The Ageing Heart

Question 1

STRUCTURAL CHANGES:
How does the LV and LA change?

How do the Valves change?
→ Which valves are most affected?

How does the Conduction system change?
→ Which part of it remains unaffected?

How do the Arteries changes?

How does the Aorta change?

How do the Veins changes?

Answer 1

• • LV enlargement and hypertrophy (↑Myocyte size and thickness), Deposition of Amyloid and Fibrous tissue
  • LA enlargement
• ↑Thickness and ↓Flexibility
  → Mitral and Aortic valves
• ↓Pacemaker cells (SAN), Deposition of Fibrous tissue
  → AV node
• Stiffening, Less elastic, Calcification, Stenosis
• Dilated, Elongated, Rigid, may become Calcified and Tortuous; ↓Elastin and ↑Collagen = Calcification
• Dilated, T.media and intima thicken and become less elastic

Question 2

PHYSIOLOGICAL CHANGES:
How does BP change?

How does Myocardial function change?

Why is there Diastolic Dysfunction?

Answer 2

• Rise in Systolic BP more than Diastolic BP
• ↓Contractility and ↓CO in response to exercise/stress
• Dilated ventricle, Abnormal relaxation, ↑LA size and pressure

Question 3

HAEMODYNAMIC CHANGES:
Why do Systolic and Diastolic murmurs occur?

How does Preload change?

How does Afterload change? What does this lead to?

How does the Ejection fraction on exercise change?

Answer 3

• Calcified, thickened, maligned valves
• • EARLY diastolic LV filling is slower
  • LATE diastole is faster due to stronger atrial contraction
  • EDV not usually decreased in a healthy older patient
• Increased due to ↓Elasticity and Responsiveness to vasodilation = ↑TPR and Systolic BP
• ↓Ejection Fraction on exercise - Due to ↑TPR, ↑EDV, ↓Contractility, ↓Responsiveness to Sympathetics

Question 4

What are the consequences of all these heart changes?

What are the Modifiable Cardiovascular Risk factors?

Answer 4

• HTN, Angina, IHD, MI, Heart failure, Arrhythmia, Stroke
• • HTN, Diabetes, Obesity, Dyslipidaemia, Smoking, Inactivity
  • Stress, Excessive alcohol intake, Post-menopause hormone therapy