Geezer Medicine

Question 1

3 Specific Aging Effects on CV System

Answer 1

Aortas and other arteries stiffer (loss of elastin -> collagen, which is stiffer)
Hearts are stiffer
Less response to adrenergic stimuli -> decreased ability to increase pumping

Question 2

Effect of Stiffening

Answer 2

Higher pressure at a given SV. Also get P wave reflection back faster, before aortic valve closure increasing systolic P as well. Diastolic decrease in P so higher pulse pressure (hammer like). Overall of this leads to decreased coronary perfusion (decreased diastolic P) and increased AL so higher O2 demand

Question 3

Diastolic Dysfunction

Answer 3

Prolonged AP relaxation (worse Ca pumping) and decreased compliance, causing less filling reserve yielding HF and increased Afib risk

Question 4

Systolic Dysfunction

Answer 4

Decreased response to symp and decreased ability to contract. EF doesn’t decrease, just ability to decrease it

Question 5

Body Fat % and Drug Distribution

Answer 5

Change in muscle to fat. Fat has less H2O, so hydrophilic drugs have higher conc. Also lipophilic have lower conc but can accumulate over time

Question 6

Age and Aggressive Treatment

Answer 6

Actually aggressive treatment can lead to greater improvement (bc mortality is worse anyway), so it might be a reason to consider more aggressive treatment. Gotta consider other RFs for bleeding out and shit though

Question 7

Treatment-Risk Paradox

Answer 7

Despite increased risk, less use of invasive strategies