Heart disease in elderly

Old age population is increasing  with its attendant health, social and economic issues. A new branch of medicine has emerged to cater for the elderly age related health issues called geriatrics.

There is increasing old age population which is a global phenomenon. Old age population is increasing with its attendant health, social and economic issues. A new branch of medicine has emerged to cater for the elderly age related health issues called geriatrics.

There are some common cardiac disorders as well as special cardiac problems other than the category of accrued health issues from middle age. Age is an important and strong risk factor for the coronary heart disease. There are also diseases which have clustered and need to be tackled simultaneously to reduce the impact on cardiovascular system.

There is declining function of other organ systems including liver, kidneys decreased serum albumin which has an impact on the drugs which need to be considered in terms of dosage, pill burden, drug-drug interactions and drug- food interactions.

Equally of relevance is the social fabric of India where parents are dependent on children for social security and insurance penetration is inadequate, putting recurring cost burden on the patient as well as family.

Aging is an inevitable phenomenon. Some age rapidly some slowly. This has brought in the concept of inappropriate aging or premature aging. Incidence and prevalence of hypertension, coronary artery disease, congestive heart failure, stroke arterial aneurysms and atrial fibrillation are increasing steeply with advancing age.

Age related stiffening of heart

As age advances heart becomes stiffened and shows thickening which may concentric or eccentric.  Stiffened ventricle is responsible for diastolic dysfunction that reduces effort tolerance over time systolic performance also decreases.

Age also produces sinus brady cardia, sick sinus syndrome AV node disease combined SA and AV node disease which may require pacemaker therapy.

Age related stiffening of arteries

As age advances, arteries become stiff, lose elasticity and become dilated.

Isolated systolic hypertension

Arterial stiffness along with altered pulse pressure as well as pulse reflectivity is responsible for hypertension. Elderly have special form of hypertension called isolated systolic hypertension. Any value above 140/90 is abnormal. In aged only systolic pressure is elevated. Hypertension needs to be managed aggressively since uncontrolled hypertension has impact on heart kidney and brain.

Increasing burden of CVD

10- 20% are having CAD by 4th decade which increases to 0 to 70% by 80 yrs age. Coronary disease is extensive and carries high mortality. The symptoms are underappreciated due to reduced exercise tolerance and presentation is often atypical or silent. Acute coronary syndromes are also atypical complication rates high and frequent including atrial fibrillation, heart failure and cardiogenic shock.

In chronic CAD, time tested treatment strategies are all useful and well accepted. PTCA as well as CABG are both feasible in selected cases though at a higher complication rate. Quality of life studies have shown long term benefits.

Increasing valvular heart disease

Aortic valve sclerosis is the commonest observation and itself in an independent predictor of associated CAD. It also progresses and produces aortic stenosis. Inflammatory contribution is appreciated and there is role of statins in blunting the progression of disease. Aortic stenosis is the commonest valvular disease which  remains relatively asymptomatic. It is one of the causes of sudden death and heart failure in elderly and both established aortic valve replacement as well as emerging transcutaneous aortic valve replacement are possible. Chronic aortic regurgitations is also frequent. Mitral annular calcification with or without mitral regurgitation is another age related problem. However significant mitral regurgitation in elderly is on the basis of IHD.

Increasing heart failure

Heart failure increases as age advances about 10% above 70 to 80 yrs have heart failure and is of both diastolic as well as systolic failure. Drug therapy as well as CRT therapy are feasible.

Incidence of atrial fluter, atrial fibrillation and ventricular PVC vent tachycardia are also more with aging.

Relevance of preventive cardiology and health checkups

Since the CAD and hypertension are frequent as well as other co-morbid disease is often present regular doctor visits with frequent health checkups are highly recommended. Many times patients are having poor exercise tolerance and thus conventional tests may not be relevant.

Good dietary habits, regular exercises and avoidance of stress are definitely important though their impact is less than in a young man of 20s. Healthy habits are to be followed since they are cost effective keeping quality of life in mind.

For more information and help, visit the BGS Global Hospitals in India to get healed.

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