The Aging Cardiovascular System Flashcards
What is the most common cardiovascular disease, 2nd, 3rd, 4th
HTN
CHD
HF
Stroke
Which heart diseases occur more in men, which more in women?
Men:CHD
Women: CHF
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?
74
Women the event usually occurs 10 years later in life
How does the thickness of the ventricular wall and size of heart chambers change with age?
Increase in LV thickness but no change in size of heart chambers
How do the distal conduction fibers and bundle of His change with age?
Small decline in distal fibers, little change in bundle of His
By 75 years, ____% of pacemaker cells are no longer present
90%
What is lipofuscin, where does it accumulate in the heart with aging
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.
2 autonomic control in cardiac function and circulation that occur with aging
Reduction in HRV
Reduction in arterial baroreflex sensitivity
Associated with increased CV risk
The effects of aging on the __________ system make up the greatest risk factors for CV disease, what happens
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)
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?
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
VO2=
How does it decline over time
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
Central (3) and peripheral (3) adaptations that contribute to decrease VO2max
Central: decreased CO, SV, HR
Peripheral: decreased capillaries in muscle tissue, decreased lean body mass, decreased ability for skeletal muscle to use O2
Normal CO at rest is ____ to____ L/min
4-6
Increases linearly with workload
SV=
How does body position affect this
When does it reach a max
EDV-ESV
Will be lower when sitting or standing vs supine
Max at approx 50% of a person’s exercise capacity
To boos SV during heavy exercises, how to older people adapt?
Frank-Starling Mechanism to maintain L V EDV as well as more complete L ventricular emptying to reduce end systolic volume
What did the authors of the Framingham Heart Study find about BP with age
Linear rise in SBP 30-84, whereas DPB increased then after ages 50 to 60 declined, appears to be due to large artery stiffness
HTN definition
> /= 140/90
Arteriovenous difference decrease with age is largely attributed to what?
Decreased blood flow to tissue due to impaired CO
Stage II HTN
> /=160/100
CHD caused 1 out _____ deaths in the US in 2005
1 in 5
According to the Framingham heart study, _____% of men and _____% of women under _____ years die of CHF within 8 years
80%
70%
65 years
Women and older adults showed the least improvement after onset
The most recognizable signs of HF are what (3 things)
Dyspnea, peripheral edema, and fatigue
R heart failure fluid builds up most notably in which 3 areas
Ankles, liver, spleen
L Heart failure, fluid builds up in which tissue(s)
Pulmonary veins
HTN affects more men or women?
Women
The end result of tachy, Brady, and dysrhthmia is what
Symptoms: 4
Decreased CO Dizziness Confusion Fatigue syncope
A-fib increases the risk of stroke by _____% and can be blamed for ____ to ____% of all strokes
500%
15-20%
People who have strokes caused by a-fib usually suffer more severe strokes and twice as likely to be bedridden
V-fib typically defined as ____ to ____ bum
140 to 200
Doesn’t usually directly cause death but 330,000 sudden cardiac deaths from coronary disease attributed to V fib
Acute coronary syndrome describes what?
Either an acute MI or unstable angina
Which 4 factors account for 75% of all PAD cases
Smoking
HTN
DMII
Hypercholesterolemia
Effects of Cardiovascular Medications on
Heart Rate
Exercise Capacity
Beta Blockers
Decrease in resting and exercise HR
Decreased or no effect in those without angina
Increased in those with angina
Effects of Cardiovascular Medications on
Heart Rate
Exercise Capacity
Nitrates
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
Effects of Cardiovascular Medications on
Heart Rate
Exercise Capacity
Ca2+ Channel Blockers
Variable
Increased in those with angina, no effect without angina
Effects of Cardiovascular Medications on
Heart Rate
Exercise Capacity
Digitalis
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
Effects of Cardiovascular Medications on
Heart Rate
Exercise Capacity
Vasodilators
Increased or no effect on resting and exercise HR
Increased or no change in those with CHF otherwise no change
“il” e.g. Minoxidil
Effects of Cardiovascular Medications on
Heart Rate
Exercise Capacity
ACE Inhibitors
No change in rested and exercise
Increased or no change in CHF, otherwise no change
“Pril”s
Diuretics work well for people with mild, moderate, and/or severe HTN
Mild to mod
Side effects of diuretics
What do the drug names end with
Hypokalemia, hyponatremia, which can cause serious metabolic and cardiac problems, weakness, fatigue (esp with sodium depletion) orthostatic hypotension
“IDE” e.g. Furosemide, thiazides
Side effects of vasodilators:
Which one increases hair growth
Reflex tachycardia, dizziness, postural hypotension, weakness, fluid retention, headaches
Minoxidil increases hair growth
Excess angiotensin II can lead to what?
Hypertrophy of the vascular wall, and vasoconstriction
Side effects of angiotensin II blockers vs ACE inhibitors
“Pril”
ACE inhibitors can cause dry cough and rash which can lead to poor adherence
Angiotensin II doesn’t have these “sartan”
Calcium channel blockers more commonly used to treat ______ but also _____
Associated with increased risk of what?
Angina, HTN
MI and other CV events
The 4 types of drugs used to treat cardiac arrhythmias
Side effects
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
Angina is usually treated with one of 3 drugs
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
3 antithrombotic agents and side effects
Aspirin
Clopidogrel
Ticlopidine
Gastric irritation, bleeding, liver and kidney toxicity
Anticoagulant drugs 2
Heparin, warfarin
thrombolytic drugs 2
Anistreplase, streptokinase
Good for treating acute MI , dissolve blood clots already formed
Side effects of statins
GI distress, should follow up with physician regularly because can cause liver dysfunction
Neuromuscular problems can also occur, including paresthesias, myalgia, myositis, fatigue.
Costs/benefits of CABG vs cardiac angioplasty
More risk with CABG
Outcomes similar
More complete revascularization with CABG
Activity restrictions following pacemaker placement
Should avoid driving or participating in vigorous, esp UE activity for several weeks
Hemoglobin A1c test results, what should it be less than for people with diabetes, without diabetes in people with CV disease
<6.5 for ppl with DM
<6 for ppl without
>6.5 means DM
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
<70mg/dL
<100
<130
HDL should be higher than ____ for everyone
40 mg/dL
Low Intermediate High Risk of MI, stroke, PVD, re-stenosis Of C-reactive protein
<1 mg/L low
1.0-2.9
>3 high
Homocysteine levels greater than ______ are associated with increased risk of CV disease
10 micromol/L
Metric and American ways to calculate BMI
Lbs x 705/height in inches = # #/inches = BMI
Kg/m^2
If person a long term statin user, what can happen to muscles
Weakness: drug-induced myopathy
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
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
What is the new recommended formula for HRmax for healthy older adults, why change?
What is the Best Fit formula
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.
Karvonen formula
((HRmax-HRrest) x percent intensity) + HR rest
The AHA and ACSM recommend alternating ____ to ____ on the modified Bord for moderate activity to _____ to _____ for intense activity
5-6
7-8
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?
30 20 Recommend 20-60 minutes per day 3-7 days per week 11-14 on the borg (3-4 out of 10)
Initial stage of progression How long How intense? Improvement Stage Maintenance Stage
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
What does the ACSM recommend increasing instead of intensity initially
Frequency, duration, or both
Strength training ACSM recommendations for older adults
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
What is Ehsani et al find about the physiological mechanisms underlying increased aerobic power in octogenarians with mild to moderate frailty.
Improvements in aerobic power, CO and L ventricular SV. Attributed increased CO to increased HR and SV, rather than improved O2 extraction.
What is Andes et all find about intense aerobic exercise following MI or CABG in individuals 75 years and older
Peak exercise CO didn’t improve, but peak aerobic capacity and AV O2 difference at peak did.
What does Okazaki recommend for exercise to reduce BP
75% of HR max for ~200 minutes per week, but can also obtain modest effect if 75% for 95 to 150 minutes per week.
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
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
What may be better than angina to determine exercise capacity in an individual with HF
SOB
Resistance level should be reassessed every ______ weeks to ensure strength improves
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
Recommended equation for Max HR for older adults
208-(.7xage)
