Download Cardiovascular Aging

Cardiovascular Aging
© Continuing Medical Implementation ®
…...bridging the care gap
Cardiovascular Aging 1
• Resting LV systolic function normal in absence of
CAD, Hypertension
• SBP and pulse pressure increase with age
• Sedentary lifestyle may impact on CV system and
obscure impact of aging changes
• Lifestyle alterations may delay and partially
reverse changes of cardiovascular aging
– MVO2, peak exercise EF,CI,SVI;ESVI
© Continuing Medical Implementation ®
…...bridging the care gap
Cardiovascular Aging 2
• Increased systemic vascular impedence
– Systolic hypertension
– LV hypertrophy
• Impaired ventricular diastolic relaxation and
compliance
–
–
–
–
–
Increased cardiac interstitial collagen
Compensatory myocyte hypertrophy
Impaired calcium flux during diastole
Increased LVEDP, LA size
Predispose to atrial fibrillation
© Continuing Medical Implementation ®
…...bridging the care gap
Cardiovascular Aging 3
• Diminished responsiveness to betaadreneric stimulation
– Reductions in maximum HR
• 1 & 2 effect
– Impaired peripheral vasodilatation
• 2 effect
• Altered myocardial energy metabolism
– Impaired mitochondrial capacity to increase
ATP
© Continuing Medical Implementation ®
…...bridging the care gap
Cardiovascular Aging 4
Clinical implications
• Increased preload and afterload
• Impaired augmentation of cardiac output
– Physiologic stress (exercise)
– Pathologic stress (e.g. MI, infection, surgery)
• CO = HR X SV (preload and afterload)
© Continuing Medical Implementation ®
…...bridging the care gap
Cardiovascular Aging 5
• Echocardiography
– LV wall thickness and mass increase linearly
with age
–  LVEF correlates strongly with presence of
CAD and HTN
• EBCT
– Increased coronary and aortic calcification
– Correlate with  pulse pressure, low HDL, 
LDL, BS, smoking & obesity
© Continuing Medical Implementation ®
…...bridging the care gap
CV Disease and the Elderly
• CV disease rises sharply with age
• 85% of CHD deaths are in patients
> 65 years of age
• 60 % of admissions for acute MI are in patients
> 65 years of age
• In the US about 35 million people will be
> 65 by 2000
• The subset > 85 is growing the fastest
– 2/3 of this elderly population is female
© Continuing Medical Implementation ®
…...bridging the care gap
Age as a Risk Factor:
12-year Incidence Rates for CAD
Age, years
Men
Women
30-39
5%
1%
40-49
11%
5%
50-59
20%
12%
60-69
29%
15%
70-74
26%
20%
Source: Framingham Heart Study. Am J Hypertens 1993;6:309S-313S
© Continuing Medical Implementation ®
…...bridging the care gap
Traditional medical approaches do not cater for
the heterogeneity of disease in the elderly!
© Continuing Medical Implementation ®
…...bridging the care gap
Spectrum of CV Disease
in the Elderly
• Arrhythmias
– atrial fibrillation
– ventricular
• Atherosclerotic vascular
disease
– cerebrovascular disease
– peripheral vascular disease
• CAD
– chronic stable angina
– acute ischaemic syndromes
• Conducting System
Disease
© Continuing Medical Implementation ®
• Congestive Heart Failure
 Systolic
 Diastolic
• Hyperlipidemia
• Hypertension
• Hypertrophic
cardiomyopathy
• Valvular Heart Disease
– Aortic sclerosis
– Aortic stenosis
– Mitral annular calcification
…...bridging the care gap