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Cardiovascular physiology-changes with aging
1University of California at San Francisco, Former Chief of Cardiology, San Francisco General Hospital, San Francisco, CA 94110, USA.
Insights
Aging causes cardiovascular changes like decreased arterial elasticity and heart rate, leading to conditions such as hypertension and heart failure in older adults.
Area of Science:
- Cardiovascular Physiology
- Gerontology
- Internal Medicine
Background:
- Cardiovascular system undergoes significant physiological changes with advancing age.
- These age-related changes must be distinguished from cardiovascular pathologies.
- Individual aging rates vary, leading to differences between chronological and physiological age.
Purpose of the Study:
- To delineate the physiological alterations in the cardiovascular system associated with aging.
- To differentiate normal aging processes from age-related cardiovascular diseases.
- To understand the implications of these changes for geriatric cardiovascular health.
Main Methods:
- Review of physiological changes in the cardiovascular system due to aging.
- Analysis of structural and functional alterations in the heart and vasculature.
- Examination of neurohormonal and receptor system modifications with age.
Main Results:
- Aging leads to decreased arterial elasticity and increased stiffness, raising left ventricular afterload and systolic blood pressure.
- Reduced atrial pacemaker cells decrease intrinsic heart rate; cardiac skeleton fibrosis can cause aortic valve calcification and His bundle damage.
- Diminished beta-adrenergic responsiveness, baroreceptor/chemoreceptor reactivity, and increased catecholamines are observed.
Conclusions:
- Age-associated cardiovascular changes predispose individuals to isolated systolic hypertension, diastolic dysfunction, and heart failure.
- Atrioventricular conduction defects and aortic valve calcification are common outcomes of the aging cardiovascular system.
- Understanding these physiological shifts is crucial for managing cardiovascular health in the elderly population.
Abstract:
With aging there are changes in the cardiovascular system, which result in alterations in cardiovascular physiology. The changes in cardiovascular physiology must be differentiated from the effects of pathology, such as coronary artery disease, that occur with increasing frequency as age increases. The changes with age occur in everyone but not necessarily at the same rate, therefore accounting for the difference seen in some people between chronologic age and physiologic age. The changes in the cardiovascular system associated with aging are a decrease in elasticity and an increase in stiffness of the arterial system. This results in increased afterload on the left ventricle, an increase in systolic blood pressure, and left ventricular hypertrophy, as well as other changes in the left ventricular wall that prolong relaxation of the left ventricle in diastole. There is a dropout of atrial pacemaker cells resulting in a decrease in intrinsic heart rate. With fibrosis of the cardiac skeleton there is calcification at the base of the aortic valve and damage to the His bundle as it perforates the right fibrous trigone. Finally there is decreased responsiveness to beta adrenergic receptor stimulation, a decreased reactivity to baroreceptors and chemoreceptors, and an increase in circulating catecholamines. These changes set the stage for isolated systolic hypertension, diastolic dysfunction and heart failure, atrioventricular conduction defects, and aortic valve calcification, all diseases seen in the elderly.