11 - Diagnosis and Management of Heart Disease in the Elderly

Summary

SIGNIFICANCE OF GERIATRIC CARDIOLOGY

As the leading cause of death and major disability in the United States, cardiovascular disease (CVD) has become a modern epidemic resulting in part from the aging of our population. Nearly two-thirds of all cardiovascular hospitalizations occur in patients aged 65 years and older, more than 83% of cardiovascular deaths occur in geriatric individuals, and an estimated 70% of Americans older than the age of 70 years have clinically recognized cardiovascular diagnoses. For these reasons, both geriatric and nongeriatric practitioners should become familiar with strategies for CVD prevention and management in older individuals.

EFFECTS OF AGING ON THE CARDIOVASCULAR SYSTEM

Aging is associated with many alterations of cardiovascular structure and function (Table 11.1). Some of the most clinically relevant changes include increasing vascular stiffness, impaired endothelial function, impaired left ventricular relaxation and compliance, diminished responsiveness to neurohormonal signals such as β-adrenergic stimulation, and degeneration of the sinus node and electrical conduction system. These factors contribute to the development of medical conditions such as hypertension, coronary artery disease (CAD), and heart failure (HF), and many components of these aging processes also modulate clinical presentations and responses to cardiovascular therapies in the geriatric population. Similarly, aging affects other organ systems (Table 11.2), which frequently interact with CVDs and therapeutics. Other influences related to medical comorbidities, absorptive and metabolic alterations, behavioral or neuropsychiatric changes, and financial issues frequently play a role in modulating cardiovascular prognosis in older individuals as well.