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Geriatric Clinical Specialist > The Aging Cardiovascular System > Flashcards

The Aging Cardiovascular System Flashcards

1
Q

What is the most common cardiovascular disease, 2nd, 3rd, 4th

A

HTN
CHD
HF
Stroke

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2
Q

Which heart diseases occur more in men, which more in women?

A

Men:CHD
Women: CHF

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3
Q

Based on the National Heart, Lung, and Blood Institute’s Framingham Heart Study 2006 report the average annual rate of first-time major CV event in men rises from 3 per 1000 agent 35 to 44 to ______ per 1000 agent 85 to 94. Difference in women?

A

74

Women the event usually occurs 10 years later in life

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4
Q

How does the thickness of the ventricular wall and size of heart chambers change with age?

A

Increase in LV thickness but no change in size of heart chambers

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5
Q

How do the distal conduction fibers and bundle of His change with age?

A

Small decline in distal fibers, little change in bundle of His

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6
Q

By 75 years, ____% of pacemaker cells are no longer present

A

90%

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7
Q

What is lipofuscin, where does it accumulate in the heart with aging

A

In the poles of cardiac muscle cell nuclei
Lipofuscin is the name given to finely granular yellow-brown pigment granules composed of lipid-containing residues of lysosomal digestion. It is considered to be one of the aging or “wear-and-tear” pigments, found in the liver, kidney, heart muscle, retina, adrenals, nerve cells, and ganglion cells.

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8
Q

2 autonomic control in cardiac function and circulation that occur with aging

A

Reduction in HRV
Reduction in arterial baroreflex sensitivity
Associated with increased CV risk

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9
Q

The effects of aging on the __________ system make up the greatest risk factors for CV disease, what happens

A

Vascular system
Decreased elasticity so frayed, fragmented, thinned
Increase in amyloid plaque deposition and collagen deposition on the walls (may be insulin-Ruiz-Torres found that decrease in blood levels of insulin-like growth factor I even though there is an increase in insulin secretion , especially in those with obesity)

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10
Q

In the media of the cells of the blood vessels, most significant age related change? Which vessel demonstrates the most prominent, which the least prominent?

A

Increased calcification and thickening elastic fragmentation, thoracic aorta most prominent, renal artery least
Proximal vessels demonstrate changes soonest, but distal undergo the most prominent changes

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11
Q

VO2=

How does it decline over time

A

CO x (a-vo2diff)
10% per decade from ages 20 to 60 both sedentary and active people
Primarily related to reductions in physical activity and aging

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12
Q

Central (3) and peripheral (3) adaptations that contribute to decrease VO2max

A

Central: decreased CO, SV, HR
Peripheral: decreased capillaries in muscle tissue, decreased lean body mass, decreased ability for skeletal muscle to use O2

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13
Q

Normal CO at rest is ____ to____ L/min

A

4-6

Increases linearly with workload

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14
Q

SV=
How does body position affect this
When does it reach a max

A

EDV-ESV
Will be lower when sitting or standing vs supine
Max at approx 50% of a person’s exercise capacity

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15
Q

To boos SV during heavy exercises, how to older people adapt?

A

Frank-Starling Mechanism to maintain L V EDV as well as more complete L ventricular emptying to reduce end systolic volume

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16
Q

What did the authors of the Framingham Heart Study find about BP with age

A

Linear rise in SBP 30-84, whereas DPB increased then after ages 50 to 60 declined, appears to be due to large artery stiffness

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17
Q

HTN definition

A

> /= 140/90

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18
Q

Arteriovenous difference decrease with age is largely attributed to what?

A

Decreased blood flow to tissue due to impaired CO

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19
Q

Stage II HTN

A

> /=160/100

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20
Q

CHD caused 1 out _____ deaths in the US in 2005

A

1 in 5

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21
Q

According to the Framingham heart study, _____% of men and _____% of women under _____ years die of CHF within 8 years

A

80%
70%
65 years
Women and older adults showed the least improvement after onset

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22
Q

The most recognizable signs of HF are what (3 things)

A

Dyspnea, peripheral edema, and fatigue

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23
Q

R heart failure fluid builds up most notably in which 3 areas

A

Ankles, liver, spleen

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24
Q

L Heart failure, fluid builds up in which tissue(s)

A

Pulmonary veins

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25
Q

HTN affects more men or women?

A

Women

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26
Q

The end result of tachy, Brady, and dysrhthmia is what

Symptoms: 4

A 
Decreased CO
Dizziness
Confusion
Fatigue
syncope
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27
Q

A-fib increases the risk of stroke by _____% and can be blamed for ____ to ____% of all strokes

A

500%
15-20%
People who have strokes caused by a-fib usually suffer more severe strokes and twice as likely to be bedridden

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28
Q

V-fib typically defined as ____ to ____ bum

A

140 to 200

Doesn’t usually directly cause death but 330,000 sudden cardiac deaths from coronary disease attributed to V fib

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29
Q

Acute coronary syndrome describes what?

A

Either an acute MI or unstable angina

30
Q

Which 4 factors account for 75% of all PAD cases

A

Smoking
HTN
DMII
Hypercholesterolemia

31
Q

Effects of Cardiovascular Medications on
Heart Rate
Exercise Capacity
Beta Blockers

A

Decrease in resting and exercise HR
Decreased or no effect in those without angina
Increased in those with angina

32
Q

Effects of Cardiovascular Medications on
Heart Rate
Exercise Capacity
Nitrates

A

Increased resting HR and Increased or no effect exercise HR

Increased in those with angina, in effect in those without angina, increased or no effect in those with CHF

33
Q

Effects of Cardiovascular Medications on
Heart Rate
Exercise Capacity
Ca2+ Channel Blockers

A

Variable

Increased in those with angina, no effect without angina

34
Q

Effects of Cardiovascular Medications on
Heart Rate
Exercise Capacity
Digitalis

A

Decreased HR in those with A-fib and possible CHF
No change in those with sinus rhythm
Increased only in those with A-fib or CHF
Digitalis plant used to create drugs e.g. Digoxin and Digitoxin
Low therapeutic index so higher change of toxicity

35
Q

Effects of Cardiovascular Medications on
Heart Rate
Exercise Capacity
Vasodilators

A

Increased or no effect on resting and exercise HR
Increased or no change in those with CHF otherwise no change

“il” e.g. Minoxidil

36
Q

Effects of Cardiovascular Medications on
Heart Rate
Exercise Capacity
ACE Inhibitors

A

No change in rested and exercise
Increased or no change in CHF, otherwise no change
“Pril”s

37
Q

Diuretics work well for people with mild, moderate, and/or severe HTN

A

Mild to mod

38
Q

Side effects of diuretics

What do the drug names end with

A

Hypokalemia, hyponatremia, which can cause serious metabolic and cardiac problems, weakness, fatigue (esp with sodium depletion) orthostatic hypotension
“IDE” e.g. Furosemide, thiazides

39
Q

Side effects of vasodilators:

Which one increases hair growth

A

Reflex tachycardia, dizziness, postural hypotension, weakness, fluid retention, headaches
Minoxidil increases hair growth

40
Q

Excess angiotensin II can lead to what?

A

Hypertrophy of the vascular wall, and vasoconstriction

41
Q

Side effects of angiotensin II blockers vs ACE inhibitors

A

“Pril”
ACE inhibitors can cause dry cough and rash which can lead to poor adherence
Angiotensin II doesn’t have these “sartan”

42
Q

Calcium channel blockers more commonly used to treat ______ but also _____
Associated with increased risk of what?

A

Angina, HTN

MI and other CV events

43
Q

The 4 types of drugs used to treat cardiac arrhythmias

Side effects

A

Class I Sodium channel blockers,
Class II Beta blockers most effective if dys. In atria
Class III Prolong depolarization act on potassium
Class IV Ca2+ Channel Blockers SA node

Developing new arrhythmia, esp Class I
Class I visual disturbances and nausea
Class IV:  excessive bradycardia
Class II : heart failure
Class I and IV dizziness
44
Q

Angina is usually treated with one of 3 drugs

A

Organic nitrates-decrease O2 demand of heart by decreasing pre-load and after load due to distal vessel dilation
Beta blockers
Ca2+ Channel blockers-increase myocardial O2 supply by vasodilation of vessels in heart

45
Q

3 antithrombotic agents and side effects

A

Aspirin
Clopidogrel
Ticlopidine
Gastric irritation, bleeding, liver and kidney toxicity

46
Q

Anticoagulant drugs 2

A

Heparin, warfarin

47
Q

thrombolytic drugs 2

A

Anistreplase, streptokinase

Good for treating acute MI , dissolve blood clots already formed

48
Q

Side effects of statins

A

GI distress, should follow up with physician regularly because can cause liver dysfunction
Neuromuscular problems can also occur, including paresthesias, myalgia, myositis, fatigue.

49
Q

Costs/benefits of CABG vs cardiac angioplasty

A

More risk with CABG
Outcomes similar
More complete revascularization with CABG

50
Q

Activity restrictions following pacemaker placement

A

Should avoid driving or participating in vigorous, esp UE activity for several weeks

51
Q

Hemoglobin A1c test results, what should it be less than for people with diabetes, without diabetes in people with CV disease

A

<6.5 for ppl with DM
<6 for ppl without
>6.5 means DM

52
Q

What should LDL be below for people with heart/blood vessel disease, at very high risk of CV,
Those at high risk of CV such as those with diabetes
All others

A

<70mg/dL
<100
<130

53
Q

HDL should be higher than ____ for everyone

A

40 mg/dL

54
Q 
Low
Intermediate
High
Risk of MI, stroke, PVD, re-stenosis 
Of C-reactive protein
A

<1 mg/L low
1.0-2.9
>3 high

55
Q

Homocysteine levels greater than ______ are associated with increased risk of CV disease

A

10 micromol/L

56
Q

Metric and American ways to calculate BMI

A 
Lbs x 705/height in inches = #
#/inches = BMI

Kg/m^2

57
Q

If person a long term statin user, what can happen to muscles

A

Weakness: drug-induced myopathy

58
Q

The optimal training intensity for the well older adult is _____ to ______ of Vo2 max which corresponds to _____ to _____ of HRmax according to ACSM
How did Swain et al adjust this
Generally for healthy adults, ____ to ____of HR max is accepted training range

A

60-80
70-85
Swain though this was an underestimate, suggested 60 should correspond to 75% HR max, and 80 should correspond to 88% HR max
60-90

59
Q

What is the new recommended formula for HRmax for healthy older adults, why change?
What is the Best Fit formula

A

220-age can underestimate older adults
208-.7xage

Best fit formula takes into account person’s weight
210-50% of age minus 5% of body weight + 4 if male and 0 if female.

60
Q

Karvonen formula

A

((HRmax-HRrest) x percent intensity) + HR rest

61
Q

The AHA and ACSM recommend alternating ____ to ____ on the modified Bord for moderate activity to _____ to _____ for intense activity

A

5-6

7-8

62
Q

ACSM recommend a minimum of ____ min if the activity is moderate and minimum of ____ if the activity is vigorous
How many days per week?
RPE?

A 
30
20
Recommend 20-60 minutes per day
3-7 days per week
11-14 on the borg (3-4 out of 10)
63
Q 
Initial stage of progression
How long
How intense?
Improvement Stage
Maintenance Stage
A

4 weeks, moderate, work up to 30 min
4-5 months, increase higher intensity, 35-40 min, 20-30 high intensity
Continue for maintenance stage

64
Q

What does the ACSM recommend increasing instead of intensity initially

A

Frequency, duration, or both

65
Q

Strength training ACSM recommendations for older adults

A

8-10 exercises, ~12 reps, 12-13 on RPE first increase reps then resistance
At least 2 days per week, 48 hours rest between
20-30 minutes, >60 min bad

66
Q

What is Ehsani et al find about the physiological mechanisms underlying increased aerobic power in octogenarians with mild to moderate frailty.

A

Improvements in aerobic power, CO and L ventricular SV. Attributed increased CO to increased HR and SV, rather than improved O2 extraction.

67
Q

What is Andes et all find about intense aerobic exercise following MI or CABG in individuals 75 years and older

A

Peak exercise CO didn’t improve, but peak aerobic capacity and AV O2 difference at peak did.

68
Q

What does Okazaki recommend for exercise to reduce BP

A

75% of HR max for ~200 minutes per week, but can also obtain modest effect if 75% for 95 to 150 minutes per week.

69
Q

In their 2009 updated Practice the American College of cardiology Foundation and AHA found evidence to recommend what in terms of people with reduced ejection fraction

A

Recommend exercise training as beneficial adjust to improve clinical status in ambulatory individuals with current and prior symptoms of HF and reduced LV ejection fraction

70
Q

What may be better than angina to determine exercise capacity in an individual with HF

A

SOB

71
Q

Resistance level should be reassessed every ______ weeks to ensure strength improves

A

2-3 weeks

If 70% to 80% of one rep max should be somewhat hard to hard, should be able to complete about 10 reps

72
Q

Recommended equation for Max HR for older adults

A

208-(.7xage)

Geriatric Clinical Specialist (8 decks)

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