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[The etiology and management of congestive heart failure in the elderly]
1Division of Cardiology, Tokyo Metropolitan Geriatric Hospital.
Insights
Elderly patients with congestive heart failure (CHF) often have underlying heart disease, with ischemic heart disease being most common. Inadequate neurohumoral compensation contributes to CHF in older adults.
Area of Science:
- Cardiology
- Geriatrics
- Internal Medicine
Context:
- Congestive heart failure (CHF) is a significant health concern in the elderly population.
- Understanding the diverse etiologies and precipitating factors of CHF in older adults is crucial for effective management.
Purpose:
- To identify the common underlying heart diseases, extracardiac conditions, and precipitating factors contributing to CHF in elderly patients.
- To explore the neurohumoral response to exercise in elderly patients with mild CHF.
Summary:
- Ischemic heart disease (39%), valvular heart disease (27%), and hypertensive heart disease (10%) were the most frequent underlying cardiac conditions in 104 elderly CHF patients (mean age 79).
- Extracardiac diseases (anemia, hypothyroidism, renal failure, pulmonary disease) and factors like respiratory infection, ischemia, arrhythmia, and inappropriate medication use also contributed to CHF.
- Elderly patients with mild CHF exhibited insufficient cyclic AMP and GMP production relative to norepinephrine and atrial natriuretic peptide increases post-exercise, suggesting inadequate neurohumoral compensation.
Impact:
- Highlights the multifactorial nature of CHF in the elderly, emphasizing the need for comprehensive assessment beyond cardiac causes.
- Suggests that impaired neurohumoral compensation plays a role in the development of CHF in older individuals.
- Informs clinical practice regarding the recognition of underlying diseases, complications, and appropriate management strategies for acute CHF in the elderly.
Abstract:
The common underlying heart diseases were ischemic heart disease (39%), valvular heart disease (27%), hypertensive heart disease (10%) in 104 patients (mean age 79 yrs) with congestive heart failure (CHF). Cardiomyopathy (5%) and congenital heart disease (2%) such as atrial septal defect were less common. In addition, many extracardiac diseases including anemia, hypothyroidism, renal failure and pulmonary disease contributed to the etiology of CHF in the elderly. Cardiac amyloidosis should be considered as an uncommon cause of refractory CHF. While the precipitating factor was not found in half of the 104 patients with CHF, the most common factors were respiratory infection, myocardial ischemia and arrhythmia. In addition, inappropriate drug usage including poor drug compliance, the use of beta-blockers and excessive intake of sodium and fluid precipitated or exacerbated heart failure. Renal failure was a most important complication and predisposed to refractory CHF. Aged patients with mild CHF (NYHA class II) showed an insufficient production of cyclic AMP and GMP in proportion to the increases of norepinephrine and atrial natriuretic peptide in comparison with health aged subjects after the submaximal treadmill exercise test. This finding may suggest that an inadequate compensation of neurohumoral factors is prone to cause CHF in the elderly. Appropriate management of acute CHF in the elderly begins with recognition of the underlying heart disease, complications and the severity of cardiac function. In addition to medical management including loop diuretics, vasodilator, beta-receptor agonist and phosphodiesterase inhibitor, cases associated with respiratory and renal failure require mechanical ventilation and continuous hemofiltration.