CCF and Aging

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CCF and Aging

• John Puxty
• puxtyj_at_post.queensu.ca

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Issues to consider

• Diagnosis may be delayed
• Many of the studies with B blocker, ACIs and
  vasodilators in ambulatory setting with gradual
  dose adjustment
• Confounding co-morbidities both cardiac and
  non-cardiac
• Diastolic dysfunction common so do not treat only
  cosmetic finding
• Underuse of diagnostic proceedures and effective
  Txs

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The Aging Heart
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Cardiac Output and Age
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Heart Rate and Age
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Presentation Of CCF

• Prevalence of 10 80 years group
• Often atypical weakness, fatigue, weight loss,
  confusion
• Often associated with pneumonia, AF, Thyroid
  disease, Renal Disease
• Medication usage often factor in precipitation
• 50 have normal LVEV (diastolic dysfunction)

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General Management Measures

• Fluid and Na restriction
• Regular physical activity
• Review medications Alcohol, NSAIs
• Manage Hypertension and IHD appropriately
• Treat exacerbating factors anemia, thyroid
  disease, obesity, arryhthmias, infection

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Specific Treatment of CCF

• Diuretics

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Specific Treatment of CCF

• Diuretics
• Ace Inhibitors (A2 receptor antagonists)

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Specific Treatment of CCF

• Diuretics
• Ace Inhibitors (A2 receptor antagonists)
• Beta Blockers carvedilol (3.125 mg bid 25 mg
  bid, Metoprolol 12.5 mg bid 50 mg bid)

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Specific Treatment of CCF

• Diuretics
• Ace Inhibitors (A2 receptor antagonists)
• Beta Blockers
• Digoxin (nb NOT with normal LVEF and Sinus rhythm)

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Specific Treatment of CCF

• Diuretics
• Ace Inhibitors (A2 receptor antagonists)
• Beta Blockers
• Digoxin
• Spironolactone

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Specific Treatment of CCF

• Diuretics
• Ace Inhibitors (A2 receptor antagonists)
• Beta Blockers
• Digoxin
• Spironolactone
• Vasodilators Isosorbide (10 mg tid-40 mg tid)
  and Hydralazine 10 mg tid 100 mg tid)

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Specific Treatment of CCF

• Diuretics
• Ace Inhibitors (A2 receptor antagonists)
• Beta Blockers
• Digoxin
• Spironolactone
• Vasodilators
• Calcium Channel Blockers (If normal LVEF!)