The ageing heart and lungs

Question 1

What does a normal artery consist of?

Answer 1

intima, media, adventitia

Question 2

What happens to arteries when ageing?

Answer 2

artery becomes thicker and less compliant:

increased collagen
less elastin
calcification
endothelium becomes more permeable= blood and leucocytes can go under endothelial layer
leukocytes secrete cytokines= change interaction in intima and media

Question 3

Where do smooth muscle cells migrate during ageing and what do they become?

Answer 3

to the intima

they become fibroblasts

Question 4

What can happen to large arteries when ageing?

Answer 4

become elongated and tortuous (twisted)

Question 5

If large arteries become elongated and twisted, what happens as a result?

Answer 5

reduced baroreflex sensitivity= leads to sympathetic activation

Question 6

What is endothelial dysfunction?

Answer 6

NO = vasodilator, relaxes VSMC, lowers risk of atheroma

after 20 years, NO decreases

Question 7

What does NO do?

Answer 7

vasodilator and relaxes VSMC

Question 8

What happens as a result of arterial wall thickening and endothelial dysfunction?

Answer 8

atherosclerosis

Question 9

Why does ventricular hypertrophy happen?

Answer 9

because the heart is working against high afterload
fibrosis
hypertrophy of cardiac myocytes
addition of sarcomeres
left ventricle is thicker
and left ventricle volume is smaller compared to normal heart

Question 10

because of left ventricular hypertrophy, why will there be changes in diastole?

Answer 10

bc in early diastole, filling or the ventricle occurs bc the heart is relaxed
later diastole there is atrial contraction which fills ventricle even more
when the heart is stiff, it cant relax
so filling can only occur in late diastole (when atria contracts)

Question 11

Which function of the heart is most affected in ageing- systolic or diastolic?

Answer 11

diastolic

systolic rises more though

Question 12

What is a risk for atrial fibrillation?

Answer 12

increased atrial contractions bc it leads to hypertrophy and fibrosis of the atria

Question 13

What happens to heart rate as we age?

Answer 13

max heart rate in stress/ exercise is LOWER

RESTING HR IS SAME THROUGHOUT

Question 14

Why does heart rate for stress/exercise decrease with age?

Answer 14

autonomic dysfunction

Question 15

What happens to cardiac output in elderly at rest?

Answer 15

AT REST: no change bc HR and SV normal at rest

Question 16

What happens to cardiac output in elderly under stress/exercise?

Answer 16

CO= HR X SV
less max heart rate at exercise so cant increase CO by heart rate
low ventrical filling bc of hypertrophy and increased HR (bc of exercise) so SV is less
so CO will be less at exercise

Question 17

What happens to the SAN with ageing?

Answer 17

fibrosis
less SAN cells
so less SAN function

Question 18

What happens to the conduction system of the heart?

Answer 18

slower

bc fibrous, fatty and amyloid infiltration

Question 19

How is slower conduction shown on an ECG?

Answer 19

prolonged QRS complex

prolonged PR interval

Question 20

wHAT HAPPENS TO AGEING mitral valve?

Answer 20

mixomatous changes= fibrous and mucosal deposition

Question 21

What does mixomatous changes to the mitral valve lead to?

Answer 21

a floppy mitral valve so mitral regurgitation

pan systolic murmur

Question 22

What happens to the aortic valve?

Answer 22

calcification= aortic stenosis

will hear systolic murmur

Question 23

What happens in between vertebraes?

Answer 23

degenerating intervertebral discs= leads to kyphosis

Question 24

What does kyphosis lead to?

Answer 24

less space between ribs
smaller chest cavity
so less FEV1 and FVC

Question 25

What happens to the respiratory muscles when ageing?

Answer 25

become weaker diaphragm flattens inspiratory and expiratory muscles weaken less ATP in resp muscles mitochondria

Question 26

Why, in elderly, is there poor airway clearance?

Answer 26

decreased cough strength | less mucociliary clearance

Question 27

Why is there less mucociliary clearance in elderly?

Answer 27

less cilia | slow and less effective cilia beatig

Question 28

What happens to alveoli in ageing?

Answer 28

less elastin fibres in alveoli ducts= become thinner | less gas exchange

Question 29

What happens to carbon dioxide excretion with age?

Answer 29

doesn't change

Question 30

What happens to chemoreceptor function?

Answer 30

less respiratory response to hypercapnia and hypoxia

Question 31

What happens to the veins of the ageing heart?

Answer 31

dilate and have less elastin | intima and muscle wall thicken

Question 32

What do stiffer arteries lead to?

Answer 32

increased TPR increased systolic BP diastolic pressure decrease

Question 33

What is isolated systolic hypertension?

Answer 33

raises systolic BP contributes to further systolic BP increase

Question 34

Where is NO produced?

Answer 34

endothelial cells that line the lumen

Question 35

What happens to the afterload in the left ventricle?

Answer 35

increases

Question 36

With age, by how many beats per minute does the intrinsic heart rate (HR NOT AFFECTED BY ANS) reduce every decade?

Answer 36

5-6 bpm

Question 37

What happens to cardiac reserve as we age?

Answer 37

reduces- so we have less ability to compensate

Question 38

Why do we have a reduced cardiac reserve when we age?

Answer 38

less contractility less blood volume in LV less max heart rate

Question 39

What can a slow conduction system of the heart cause?

Answer 39

premature atrial beats ventricular ectopics high risk of arrhythmias

Question 40

What happens as a result of less gas exchange in the lungs?

Answer 40

increase V/Q mismatch

Question 41

What is a pulmonary function test?

Answer 41

Pulmonary function tests are a group of tests that measure how well the lungs work in ventilation and they are good at diagnosing obstructive and restrictive illnesses

Question 42

What happens to total lung capacity, FVC, FEV1 as we age?

Answer 42

total lung capacity stays same FVC reduces FEV1 reduces

Question 43

Why do older people have reduced cough strength?

Answer 43

weaker muscles | less sensitive cough reflex

Question 44

How does surfactant composition change with age?

Answer 44

increased proinflammatory proteins

Question 45

What is primary ageing?

Answer 45

genetically pre-programmed limit on cellular longevity

Question 46

What is secondary ageing?

Answer 46

environment insults, trauma and disease

Question 47

What can irritability of the myocardium lead to?

Answer 47

extra systoles, sinus arrhythmias and sinus bradycardia