Cardiovascular Diseases In The Elderly
Cardiovascular disease in the elderly is a topic of particular interest given that, on the one hand it is the leading cause of morbidity and mortality in this population, and that in the last century, the population over 60 years (which is the arbitrary limit set by WHO from which a person is considered elderly) has doubled and is expected to increase by 2-3 times in the first century of this millennium. With the population growing old, there is also an increase in the number of aging-related diseases, but also, in the complexity of the treatment of these diseases and the cost of the hospitalization.
It is characterized by the physiological appearance of the structural and functional changes. There is left ventricular hypertrophy, cardiac geometry changes, there are valvular calcifications and fibrosis, degenerative changes occur in the excitoconductor tissue and sympathetic nervous system. All these structural changes determine functional changes in the heart, with the remodelling of the left cardiac chambers by lowering their compliance and increasing their rigidity, decreasing the lusitrope function and the response to beta-adrenergic stimuli. Also, although during rest the function of the left ventricle is normal and the heart rate is unchanged, during exercise the heart rate reaches a maximum, which is about 20% of the young heart rate, and the cardiac output is decreased by 20-30% compared to the young people. All these physiological changes may cause pathological changes in time. Thus, left ventricular hypertrophy, by increasing the rigidity and the diastolic pressure, may precipitate diastolic heart failure, while the expansion of the pulmonary veins and of the left atrium and may lead to atrial fibrillation.
The most common diseases in the elderly are heart failure, coronary heart disease and syncope.
It has a high incidence among this segment of the population and has a higher frequency in female population over 60 years. In general, the elderly with heart failure have a higher prevalence of hypertension, atrial fibrillation and other comorbidities such as anaemia, kidney disease, stroke, chronic obstructive pulmonary disease. What is worth mentioning is the fact that over 70% of octogenarians have heart failure. The clinical picture of the disease is very often nonspecific, with fatigue, confusion, depression, weight loss. Age itself is an independent prognostic factor for hospital mortality. On one hand, older age, but on the other hand also nonspecific symptoms are the main causes of suboptimal treatment and investigation of patients in this category. Choosing the appropriate treatment is also more difficult, drugs are generally not so easily tolerated, adverse effects are more frequent among the elderly and, in addition, they are less compliant to treatment.