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[Changes in the electrocardiogram in the elderly patient. The limits between normality and pathology]
M Molaschi1, M Ponzetto, R Romin
1Istituto di Medicina e Chirurgia Geriatrica, Università, Torino.
Insights
Electrocardiographic abnormalities are common in the elderly, increasing with age. Sinus rhythm prevails, but conditions like atrial fibrillation and various heart blocks become more prevalent in older adults.
Area of Science:
- Cardiology
- Geriatrics
- Electrocardiography
Background:
- Normal electrocardiographic (ECG) criteria in the elderly are not well-defined.
- The prevalence of ECG abnormalities significantly increases with advanced age.
- Aging impacts cardiac electrical activity, necessitating age-specific interpretation guidelines.
Purpose of the Study:
- To define normal electrocardiographic criteria in the elderly population.
- To determine the prevalence of various electrocardiographic abnormalities in different age groups of the elderly.
- To analyze age-related changes in cardiac electrical activity.
Main Methods:
- Review and synthesis of existing literature on electrocardiographic findings in elderly populations.
- Analysis of prevalence data for specific ECG abnormalities across different age strata (e.g., 65-69, >70, >85, >90 years).
- Inclusion of data from hospitalized elderly patients for comparison.
Main Results:
- Prevalence of ECG abnormalities is three times higher in individuals over 85 compared to those aged 65-69.
- Common findings include sinus pauses (especially nocturnally), first-degree atrioventricular block (8.1%-19%), left anterior hemiblock (11% over 70), and bundle branch blocks.
- Atrial fibrillation prevalence increases with age, reaching 27% in hospitalized individuals over 90; ventricular ectopic contractions are highly prevalent (76%-96%).
Conclusions:
- Electrocardiographic abnormalities are a common feature of aging, with prevalence increasing significantly in advanced age.
- Specific conditions like atrial fibrillation, various heart blocks, and ectopic beats require careful consideration in geriatric ECG interpretation.
- Further research is needed to establish definitive normal ECG criteria for the elderly.
Abstract:
Normal electrocardiographic criteria in the elderly are not well defined. The prevalence of electrocardiographic abnormalities is three times higher in subjects over 85 years than in subjects 65-69 years old. With aging the heart rate does not vary during rest and sinus rhythm is prevalent, although sinus pauses, overall at night, are frequently seen. First degree atrio-ventricular block is present in 8.1%-19% of the elderly. 11% of subjects over 70 years suffer from left anterior hemiblock. 4.3% of subjects over 65 years and 7% of those over 85 present a right bundle branch block. 1.7% of subjects older than 65 years and 9% of those older than 85 are affected by a left bundle branch block. Atrial ectopic contractions are present in 8.8% of subjects over 60 years and in all older subjects. Atrial fibrillation is more common as age increases, being found in 2% of under 75s, in 5% of all subjects over this age, in 14% over 85 years and in 27% of patients hospitalized or institutionalized aged over 90 years. The prevalence of ventricular ectopic contractions varies from 76% in studies performed with baseline electrocardiogram to 96% in studies performed with portable monitoring electrocardiogram. Major ST-T wave alterations are present in 6.3%-13% of the elderly. In 340 patients over 80 years, hospitalized for diseases, other than cardiovascular, we found atrial fibrillation in 27.9% of subjects, ectopic beats in 26.2%, first degree atrioventricular block in 8.5%, right bundle branch block in 11.2%, left bundle branch block in 5.9%, left anterior hemiblock in 8.2%, ST-T wave alterations in 23.8% of the population.