The Ageing Cardiovascular System

Jennifer Inglis

12th December 2006

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?

Why?

Prevalence of cardiovascular disease amongst elderly populations

“It’s just my age, doctor”

Impact on our assessment and treatment of elderly patients

What changes occur?

Vascular changes

Postural changes

Cardiac changes at rest

Cardiac changes on exercise

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

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

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

During exercise…

in maximum HR ( response to β-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

Frank Starling Mechanism

EDV, due to:

Longer diastolic interval ( HR)

EF - amount of blood in LV at start of diastole

Summary of changes

HR SV CO EDV EF

At rest = = =

Exercise =

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

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!

Comments?

Or easy questions?