The Ageing Cardiovascular System

Jennifer Inglis12th December 2006

Overview

Why is it important to understand ageing of the cardiovascular system?What changes in cardiovascular structure and function are associated with ageing?How might this affect our practice?

Why?

Prevalence of cardiovascular disease amongst elderly populations“It’s just my age, doctor”Impact on our assessment and treatment of elderly patients

What changes occur?

Vascular changesPostural changesCardiac changes at restCardiac changes on exercise

Vascular Changes

Aorta and large elastic arteries - wall thickness, dilation and stiffening in mean systemic arterial pressure in most, but not allSystolic BP rises more than diastolic – increasing chance of isolated systolic hypertension

Postural Changes

Blunting of in HRSlowed baroreceptor response to postural changeMay be reduced vasoconstriction in response to reduced BPIncrease the chance of postural hypotension

Cardiac Changes at Rest

Minor in HRCO output maintained by SV ejection of blood during late systole early diastolic filling rateEDV not - enhanced atrial contribution to LV filling – beware AF, particularly if tachycardic

During exercise…

in maximum HR ( response to β-adrenergic stimuli) in cardiac output - reduced by 30% between ages 20 and 80Maximum SV not reduced – but maintained in different mannerFrank Starling mechanism

Frank Starling Mechanism

EDV, due to:Longer diastolic interval ( HR) EF - amount of blood in LV at start of diastole

Summary of changes

HR SV CO EDV EF

At rest = = =

Exercise =

Some Practical Points

Beware of increased risk of hypertension……and postural hypotensionElderly patients unlikely to tolerate tachycardia or AF as well as younger patientsCaution with beta blockers

In summary…

Ageing does alter the structure and function of the cardiovascular systemChanges more evident during exerciseThese effects may contribute to earlier decompensation when unwell…and remember your erect and supine BPs!

Comments?

Or easy questions?