Cardiovascular Changes in Older Adults PDF

Cardiovascular Changes in Older Adults: Structural changes with aging involve the: 1. Myocardium and Endocardium 1. Endothelium thickens, causing constant constriction of blood vessels and higher blood pressure 2. Inner layer of vessel, elasticity decreases, decreasing blood...

Cardiovascular Changes in Older Adults: Structural changes with aging involve the: 1. Myocardium and Endocardium 1. Endothelium thickens, causing constant constriction of blood vessels and higher blood pressure 2. Inner layer of vessel, elasticity decreases, decreasing blood circulation, causing inadequate blood supply and higher blood pressure 2. Cardiac conduction system- affected by the decrease in the number of pacemaker cells in the sinoatrial node with age, decreasing heart rate. 3. Aorta- becomes thicker, stiffer, and less flexible. This is probably related to changes in the connective tissue of the blood vessel wall. This makes the blood pressure higher and makes the heart work harder, which may lead to hypertrophy of the myocardium. 4. Arteries- Thicken and stiffen. In general, most older people have a moderate increase in blood pressure. Receptors called baroreceptors monitor the blood pressure and make changes to help maintain a fairly constant blood pressure when a person changes positions or is doing other activities. The baroreceptors become less sensitive with ageing, possibly explaining why many older people have orthostatic hypotension. 5. Veins- The walls of veins may become thicker with age because of an increase in connective tissue and calcium deposits. and the valves become stiff and incompetent. Varicose veins may develop. 6. Valve circumference- reported in all four cardiac valves (aortic semilunar valve, semilunar valve, bicuspid valve, tricuspid valve), with the greatest changes occurring in the aortic valve (the valve between the left ventricle and the aorta). Valves stiffen, allowing for more regurgitation of blood, edema and clots. 7. Blood vessels- decreased elasticity as one ages results in increased vessel diameter and vessel wall rigidity. There is a [progressive degeneration of the cardiac structures] with a loss of elasticity, fibrotic changes in the valves of the heart, and infiltration with amyloid. The age-associated structural characteristics that have the greatest impact involve the contractility of the heart\'s left ventricular wall. The pumping capacity of the heart is reduced. This [persistent inflammatory state] contributes to endothelial dysfunction, arterial stiffness, and the progression of atherosclerosis. Elevated levels of pro-inflammatory cytokines and oxidative stress accelerate vascular ageing, increasing the risk of hypertension, ischemic heart disease, and other cardiovascular conditions.\[11\] Understanding and mitigating inflammaging through lifestyle modifications, such as regular physical activity, a healthy diet, and stress management, can help preserve cardiovascular health in older adults. [Blood Volume]- Normal ageing causes a reduction in total body water. Consequently, there is less fluid in the bloodstream, [so blood volume decreases]. Red blood cells are produced more slowly in response to stress or illness is reduced. This creates a slower response to blood loss and anemia. Most of the white blood cells stay at the same levels, although neutrophils decrease in their number and ability to fight off bacteria. This reduces the ability to resist infection. [Heart Rate]-The [reduction in maximal heart rate] is thought to be due to changes in the autonomic nervous system, along with age-related decrease in the number of cells in the sinoatrial node, leading to smaller aerobic workload possible and slower aerobic performance. Stroke volume is changed little by aging; at rest in healthy individuals, there may even be a slight increase. Emotional stress, illness or injury, exertion causes heart to work harder. [Blood pressure] is a measure of cardiovascular efficiency. In general, most older people have a moderate increase in blood pressure (systolic), due to vascular changes, increased vascular resistance, heart workload. [Orthostatic hypotension occurs as we age, due to baroreceptors becoming less sensitive during positional changes.] - For an elderly patient with isolated systolic hypertension, Hydrochlorothiazide 12.5 mg daily Unaffected with aging 1. Cardiac output at rest is unaffected by age. Maximum cardiac output and aerobic capacity are reduced with age. Labs - Troponin- Evaluate if there is any damage to the heart - Kidney function decreases with age, want to see if kidneys are adequately perfused. If heart is overworking, other organs are perfused well, so check GFR, BUN, Cr Assessment - Murmurs are common due to valves thickening - Skin: pale, temp cool and clammy, cap refill \> 2 sec (means decreased perfusion) - Varicose veins: due to valve weakening, increases risk of stroke and aneurysms due to clots Pathophysiology - CV disease develops due to normal age-related changes as well as other risk factors - Atherosclerosis and hypertension is common in older population - Hypertension- due to poor diet, sedentary lifestyle, stress. Can go unnoticed for a long time since asymptomatic. - Atherosclerosis- develops overtime due to fat, cholesterol in and around arterial walls, causing narrowing of arteries or complete blockage, resulting in ischemia, emboli's - Both can lead to CAD and HF Educational Points - Smoking Cessation: Damages vessels, leading to aneurysms and other - Hypertension and diabetes management: uncontrolled leads to HF, CAD - Physical activity: be part of everyday life to increase blood flow circulation, can reduce emotional stress - Moderate exercise is one of the best things older persons can do to keep their heart, and the rest of their body, healthy. - Angina/Chest pain- sudden or complete blockage of oxygen in heart muscle. If last longer than 10 min, get help right away (this is a myocardial infarction). If crushing or pain radiating down shoulder, jaw pain are also signs of - Proper nutrition- DASH diet- meals based on low sodium, cholesterol and saturated fat - Low in sodium- for hypertensive conditions - Low cholesterol/saturated fat- plaque buildup