Cardiopulmonary Changes in the Elderly Lecture Powerpoint Flashcards
How does the heart change with aging (5)
- changes even in absence of underlying cardiac disease
- increased intimal media thickness and reduced compliance
- systolic pressure increases and diastolic decreases (pulse pressure widens)
- decreased ability to respond to sympathetic and parasympathetic stimulation (decreased peak cardiac output)
- ventricle enlargement and eventually late diastolic filling increase (atria) and potentially afib
ACC/AHA guidelines for treatment of hypertension
Don’t start treating until stage 2 unless have comorbidities (diabetes or known vascular disease) then treat at stage 1
Why does JNC8 not recommend treatment for hypertension until hitting 150/90 mmHg opposed to 140/90 for others?
Because treatment sometimes puts at risk for hypotensive events, you have to treat patient specifically
Mostcommon type of high blood pressure in older patients
Isolated systolic hypertension
Hypertension first line drug class treatments in whites (4) and in african american patients (2), what drug class is missing?
- thiazide diuretics
- ACE
- ARB
- Calcium channel blockers
- thiazide
- calcium channel blockers
Notice that B blockers alone are NOT recommended, they increase stroke rate
Sick sinus syndrome definition, presentation
Generally occurs in geriatric populations due to most often replacement of sinus node by fibrous tissue, often present as bradycardia, hypotension, orthostasis, ekg changes (may indicate for a holter monitor
Sick sinus syndrome treatment options (2)
- treat drug induced causes
- pacemaker insertion**
Tachybrady syndrome
Sick sinus syndrome co-ocurring with afib, aflutter, or PSVT therefore indicating that treatment will require both pacemaker insertion and rate controlling medications
Most common sustained cardiac arrhythmia
Atrial fibrillation
Atrial fib signs and symptoms (4)
- heart racing
- shortness of breath
- often asymptomatic***
- chest pains
Paroxysmal, persistant, vs permanent atrial fib
Paroxysmal self terminates or terminates with treatment in 7 days, persistant is greater than 7, permanent is when physician and patient have decided not to pursue and rhythm controls strategy
Atrial fib management options (5)
- B blocker
- nondihydropyridine calcium channel blocker
- amiodarone (typically in younger population)
- cardioversion
- anticoagulation depending on CHADS2-VASc score >=2 (warfarin, xarleto, pradaxa, eliquis)
Atypical acute coronary syndrome presentations that increases with age (3)
- fatigue, nausea, syncope, confusion
- NSTEMI’s increase in age
- DM and HTN increase incidence of silent MI
Most common valvular disease of old age
Aortic valve disease
Aortic sclerosis vs aortic stenosis
Sclerosis is calcifying of valve and affects up to 1/3 all elderly patients, aortic stenosis is narrowing of valve and occurs at lower rates but progressively increases with age
