Aging of Cardiac Muscle and Cardiac Failure - PowerPoint PPT Presentation

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Aging of Cardiac Muscle and Cardiac Failure


Aging of Cardiac Muscle and Cardiac Failure Dr. Franco Navazio Physiological Changes with Age Cardiovascular Changes with Age Hypertension: most common treatable ... – PowerPoint PPT presentation

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Title: Aging of Cardiac Muscle and Cardiac Failure

Aging of Cardiac Muscle and Cardiac Failure
  • Dr. Franco Navazio

Aging Heart in the Elderly
In absence of specific disease the heart adjusts
very well to advancing age.
Myocardium Cardiac muscle syncytium
(multi-nucleated) Endocardium Internal layer of
heart Pericardium External connective tissue
layer of heart Valves openings between cardiac
chambers (atrial ventricular) or between heart
the arteries (aorta and pulmonary) Conduction
system sinoatrial node (SA) is the pacemaker
also atrial ventricular node (AV), Bundle of His,
Purkinje system

Aging Heart Physiology
  • Decline in the VO2 Max with advancing age
  • Minor decline in the cardiac output
  • Important Variables
  • physical conditions
  • dietary habits

Conclusions Physically fit elderly people have
a cardiac physiology similar to younger
Physiological Changes with Age
Parameter 20 years 60 years
VO2 Max (mL x kg x min) 39 29
Maximum Heart Rate 194 162
Resting Heart Rate 63 62
Max. Cardiac Output (L x min) 22 16
Resting BP 120/80 130/80
Total Lung Capacity (L) 6.7 6.5
Vital Capacity (L) 5.1 4.4
Residual Lung Volume (L) 1.5 2.0
Body Fat 20.1 22.3
Cardiovascular Changes with Age
  • Hypertension most common treatable
    cardiovascular change in the elderly
  • Definition values above 140/190
  • In young, if standing BP but in elderly it may
    to 20 mmHg

Systolic mumur 50 of elderly but of very short
duration EXG (or ECG) only nonspecific changes
due to aging in voltage and nonspecific
RBBB Hypotension diminished baro-reflex response
in the elderly. With age, cerebral blood flow
but autoregulation acts in a compensatory
fashion some patients maybe affected by
symptomatic orthostatic hypotension Orthostatic
hypotension drop of 20 mmHg in the systolic and
10 or more in the diastolic BP on standing
upright MEMO as well as the post-prandial
Pathology of the Aging Heart
  • Changes due to
  • Normal Aging Processes
  • Superimposed Processes
  • (i.e. endocarditis)
  • Residuals of other conditions
  • (i.e. hypertension, bicuspid, aortic valve

Aging Heart
  • Size can atrophy, remain unchanged or develop
    moderate hypertrophy. The normal aging heart
    demonstrates a modest in L ventricular wall
    thickness. Possible enlargement of the L atrium
    and L ventricular cavity.
  • Cardiac myocytes in size, not numbers (some
    replaced with fibrous tissue). Cardiac myocytes
    effective in reentering the cell cycle
    proliferating, partly offsetting cell loss due to
    necrosis or apoptosis.
  • Amyloid deposition half of those 70 years have
    some amyloid deposits in the heart but mostly in
    small amount confined to the atria. Amyloid is
    not present in all elderly persons, not even in

Aging Heart
  • Vasculature (atherosclerosis)
  • Walls of large arteries thicken, vessels become
    dilated and elongated
  • Increase intimal thickness (due to cellular and
    matrix deposition)
  • Fragmentation of the internal elastic membrane
  • Cardiac output (L x min)
  • not decreased in healthy older men
  • slightly decreased in older women

Age Associated Changes in Cardiac Function
  1. Overall in systolic BP due to arterial
    stiffening in plus wave velocity. Reflects
    resetting of the baro-receptor reflex to a higher
    level in the elderly
  2. Myocardial contractility relaxation is prolonged
    in senescent cardiac muscle due the sarcoplasmic
    reticulum seugesters less Ca2
  3. Ejection Fraction (EF) no change in resting EF
  4. Heart Rate (HR) supine HR does not change, in
    sitting and standing positions from 10 to 25.

Aerobic Capacity Cardiovascular Function During
Exercise in the Elderly
  • With age, peak exercise capacity peak oxygen
    consumption slightly but inter-individual
    variation is substantial
  • Aerobic capacity 50 between 20 years to 80
  • Maximal Cardiac Output (CO) 25
  • Peripheral O2 utilization 25 (due to in
    muscle mass strength)
  • Although the stroke volume in older persons is
    maintained, age apparently blunts the
    Frank-Starling mechanism

Heart Failure Cardiac Output (CO) insufficient
to meet physiologic demands
  • In the elderly, heart failure due to
  • Mostly systemic arterial hypertension
  • Coronary artery valvular diseases (due to
    impaired cardiac filling chronic volume
  • Combined right left cardiac failure most
    common, but isolated occurrence of left or right
    also probable

Heart Failure in the Elderly
  • Symptoms dyspnea, orthopnea, fatigue on exertion
    and dependent edema
  • Severity classified according to the NY Heart
    Association Scale

The CardiomyopathiesMyocardial disorders
without a known underlying cause BUT where
other heart diseases may coexistDilated
CardiomyopathyHyperthrophic CardiomyopathyRestri
ctive Cardiomyopathy
Dilated Cardiomyopathy
Normal Heart

Hypertrophic Cardiomyopathy
Normal Heart

Restrictive Cardiomyopathy The classic example
is the senile cardiac amyloidosis of the elderly,
especially over 95 years old.
Normal Heart

Cardiomyopathy Any heart muscle disorder not
caused by coronary artery disease, hypertension
or congenital valvular or pericardial diseases.
  • Prevalence of heart failure
  • 25-54 yrs 1
  • 55-65 yrs 3
  • 65-74 yrs 4.5
  • 75 yrs 10
  • gt 75 of patients with heart failure 60 years
    of age
  • Primary reason is Coronary Heart Disease (CHD)
  • Secondary reason is Hypertension
  • Third reason is cardiomyopathy

Sudden Death
  • In young athletes (also in middle aged men),
    SUDDEN DEATH can occur in patients with
    congenital hypertrophic cardiomyopathy
  • Usually due to severe arrythmia (ventricular
  • If diagnosis is made a cardiac defibrillator
    should be implanted.
  • The SUDDEN DEATH of runners are usually limited
    to 1 case per 15,000 runners per year-- hence,
    very rare.
  • MEMO There is still the possibility of
    ANAPHYLACTIC SHOCK in runners or walkers, if
    stung by a bee.

Syncope in Elderly
  • Definition temporary suspension of conciousness
    due to cerebral ischemia
  • Causes
  • Orthostatic Hypotension
  • Vaso-Vagal Reflex (?)
  • Arrhythmias (brady- tachyarrhythmias)
  • Drugs
  • Antihypertensives (vasodilators/diuretics)
  • Cardiac drugs beta-blockers, digitalis, anti-
    arrhythmias, Ca2 channel blockers, nitrates.
  • Recreational alcohol, marijuana and cocaine.
  • Psychiatric Antidepressants and phenothiazines

Contributory Causes to Heart Failure in the
  • Hypertension (poor elasticity of arterial system)
  • Alcohol, but only if in excess
  • Viral infections
  • Autoimmunity
  • Heredity (specially for the cardiomyopathies)
  • Senile amyloid
  • Diabetes (due to the microvascular disease)
  • Arrhythmias and especially the TACHYCARDIAS

Conduction System in Aged Heart
  • Sinoatrial Node Increased fibrous tissue
    seldom origin for arrythmias
  • Atrio-Ventricular Node Slight increase in
    collagen fibers
  • Bundle of His Increased fibrous tissue with
    higher frequency of First or Second degree heart
    block (the mobitz)
  • Also the possibility of L or R BBB (Bundle
    Branch Block) -this is seldom a complete heart
  • In the conduction system fibrosis occurs 40
  • Coronary Artery Disease 20
  • Calcification 10

Normal ECG
Ventricular Fibrillation
Atrial Fibrillation
Aortic StenosisNarrowing of the aortic orifice
of the heart or of the aorta itself
  • A common condition due to
  • Fatty alteration of collagen
  • Calcification
  • Rigidity and various degrees of aortic stenosis
  • Amyloid infiltration of the valves

Age Specific Lesion The Valves
  • Fibrous thickening at sites of closure
  • Valvular sclerosis caused by collagen and elastic
    tissue, this is a true wear and tear phenomenon
  • Calcification of the mitral ring where fatty
    degeneration invites deposition of calcium
  • Calcifications is detected in 17 to 45 of
    patients over 90 years of age
  • Complications include heart blocks, infections,
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