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[Heart failure in the elderly. Therapeutic strategies]
1Servizio di Cardiologia ed UTIC, Ospedale Civico Renzetti, Lanciano, ULS 3 Lanciano-Vasto, Chieti.
Insights
Heart failure in the elderly often involves diastolic dysfunction, not just reduced ejection fraction. Early intervention and prevention targeting left ventricular dysfunction are key for better outcomes.
Area of Science:
- Cardiology
- Geriatrics
Background:
- Heart failure presents diverse types, including chronic systolic/diastolic dysfunction, refractory, and acute forms.
- Elderly heart failure frequently involves diastolic dysfunction of the left ventricle (LV), not always impaired contractility or reduced ejection fraction (EF).
Purpose of the Study:
- To examine different types of cardiac heart failure.
- To highlight the specific challenges of heart failure in the elderly, particularly diastolic dysfunction.
- To emphasize the importance of early detection and prevention.
Main Methods:
- Review of different types of cardiac heart failure.
- Discussion of diagnostic utility of echocardiography for ventricular dysfunction.
- Consideration of age-related pharmacokinetic changes and physiological sensitivities.
Main Results:
- Diastolic dysfunction is a common presentation of heart failure in the elderly.
- Elderly patients require careful drug management (diuretics, after-load reducers, digitalis) due to altered baroceptor sensitivity and pharmacokinetics.
- Current therapies manage symptoms but prognosis remains serious.
Conclusions:
- Echocardiography is crucial for assessing ventricular dysfunction type.
- Prevention and early management of left ventricular dysfunction in asymptomatic or mildly symptomatic stages offer the most effective therapeutic strategy.
- Proactive management is essential for improving heart failure outcomes in the elderly.
Abstract:
The different types of cardiac heart failures are examined: chronic failure deriving from systolic dysfunction, diastolic dysfunction failure, refractory heart failure, acute failure. Heart failure in the elderly is not always associated with impaired ventricular contractility with decreased EF and ventricular enlargement, but frequently with diastolic dysfunction of the left ventricle (LV). The echocardiographic examination is very useful to evaluate the type of ventricular dysfunction. Since the aortic baroceptor system is less sensible, diuretics and drugs decreasing after-load must be use carefully because of orthostatic hypotension and deterioration of kidney function. The elderly are most sensible to the action of digitalis because of the pharmacokinetic changes of the drug due to age. Although the current therapy of heart failure can relieve symptoms and prolong life, prognosis is always serious. The most effective therapy is prevention as it aims at the control and, if possible, at the regression of left ventricular dysfunction in the asymptomatic or slightly symptomatic stage.