24.2 CVS changes in Elderly

Question 1

Q
a) Outline the major changes in the cardiovascular system of elderly patients. (35%)
b) What are the perioperative implications of each change? (65%)

Answer 1

1. Reduced arterial elasticity
2. Loss of atrial pacemaker cells*
3. Loss of cells of the atrioventricular Node**
4. Increased risk of valvular disease.
5. Decreased beta receptor function and numbers.**
6. Reduced carotid baroreceptor
   response to hypotension.**
7. Increased risk of
   ischaemic heart disease

Question 2

Reduced arterial elasticity

Answer 2

Reduced arterial elasticity and
arteriosclerosis causing raised
systemic vascular resistance,
longstanding hypertension and
consequent left ventricular
hypertrophy.

Cardiovascular instability.

Excessive pressor responses,
may need obtunding.

Need to maintain blood pressure at
usual levels to ensure
cerebral perfusion.

Antihypertensive medication may result in electrolyte
imbalance or perioperative hypotension.

Diastolic dysfunction, reduced ability to cope with fluid load.

Question 3

Loss of atrial pacemaker cells

Answer 3

Loss of atrial pacemaker cells.
Lower intrinsic heart rate.

In conjunction with reduced
ability to increase stroke volume,

there is less ability to respond to
reduced blood pressure caused by
vasodilatation caused by anaesthetic agents.

Question 4

Loss of cells of the atrioventricular node

Answer 4

Loss of cells of the atrioventricular
node and conduction pathways.

Susceptible to arrhythmias

Question 5

Increased risk of valvular disease.

Answer 5

Increased risk of valvular disease.

Depends on valve and problem with valve:
issues include reduced ability to
cope with fluid loads or losses;

fixed cardiac output state which
may contraindicate neuraxial
techniques.

Question 6

Decreased beta receptor functionand numbers.

Answer 6

Decreased beta receptor function
and numbers.

Impaired response to catecholamines and
sympathomimetics,
hypotension more difficult to treat

Question 7

Reduced carotid baroreceptor response to hypotension.

Answer 7

Reduced carotid baroreceptor
response to hypotension.
Impaired response to hypotension.

Question 8

Increased risk of ischaemic heart disease.

Answer 8

Increased risk of perioperative acute coronary syndrome.