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[Aging and cardiology; various physiological, pathophysiological and clinical aspects]
R Tukkie1, D R Düren, R B van den Brink
1Afd Cardiologie, Academisch Medisch Centrum, Amsterdam.
Insights
As people age, systolic blood pressure increases, leading to heart changes and atypical symptoms. Early diagnosis and treatment of heart failure, focusing on blood pressure and heart rate, are crucial for managing cardiovascular effects of aging.
Area of Science:
- Cardiovascular Physiology
- Geriatric Medicine
- Cardiology
Context:
- Aging significantly impacts cardiovascular health, primarily through increased systolic blood pressure.
- Reduced arterial impedance in aging leads to elevated afterload, causing left ventricular hypertrophy and rigidity.
- Atypical presentations of ischemia and arrhythmias in older adults can delay diagnosis.
Purpose:
- To elucidate the cardiovascular effects of aging, focusing on blood pressure changes and their consequences.
- To describe the diagnostic challenges and common causes of heart failure in the elderly.
- To outline therapeutic strategies for managing heart failure in aging populations.
Summary:
- Aging increases systolic blood pressure due to reduced arterial impedance, leading to left ventricular changes.
- Heart failure in older adults is often caused by coronary sclerosis, hypertension, or valvular defects, with atypical symptoms complicating diagnosis.
- Both systolic and diastolic heart failure benefit from antihypertensive, diuretic, and vasodilator treatments, with a focus on blood pressure and heart rate control for diastolic dysfunction.
Impact:
- Highlights the need for vigilant cardiovascular monitoring in aging populations.
- Emphasizes the importance of recognizing atypical cardiac symptoms in the elderly.
- Provides insights into optimizing heart failure management for better geriatric cardiovascular outcomes.
Abstract:
The main cardiovascular effect of aging is a rise of the systolic blood pressure due to reduced impedance of the central arteries. The resulting increase of the afterload leads to hypertrophy, increased rigidity and lengthening of the relaxation period in the left ventricle. The manifestations of ischaemia or arrhythmias are often atypical at more advanced ages and may delay diagnosis. Ejection murmur due to stenosis of the aortic valve, to calcification or degeneration, may be difficult to distinguish from a functional murmur. The cause of heart failure is usually coronary sclerosis and, less often, hypertension or a valvular defect. Systolic heart failure is associated with decreased contractility of the left ventricle and compensatory dilation, diastolic heart failure with reduced filling of the ventricles. Both forms respond well to acute treatment with antihypertensive, diuretic and (or) vasodilator drugs; the treatment in isolated diastolic heart failure should also focus on lowering the increased blood pressure and reducing the heart rate to increase the filling phase.