[Cardiac insufficiency in the elderly with particular reference to kidney function]

Cardiac insufficiency in the elderly is not a typically age-induced phenomenon, but is rather due to pathological changes of the heart. Renal function, on the other hand, does show age-related deterioration without any apparent pathological changes occurring. For the treatment of cardiac insufficiency in the elderly three groups of drugs are used: diuretics, cardiac glycosides, and vasodilators. When sinusrhythm is still present diuretics should be primarily employed, and in uneffective glycosides, and finally vasodilators. If hypertension is the main cause of heart failure diuretics and vasodilators should be preferred, and glycosides only used in the last instance. Heart failure complicated by tachyarrhythmia should be treated primarily with glycosides, then diuretics and vasodilators. Powerfully as well as long acting diuretics may cause hypovolaemia, hyponatremia, and in particular hypokalaemia in the elderly. Digoxin accumulates with impaired renal function, Digitoxin is not affected by renal function but its half-life is extremely long. In the case of atherosclerotic changes of the vascular system, vasodilators should be employed with caution to prevent extreme drops in blood pressure.