Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AID- Ageing, Impairement and Disability > S4: Ageing Heart and Lungs > Flashcards

S4: Ageing Heart and Lungs Flashcards

1
Q

Define healthy ageing

A

Process of developing and maintaining the functional ability that enables wellbeing in older age (WHO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe functional ability

A

Functional ability is about having the capabilities that enable all the people to be and do what they have reason to value. This includes a person’s ability to :

  • Meet their basic needs.
  • To learn, grow and make decisions.
  • To be mobile.
  • To build and maintain relationships .
  • To contribute to society.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe primary ageing

A
  • Postulated to reflect and intrinsic, genetically pre-programmed limit on cellular longevity.
  • Hayflick Phenomenon - cells have a finite ability to replicate and at a certain point they cannot and then undergo apoptosis.
  • Seems to account for the relatively constant maximum life span in all animal species.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe secondary ageing

A
  • Due to the accumulated effects of environmental insults, disease and trauma over a lifespan.
  • It seems to explain the variability in life span of individuals of a species.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe normal heart and functions of CVS system

A
  • Made up of muscle, valves and electrical conduction system.
  • Dual chamber pump.
  • Figure of 8 circulation system from heart –>. Lungs –> heart –> body.
  • It is the body’s major transport system made up of the heart, arteries and veins.
  • It delivers oxygenated blood, nutrients and chemical signals to the organs and tissues.
  • It also transports waste products for elimination.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List normal structural (anatomical) changes in CVS with age

A

Changes occur in:

  • Heart muscle
  • Heart valves
  • Conduction pathways
  • Arteries and veins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List normal physiological changes in CVS with age

A
  • HR
  • BP
  • Myocardial function
  • CO
  • Valvular function
  • Endothelial function
    Conduction pathways
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe anatomical changes to heart muscle with age

A

Increase in left ventricular wall thickness due to:
- Increase myocyte size.
- Deposition of fibrous tissue (scarring of the muscle).
- Deposition of Amyloid.
There is also enlargement of the L atrium and slight enlargement and hypertrophy of left ventricular cavity in older.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe anatomical changes to heart valves with age

A
  • Increased thickness.
  • Decreased flexibility.
  • Calcification.
    This puts more strain on heart as different valves need to overcome pressure of other valves not working as well.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe physiological changes to heart valves with age

A

Systolic and diastolic murmurs may result from thickened, calcified and maligned valve leaflets.
The heart may have to generate higher pressure in heart to push blood pass the valves. This is worse if individual has high afterload.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe anatomical changes to conduction pathway in heart with age

A
  • Decreased number of pacemaker cells (SA node cells and 50-75% lost by age 50).
  • Fibrous tissue infiltration of conductive system which can cause conduction delays.
  • Number of cells in AV node remain constant. This is probably because these are blocking cells rather the cells generating the electrical potential which tend to get worn out at a faster rate.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe physiological changes to conduction pathway in heart with age

A

Irritability of the myocardium may result in extra systoles along with sinus arrhythmias and sinus bradycardia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe anatomical changes with arteries with ageing

A
  • Arteries are elastic and compliant at birth.
  • During systole when blood is ejected into the circulation, the arteries stretch reducing the resistance to blood flow. Capacitance when younger gives us the ability to react faster to problems CVS encounters e.g. Low BP arteries and veins can contract to increase vascular resistance to push blood around the body.
    With age:
  • Blood vessels lose their elasticity and compliance with age. They lose muscle tissue (elastic quality) and more connective tissue (not much functional capacity).
  • Lining of vessels problems starts in 20s e.g. plaque development, cholesterol development, atherosclerosis disease.
  • Peripheral arteries less resilient.
  • Larger arteries stiffer and less elastic and difficult to dilate.
  • Calcifications in artery walls including aorta.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe changes in aorta with ageing

A
  • May become dilated, elongated and rigid.
  • Stiffness affects the afterload of heart putting a lot of pressure on L ventricle.
  • May develop calcifications and become tortuous
    Decreased elastin + increased collagen = calcification = increased stiffness + decreased compliance.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe anatomical changes in veins with ageing

A

Veins dilate and stretch with decreased elasticity:

  • Intima and muscular walls thicken and become less elastic.
  • Veins lose functional ability e.g. varicosities.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe physiological heart rate changes with age

A
  • Decreased cardiac responsiveness rate with exercise.
  • Heart may take longer to return to baseline rate
  • Linear decrease in the maximal heart rate achievable during exercise with age.
  • With age, the supine resting heart rate does not change in healthy men.
  • However, ability to increase heart rate reduces significantly e.g. During excersize.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe physiological changes in BP in age

A

Systolic blood pressure may rise disproportionately higher than diastolic BP.
This can cause microvascular damage to blood vessels (narrowing and blockage) especially at end arteries in eyes and brain due to uncontrolled hypertension.

18
Q

List 3 changes in myocardial function with age

A

Decreased contractile strength and efficiency

Decreased cardiac output

Decreased cardiac reserve to recover

19
Q

Describe physiological changes in CO in age

A

Decreased CO in response to excersize or stress.

No change at rest as not under strain.

20
Q

Describe physiological changes in cardiac function (preload and afterload) with age

A

Preload:
- Early diastolic left ventricular filling rate progressively slows with age.
- Late diastole is greater because of increased atrial contraction.
- End diastolic volume in supine or seated position is not usually decreased in a healthy older patient.
Afterload:
- Decrease in elasticity and lumen diameter within the arterial tree leads to a gradual increased systolic blood pressure (more strain in LV to push blood out increasing back pressure)with age.
- Small arteries and arterioles become less responsive to vasodilator cues with age, further increasing peripheral resistance.

21
Q

List changes in left ventricle with ageing

A
  • Concentric hypertrophy.
  • Aortic valvulopathy.
  • Decreased heart rate variability.
  • Diastolic dysfunction.
  • Conduction abnormalities.
  • Mitral annular calcification.
22
Q

Describe diastolic dysfunction, diastolic abnormality , diastolic heart failure

A
  • Diastolic abnormality is most mild e.g. abnormal relaxation, abnormal early filling with normal exercise tolerance.
  • Diastolic dysfunction/HF-PEF in elderly –> ability of heart to fully relax to fill ventricles with blood decreases (problem in higher HR). there is reduced exercise tolerance.It is heart failure with preserved ejection fraction (in echogram).
  • Diastolic heart failure: HF with reduced ejection fraction.
23
Q

Describe changes in ejection fraction with age

A

On increased exertion, the ejection fraction is reduced due to a number of factors:

  • Increased vascular resistance.
  • Increased EDV.
  • Decreased maximal myocardial contractility.
  • Decreased contractility by adrenergic NS stimulation.
24
Q

What are the functional implications of normal age related changes of CVS?

A

They are influenced by presence of disease and lifestyle variations (secondary ageing). Implications:

  • Decreased response to stress.
  • Activity intolerance.
  • Orthostatic hypotension –> Blood vessels are too thick and when standing they cannot change in size for BF.
25
Q

Relationship between cardiac ageing and excersize

A
  • Peak exercise capacity and peak oxygen consumption decreases with age.
  • Aerobic capacity decreases by 50% between ages 20 and 80.
  • There is a decreased stress response with age.
26
Q

Summary of cardiovascular ageing and their consequences

A
  • Decreased elasticity
  • Decreased compliance
  • Atherosclerosis
  • Vascular stiffness and thickening
  • Endothelial dysfunction
  • Alterations in conduction tissue
  • Fibrosis
  • Increase in LV mass
  • Calcification
  • Amyloid deposition

Consequences

  • Higher BP
  • Ischaemic heart disease
  • Myocardial infarction
  • Heart failure
  • Arrhythmias
  • Stroke
27
Q

Modifiable CV risk factors

A 
BP (most important!)
Diabetes mellitus
Dyslipidemia
Smoking
Physical inactivity
Obesity
Stress
Post menopausal hormone therapy
Excess alcohol intake
28
Q

What are the important roles of respiratory system?

A
  • Major role is in gaseous exchange (O2, CO2).
    Also involved in:
  • Acid base homeostasis.
  • Control of BP.
  • Important role in non specific immune responses.
29
Q

What are the anatomical changes in respiratory ageing?

A
  • Loss of elasticity of rib cage (stiffer due to calcification, reduced amount of connective tissue).
  • Kyphosis.
  • Diaphragm falls in height thereby reducing its ability to generate force.
  • Lung parenchyma: loss of elasticity, alveolar degeneration, increasing air trapping (non functional air not being moved), reduced clearance of surface material secretions from small airways.
30
Q

What are the lung functional changes in respiratory ageing?

A
  • Reduced residual volume.
  • Increased dead space.
  • Reduced gas exchange, lung perfusion, resting plasma oxygen, loss of central autoregulation from CNS leading to a reduced response to hypoxia and hypercarbia.
31
Q

Describe the structural changes with lung

A
  • Decrease in elastic recoil
  • Alveolar sacs become shallower, decreased alveolar surface are by 15% by the age of 70.
  • Increased diameter of the respiratory bronchioles and alveolar ducts.
  • Changes result in premature closure of small airways during normal breathing which can cause air trapping and hyperinflation (‘senile emphysema’).
32
Q

Describe age associated changes in the chest wall

A

With ageing there is reduction in chest wall compliance due to:
- Stiffening of the thoracic cage from calcification of the rib cage.
- Age related kyphosis.
- Arthritis of costovertebral joint.
Therefore more muscular work is therefore required for ventilation and (20% more at 60 years vs 20 years) and increased work for breathing.

33
Q

Describe kyphosis in age

A
  • Kyphosis is collapsed curvature of spine. If not dealt with straight away it continues to progress.
  • Severe kyphosis –> oxygen needed at rest. This is because it can compress thorax reducing size it can expand.
  • 43% in 75-93 years old.
    Some causes of kyphosis:
  • Vertebral fractures (can be treated).
  • Decreased intervertebral disc space.
  • Osteoporosis –> collapsed vertebrae.
34
Q

Describe anatomical changes in respiratory muscles with age

A

Reduction in respiratory muscle strength in healthy elderly subjects:
- Muscle atrophy.
- Decrease in fast twitch fibres.
Predisposes individuals to diaphragmatic fatigue, higher work for breathing and ventilatory failure with increased ventilatory load

35
Q

Describe functional changes in respiratory muscles with age

A

Respiratory muscle performance is impaired by the age related increased in functional residual capacity.

  • Closely related to nutritional status.
  • MIP and MEP correlate with lead body mass (LBM). They are measures of diaphragmatic power and their ability to force air in and out. Demonstrates older you get, the less functional and weaker diaphragm is. MVV significantly lower in undernourished subjects
  • Necroscopic studies: correlation with LBM and diaphragmatic muscle mass.
36
Q

Functional changes in the lungs with age with the following measures : RV, VC, TLC, gas exchange and ppO2

A
  1. Residual volume (RV): Air remaining in the lungs following a full and forced expiration. Increased with age due to loss of lung elasticity and air trapping.
  2. Vital capacity (VC): Total volume of air that can be exhaled. Decreased with age due to chest wall rigidity
    and reduced respiratory muscle strength.
  3. Total lung capacity (TLC): Total volume of air within the lungs following a full inspiration. No change in age due to loss of elasticity counterbalanced by chest wall rigidity.
  4. Gas Exchange: The diffusion of gases from an area of higher concentration to an area of lower concentration. Reduced is age due to decreased alveolar surface area and increased ventilation/perfusion mismatch.
  5. Partial Pressure of Oxygen: The part of total blood gas pressure exerted by oxygen gas. Reduced in age due to decreased alveolar surface area, decreased gas exchange and increased ventilation/perfusion mismatch.
37
Q

Describe changes in spirometry with age

A 
FEV1 and FVC Increased up to:
- 20 years in females.
- 26 years in males.
Then annual decrease of:
- 29 ml (25-39).
- 38 ml (>65).
Particularly accelerated loss after 70 years.
38
Q

Changes in static pressure volume curve with age

A

Shifts left with steeper curve in age. Older –> harder to get air in and out.

39
Q

Describe vascular remodelling in lungs with age

A

Age related remodelling of pulmonary vasculature results in:
- Increased pulmonary vascular stiffness.
- Increased vascular pressure and resistance.
- Decreased pulmonary capillary blood volume.
These can put pressure on right side of the heart.

40
Q

Describe immunological changes to lungs in ageing

A

Increased risk of respiratory tract infections due to:
- Decreased mucociliary transport..
- Blunted cough reflex.
- Increased swallowing problems.
- Decreased in number and function of T cells and macrophages.
Ageing lungs may be subject to chronic low grade inflammation in the absence of overt lung disease. Bronchoalveolar lavage has demonstrated increased levels of neutrophils. IL-1 and IL-8 as well as neutrophil elastase.
Thought to be related to long standing exposures to atmospheric particles and pollutants, including passive smoking.
Problem with chronic inflammation in alveoli:
- Swelling of alveoli.
- Disruption of interaction between blood vessel which affects gas exchange

41
Q

Relationship between respiratory ageing and excersize

A
  • Excersize capacity is highly variable.
  • VO2 max (maximum oxygen consumption) is ‘an objective surrogate of fitness’ decrease by a rate of about 1% a year.
  • Increased decline seen in more sedentary individuals.
  • Depends upon individuals fitness levels.

AID- Ageing, Impairement and Disability (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions