The Ageing Cardiovascular System

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The Ageing Cardiovascular System

• Jennifer Inglis
• 12th December 2006

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Overview

• Why is it important to understand ageing of the
  cardiovascular system?
• What changes in cardiovascular structure and
  function are associated with ageing?
• How might this affect our practice?

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Why?

• Prevalence of cardiovascular disease amongst
  elderly populations
• Its just my age, doctor
• Impact on our assessment and treatment of elderly
  patients

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What changes occur?

• Vascular changes
• Postural changes
• Cardiac changes at rest
• Cardiac changes on exercise

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Vascular Changes

• Aorta and large elastic arteries - ? wall
  thickness, dilation and stiffening
• ? in mean systemic arterial pressure in most, but
  not all
• Systolic BP rises more than diastolic
  increasing chance of isolated systolic
  hypertension

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Postural Changes

• Blunting of ? in HR
• Slowed baroreceptor response to postural change
• May be reduced vasoconstriction in response to
  reduced BP
• Increase the chance of postural hypotension

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Cardiac Changes at Rest

• Minor ? in HR
• CO output maintained by ? SV
• ? ejection of blood during late systole
• ? early diastolic filling rate
• EDV not ? - enhanced atrial contribution to LV
  filling beware AF, particularly if tachycardic

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During exercise

• ? in maximum HR (? response to ß-adrenergic
  stimuli)
• ? in cardiac output - reduced by 30 between ages
  20 and 80
• Maximum SV not reduced but maintained in
  different manner
• Frank Starling mechanism

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Frank Starling Mechanism

• ? EDV, due to
• Longer diastolic interval (? HR)
• ? EF - ? amount of blood in LV at start of
  diastole

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Summary of changes
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Some Practical Points

• Beware of increased risk of hypertension
• and postural hypotension
• Elderly patients unlikely to tolerate tachycardia
  or AF as well as younger patients
• Caution with beta blockers

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In summary

• Ageing does alter the structure and function of
  the cardiovascular system
• Changes more evident during exercise
• These effects may contribute to earlier
  decompensation when unwell
• and remember your erect and supine BPs!

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Comments?

• Or easy questions?

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