta Blockers
- Developed by James Black in the 1950s.
- Block adrenaline's effects on the heart.
- Initially used first chlorine-substituted DCI.
- Later replaced with propranolol because DCI had toxic side effects.
- Black awarded a Nobel Prize in 1988 for his work.
- Propranolol is clinically used for conditions such as angina, hypertension,and for low doses to manage heart failure or tremors.
- Later Beta blockers are selective for one receptor.
Metformin Repurposing
- Metformin has multiple applications beyond its current use in type-2 diabetes treatment.
- Can potentially help with Alzheimer's disease, ischemic stroke, and cancer.
Type 2 Diabetes- Link to CV Disease
- A significant correlation exists between Type-2 diabetes and cardiovascular complications.
- Young adults with Type-2 diabetes exhibit a higher risk of developing associated cardiovascular conditions.
Aging and CV system - summary
- Aging is not a disease.
- Inevitable modifications include reduced exercise ability, skin changes.
- Genetic influences are considerable factors in multifactorial cardiovascular issues.
- Lifestyle changes are fundamental to mitigating cardiovascular risks.
- Some conditions, though often without evident symptoms, can advance and cause further problems.
- Lifestyle and drug intervention are essential tools.
Atherosclerosis
- An inflammatory disease of the arteries.
- Fatty streaks arise early in the aorta and other arteries.
- Lesions develop with increased lipid uptake causing an inflammatory process.
- Fibrous caps form around the plaques.
Atherosclerosis Timeline
- The stepwise progression from endothelial dysfunction to atherosclerosis.
Treating Atherosclerosis
- Drugs to reduce lipid levels.
- Anti-platelet drugs to prevent plaque rupture.
- Medications to manage blood pressure.
CV Links to Other Organs
- Changes in the circulatory system reverberate throughout the body.
- Atherosclerotic changes in blood vessels can cause renal failure, vision problems (e.g., loss of vision in diabetes) and strokes.
Metformin- A Biguanide
- A medication used to treat type-2 diabetes.
- Its mechanisms of action are often investigated.
Glucose Homeostasis
- Pancreas and liver communicate to maintain blood glucose levels.
- Insulin lowers blood glucose, Glucagon raises it.
Type 2 Diabetes
- Insufficient insulin production (or resistance) leads to hyperglycemia (high blood glucose)
- Often part of the metabolic syndrome.
Type 2 Diabetes Risk Factors
- Non-modifiable (race, ethnicity, age, family history, gestational diabetes).
- Modifiable (physical inactivity, body weight, blood pressure, cholesterol)
Type 2 Diabetes-Prevalence of Obesity
- High prevalence of obesity in individuals with type-2 diabetes.
Type 2 Diabetes- Treatments
- Lifestyle modification (weight loss, diet, exercise, and reduced alcohol intake).
- Medications (sulphonylureas, SGLT-2 inhibitors, GLP-1 mimetics, and metformin) are often used.
Metformin
- Developed from Galega officinalis, used to treat diabetes for over 60 years.
- Repurposed for various non-diabetes conditions due to its influence on cellular metabolism and aging pathways.
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Description
Test your knowledge on the effects of ACE inhibitors, factors associated with primary hypertension, and the relationship between heart failure and nitrates. This quiz covers essential topics in cardiovascular health and the physiological impacts of various medications.
