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BIOL0027 > Cardiovascular Disease and Ageing > Flashcards

Cardiovascular Disease and Ageing Flashcards

1
Q

Where is most of the stroke volume stored and why?

A

Venous reservoir

Veins more compliant than arteries

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2
Q

How does CV disease incidence change with age?

A

Exponentially increases

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3
Q

What are the 2 types of age-related exposures?

A

Unavoidable - passage of time (ageing)

Avoidable - risk factors that accumulate over time

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4
Q

What do age-related exposures interact with and how do they determine outcomes?

A

Interact with genetic predisposition
Both contribute to reparative and deteriorative processes
Balance between reparative and deteriorative processes determines outcomes

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5
Q

What is the main evidence against the idea that coronary heart disease (CHD) is caused by avoidable exposures accumulating over time and not ageing itself?

A

Decreased CHD incidence since 1970s

At same time proportion of old people in population increased

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6
Q

What can most of the decrease in CHD incidence in Australia be explained by and what does this suggest?

A

Decreased lifestyle risk factor exposure - decreased smoking, controlled blood pressure, decreased cholesterol
Suggests due to lifestyle changes and improved treatments

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7
Q

How is the incidence of heart failure changing, why is this notable, and what does it suggest?

A

Increasing
Exception to overall decreasing CVD rates
Could be disease of ageing

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8
Q

Name the 3 factors that cause effects often attributed to ageing

A

Smoking
Diet salt intake effect on blood pressure
Dietary effect of cholesterol

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9
Q

How does the incidence of lung cancer change with age?

A

Increases

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10
Q

How does the number of lung cancer deaths attributable to smoking change with age?

A

Increases

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11
Q

How does blood pressure change with age in a western (high dietary salt) population?

A

Increasing systolic BP from 20-80yrs old
Increasing diastolic BP before 50 - then decline
Increasing pulse pressure after 50

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12
Q

How does blood pressure change with age in a Tsimane tribe (low dietary salt) population?

A

Minimal BP changes

Slight systolic BP increase

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13
Q

What do the differences in BP changes over the life-course between high and low salt communities suggest?

A

Western BP changes with age could be due to abnormally high dietary salt intake

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14
Q

How does blood cholesterol change with age in a Minnesota population?

A

Increasing levels until 70yrs old - then decline

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15
Q

How does blood cholesterol change with age in a Kyushu population?

A

Slight increase with age

At all ages lower than in Minnesota population

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16
Q

What are the Minnesota and Kyushu blood cholesterol levels linked to and what does this suggest?

A

Minnesota - high atherosclerosis levels
Kyushu - very low atherosclerosis levels
Atherosclerosis linked to lifetime dietary habits - not disease of ageing

17
Q

What are the age-associated effects on the heart?

A

Increased left ventricle muscle mass (cardiac hypetrophy) - decreased chamber volume
Stiffer left ventricle - fibrosis forms
Enlarged left atrium - increased contraction strength - compromises ventricular filling
Impaired left ventricular relaxation - causes diastolic dysfunction
Increased filling pressures - causes heart failure with preserved ejection fraction

18
Q

Why might heart failure with preserved ejection fraction (HFPEF) be the result of cardiac ageing?

A

Often in older people without CHD history

19
Q

What is HFPEF?

A

Proportion of blood in left ventricle ejected (ejection fraction) preserved
Left ventricle does not fill with enough blood

20
Q

What is HFREF?

A

Decreased proportion of blood ejected from left ventricle

21
Q

What is HFREF due to?

A

Weakened heart muscle

22
Q

What is HFPEF due to?

A

Left ventricular hypertrophy, fibrosis, microvascular disease - causes smaller chambers and stiffer, thicker walls - impairs relaxation in diastole

23
Q

How might HFPEF be linked to large artery stiffening?

A

Could be consequence/cause

More work needed by heart to maintain same stroke volume

24
Q

What causes cardiac fibrosis in HFPEF?

A

Neutrophils - contribute to myofibroblast activation - release extracellular matrix proteins - cause fibrosis

25
Q

How do large arteries change with age?

A

Stiffening - due to oxi stress and inflammation

26
Q

What is the effect of large artery stiffening with age?

A

Ejection into stiffer arteries - causes large pulse pressure increase after 50yrs old

27
Q

How do small arteries and arterioles change with age?

A

Decreased number of arterioles, increased arteriole tortuousity - fewer and narrower vessels - increases total systemic resistance
Oxi stress and inflammation - decreases NO production - impairs endothelial vasodilation

28
Q

How do capillaries change with age?

A

Fewer capillaries - compromises exchange
Endothelial cell apoptosis - decreases capillary permeability - in brain contributes to cognitive decline
BBB breakdown - allows aberrant factors into brain

29
Q

How do veins change with age?

A

Fibrosis and collagen fibres - veins stiffen - decreases venous compliance - decreases venous reservoir
Decreased venodilation - increases central venous pressure

30
Q

How might vein stiffening be linked to impaired heart filling?

A

Could be cause/consequence

Stiffening decreases reservoir - increases load on heart

31
Q

What is the name of the cardiovascular response to going from laying to standing?

A

Orthostasis

32
Q

What is the effect of going from laying to standing?

A

Sudden hydrostatic pressure in lower limbs
Effect mainly experienced by veins as distendable - distend - larger volume trapped within - cannot return to heart - decreases cardiac output - decreases BP

33
Q

Describe orthostasis in young people

A

Increased peripheral vasoconstriction, increased heart rate (due to decreased vagal activity) - compensates

34
Q

Describe orthostasis in old people

A

Smaller decrease in vagal activity, impaired diastolic filling, impaired sympathetic outflow
Causes smaller rise in heart rate, less arterial vasoconstriction
Causes greater decrease in BP

35
Q

How does maximum aerobic capacity change with age?

A

Decreases

36
Q

What is the main cause of the decline in maximum aerobic capacity with age?

A

CV function

BIOL0027 (20 decks)

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