Ageing Heart and Lungs

Question 1

As we age there are changes to the myocardium of the heart. All of the following have been shown to occur, EXCEPT which one?

1 - increase in myocyte size
2 - increase in the number of myocytes
3 - collagen and amyloid deposition in the myocytes
4 - stiffening of the LV wall
5 - enlarged left atrium

Answer 1

2 - increase in the number of myocytes
- the number actually decreases
- remaining myocytes undergo hypertrophy instead of hyperplasia

Question 2

As we know the LV walls undergo hypertrophy and the LA becomes enlarged during ageing. What affect does this have on the conduction system of the heart?

1 - conduction speed increases
2 - pacemaker cell number increases in SA node
3 - pacemaker cell number decreases in SA node
4 - increases re-entry circuits develop

Answer 2

3 - pacemaker cell number decreases in SA node
- estimated to be a reduction of 50% of pacemaker cells in SA node
- linked with fibrous deposits

Question 3

All of the following is said to occur in the valves or the heart in ageing, EXCEPT which one?

1 - thickening and stiffness
2 - vegetations
3 - Ca2+ deposits on valves
4 - murmurs

Answer 3

2 - vegetations
- only common in infective endocarditis

Question 4

In ageing there are changes to the valves of the heart, including thickening, reduced flexibility and Ca2+ deposits. These changes can cause murmurs, but do these always present with symptoms?

Answer 4

• no
• patients can be asymptomatic

Question 5

In ageing we can see that there are changes in the arteries. Which of the following does NOT occur in ageing arteries?

1 - Ca2+ and fibrotic deposits
2 - atherosclerosis worsens
3 - large arteries become more compliant
4 - small arteries unable to dilate as effectively

Answer 5

3 - large arteries become more compliant
- typically they become stiffer and unable to vasodilate as well

Question 6

In ageing, arteries become stiffer and less able to vasodilate. Furthermore, veins dilate more due to a loss of elastin. What then happens to BP?

Answer 6

• increased SBP
• decreased DBP

Question 7

In ageing do veins become more or less dilated?

Answer 7

• dilate more due to loss in elastin
• linked with things like varicose veins

Question 8

In ageing does the maximum HR increase or decrease?

Answer 8

• decrease
• max HR = 220 - age
• likely to be linked with less pacemaker cells in SA node and reduced sympathetic innervation

Question 9

In ageing does the SV increase, decrease or remain constant?

Answer 9

• typically remains well preserved

Question 10

Does ageing affect cardiac output at rest?

Answer 10

• no typically remains well preserved

Question 11

Ageing reduced cardiac output during exertion, such as physical activity and exercise. Which of the following contribute to the reduced cardiac output during exercise?

1 - limited LV filling during diastole due to LV stiffness
2 - LA atrium increases in size and unable to maintain contract efficiently
3 - mitral regurgitation leaks fluid back into LA
4 - reduced number of pacemaker cells in SA node so reduced conduction firing and HR
5 - all of the above

Answer 11

5 - all of the above

Question 12

What happens to preload during ageing?

Answer 12

• reduces
• veins dilate more so venous return (preload) is reduced
• LV stiffness and LA inability to contract effectively

Question 13

What happens to afterload during ageing?

Answer 13

• increases
• SVR increases as arteries are unable to vasodilate effectively
• heart has to work hard to pump blood

Question 14

What happens to diastolic function of the heart during ageing?

1 - increases to compensate for reduced systole
2 - decreases due to LV stiffness and increases PVR
3 - decreases due to RV lack of filling
4 - increases due to increased pulmonary pressure

Answer 14

2 - decreases due to LV stiffness and increases PVR

• leads to HF but with preserved ejection fraction

Question 15

Why is ischaemic heart disease risk increased in ageing?

1 - reduced HDL in blood
2 - increased coronary blood vessel calcification and atherosclerosis
3 - reduced ability of coronary blood vessels to dilate
4 - increased O2 demand of older heart

Answer 15

2 - increased coronary blood vessel calcification and atherosclerosis

Question 16

Are older patients more or less at risk to arrhythmias?

Answer 16

• increased risk
• reduced number of pacemaker cells in SA node means slower firing
• hypertrophy of LV
• dilated atria
• all of the above can lead to AF, brady and tachy arrhythmias

Question 17

Why are older patients more susceptible to postural hypotension than younger patients?

1 - increased brain natriuretic peptide causing hypovolaemia
2 - decreased renin and aldosterone and therefore Na+ and H2O
3 - decreased baroreflex sensitivity, with impaired a1-adrenergic vasoconstriction and HR responses
4 - decreased ability of venous system to respond and increase venous return
5 - all of the above

Answer 17

5 - all of the above

Question 18

As we age, do alveoli increase or decrease in size?

Answer 18

• increase in size
• no pathology is present

Question 19

As we age alveoli reduce in size, regardless of pathology and inflammation, which ultimately reduces the surface area of the alveoli. Wha affect does this have on ventilation and perfusion (V/Q)?

Answer 19

• both are reduced
• ventilation = air in and out of lungs
• perfusion = blood flow to capillaries

Question 20

As we age alveoli reduce in size, regardless of pathology and inflammation, which ultimately reduces the surface area of the alveoli. This then reduces ventilation and perfusion (V/Q). Can this affect partial pressure of O2 (PaO2)?

Answer 20

• yes
• PaO2 has been shown to be reduced in ageing

Question 21

As we age patients are at an increased risk of kyphosis, which is when the top of the vertebral column appears curved. Patients appear to be bending over. What affect does this have on breathing?

1 - thoracic shape changes
2 - thoracic cage becomes less compliant
3 - secondary muscles become less effective
4 - diaphragm becomes dominant
5 - all of the above

Answer 21

5 - all of the above
- essentially lungs cannot expand as well

Question 22

Forced vital capacity (FVC) is the the amount of air that can be forcefully exhaled following a maximum inspiration. Does FVC increase or decrease as we age?

Answer 22

• decreases
• chest walls are rigid and reduced muscle strength

Question 23

Forced expiratory volume in 1 second (FEV1) is a measure of how much air you can forcefully exhale in the 1st second of exhalation.

Answer 23

• decreases
• chest walls are rigid and reduced muscle strength

Question 24

FVC and FEV1 both decreased with ageing. Does the total lung capacity change with ageing?

Answer 24

• no
• remains relatively constant

Question 25

The residual volume (RV) is the amount of air remaining in the lungs following a full and forced expiration. Does RV change with ageing?

Answer 25

• increases
• lost of elastin in lung tissue
• recoil not as effective

Question 26

Although there are clearly significant changes to the lungs as we age, patients are typically asymptomatic. Do these changes in lung function and capacity have any impact on elderly patients?

Answer 26

• yes
• older patients have a reduced reserve capacity to deal with insults such as pneumonia, obesity, stroke, rib fracture and/or irritation to the diaphragm