Cardiovascular System and Aging Flashcards by Alex Stein

What doesn’t change with age

Resting heart rate
Plasma volume and hematocrit
Peak developed tension
Resting length-tension relationship

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Changes - properties of the myocardium - excitation contraction coupling

Prolonged activation - inc time to peak tension
Prolonged AP
Prolonged relaxion - longer refractory period

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Changes - Passive myocardial properties

Changes in mm tissue materials

Type, amount and distribution of non-contractile protein, collagen and elastin

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Changes - Age change - collagen

Inc in collagen
Cross linkage of collagen
Inc in conc of lipfuscin I

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Effects of changes with age

Inc stiffness
Dec ventricular compliance
Impaired diastolic filling
LV EDP
* Inc exertional dyspnea

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Cardiac structure - observations

Left ventricular hypertrophy
Inc LV wall thickness
Inc heart mass
Inc ratio of heart mass/body weight

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Cardiac structure - LV cavity dimension

No change

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Cardiac structure - net effect of changes

Changes correlate with pressure overload

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Cardiac structure - causes of hypertrophy

Inc myocyte size
Inc Collagen and collagen alterations
Inc lipsofusion and other inclusions

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Cardiac structure - overall results

Stiffer and more rigid myocardium

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Cardiac function - observations

Dec ventricular compliance
Prolonged isovolumetric relaxation
Dec rate of elderly diastolic filling
Inc end diastolic pressure
No change in LVEDV

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Cardiac function - Cardiac output - Rest

Relatively no change in CO

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Cardiac function - Cardiac output - Exercise

Variable changes in SV

Dec max HR

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Cardiac Output =

HR x SV

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Cardiac function = With exercise young

Inc HR, Dec EDV = SV plateaus

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Cardiac function = with exercise aged

Dec max HR, Inc late LVDV = SV

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Autonomoic modulation of CV function - Observations

Inc resting + exercise NE
Dec receptor responsiveness
Dec response to catecholamines

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Autonomic modulation of CV function - Beta adrenergic effects on blood vessels and HR

Dilation of blood vessels is not as quick

Dec HR?

Autonomic modulation of CV function - Pacemaker cells in the heart - at 75 yo

10% of the pacemaker cells of a 20 yo

Inc cardiac arrhythmia

Atrial fibrillation

Irregular beating of atria

Inc incidence

Artial fibrilation prevalence

more than 10% after 80 yo

Atrial fibrillation Symptoms

Palpitations, shortness of breath, angina

Atrial fibrillation - diagnosis

Physical exam

ECG

Atrial fibrillation - Complications

Heart failure

Stroke

Atrial fibrillation - prognosis

Good with treatment

Sick sinus syndrome - prevalence

Inc progressively with age

Sick sinus syndrome - etiology

Degeneration of sinus node pacemaker cells

Sick sinus syndrome - Symptoms

Dizziness, syncope, fatigue, effort, intolerance, heart failure, angina

Sick sinus syndrome - Diagnosis

ECG Bradycardia | Tachydysrhythmias

Sick sinus syndrome - Treatment

permanent pacemaker

Sick sinus syndrome - complications

inc risk of stroke

Vascular aging - altered vascular properties

Material composition of vasculature Vascular tree Ability of peripheral arterioles to dilate dec

Vascular aging - observe with aging

Inc intimal thickening Fragmentation of elastin Calcification Inc collagen

Vascular aging - what inc

Stiffness (dec distensibility) Arterial pressure (inc systolic) LV wall thickness

Vascular aging - inc stiffness - from

Inc pulse wave velocity | Dec volume distensibility

Vascular aging - inc aterial pressure because of

Vasculature (aorta) fails to sustain forward flow Inc LV work with systole Inc cardiac afterload

Vascular aging - inc LV wall thickness because of

Catecholamine response | Dec VD with exercise (dec exercise tolerance

Cardiovascular reflexes - observe

Dec myocardial response | Dec baroreceptor sensitivity

Cardiovascular performances - dec in functional capacity limits

ability to exercise/work

Cardiovascular performances - Cardiac output changes

Little to no change at rest | Dec with ex

Cardiovascular performances - VO2 max

Dec VO2 max

Cardiovascular performance - Blood pressure changes

Systolic inc throughout life for both M and F | Diastolic inc until middle age and then returns normotensive (50-59)

Clinical implications of age related changes in BP regulation

Orthostatic hypertension Postprandial hypotension Situational syncope Hypotensive response to dec blood volume, preload lowering medications, tachydysrhythmias