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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
HTN affects more men or women?
Women
26
The end result of tachy, Brady, and dysrhthmia is what | Symptoms: 4
``` Decreased CO Dizziness Confusion Fatigue syncope ```
27
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
28
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
29
Acute coronary syndrome describes what?
Either an acute MI or unstable angina
30
Which 4 factors account for 75% of all PAD cases
Smoking HTN DMII Hypercholesterolemia
31
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
32
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
33
Effects of Cardiovascular Medications on Heart Rate Exercise Capacity Ca2+ Channel Blockers
Variable | Increased in those with angina, no effect without angina
34
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
35
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
36
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
37
Diuretics work well for people with mild, moderate, and/or severe HTN
Mild to mod
38
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
39
Side effects of vasodilators: | Which one increases hair growth
Reflex tachycardia, dizziness, postural hypotension, weakness, fluid retention, headaches Minoxidil increases hair growth
40
Excess angiotensin II can lead to what?
Hypertrophy of the vascular wall, and vasoconstriction
41
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"
42
Calcium channel blockers more commonly used to treat ______ but also _____ Associated with increased risk of what?
Angina, HTN | MI and other CV events
43
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 ```
44
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
45
3 antithrombotic agents and side effects
Aspirin Clopidogrel Ticlopidine Gastric irritation, bleeding, liver and kidney toxicity
46
Anticoagulant drugs 2
Heparin, warfarin
47
thrombolytic drugs 2
Anistreplase, streptokinase | Good for treating acute MI , dissolve blood clots already formed
48
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.
49
Costs/benefits of CABG vs cardiac angioplasty
More risk with CABG Outcomes similar More complete revascularization with CABG
50
Activity restrictions following pacemaker placement
Should avoid driving or participating in vigorous, esp UE activity for several weeks
51
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
52
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
53
HDL should be higher than ____ for everyone
40 mg/dL
54
``` Low Intermediate High Risk of MI, stroke, PVD, re-stenosis Of C-reactive protein ```
<1 mg/L low 1.0-2.9 >3 high
55
Homocysteine levels greater than ______ are associated with increased risk of CV disease
10 micromol/L
56
Metric and American ways to calculate BMI
``` Lbs x 705/height in inches = # #/inches = BMI ``` Kg/m^2
57
If person a long term statin user, what can happen to muscles
Weakness: drug-induced myopathy
58
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
59
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.
60
Karvonen formula
((HRmax-HRrest) x percent intensity) + HR rest
61
The AHA and ACSM recommend alternating ____ to ____ on the modified Bord for moderate activity to _____ to _____ for intense activity
5-6 | 7-8
62
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) ```
63
``` 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
64
What does the ACSM recommend increasing instead of intensity initially
Frequency, duration, or both
65
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
66
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.
67
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.
68
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.
69
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
70
What may be better than angina to determine exercise capacity in an individual with HF
SOB
71
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
72
Recommended equation for Max HR for older adults
208-(.7xage)

Geriatric Clinical Specialist (8 decks)

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