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Characteristics of the cardiovascular system , abnormalities and diseases PART 2 PowerPoint PPT Presentation


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Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Master’s Programmes at the University of Pécs and at the University of Debrecen Identification number: TÁMOP-4.1.2-08/1/A-2009-0011.

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Characteristics of the cardiovascular system , abnormalities and diseases PART 2

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Characteristics of the cardiovascular system abnormalities and diseases part 2

Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat the University of Pécs and at the University of Debrecen

Identification number: TÁMOP-4.1.2-08/1/A-2009-0011


Characteristics of the cardiovascular system abnormalities and diseases part 2

Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat the University of Pécs and at the University of Debrecen

Identification number: TÁMOP-4.1.2-08/1/A-2009-0011

Miklós Székely and Márta Balaskó

Molecular and Clinical Basics of Gerontology – Lecture 9

Characteristics of thecardiovascularsystem, abnormalities and diseasesPART 2


Volume pressure diagrams 1

Volume-pressure diagrams1

Young

250

systolic pressure

200

150

Ventricular pressure (mmHg)

ejection

100

ventricular diastolic pressure

SV

isovolumic contraction

isovolumic relaxation

50

0

0

50

100

150

200

250

ventricular filling

Left ventricular volume (ml)


Volume pressure diagrams 2

Volume-pressure diagrams2

1st case

250

systolic pressure

200

150

Ventricular pressure (mmHg)

100

ventricular diastolic pressure

SV

50

0

0

50

100

150

200

250

Left ventricular volume (ml)


Volume pressure diagrams 3

Volume-pressure diagrams3

2nd case

250

systolic pressure

200

150

Ventricular pressure (mmHg)

100

ventricular diastolic pressure

SV

50

0

0

50

100

150

200

250

Left ventricular volume (ml)


Volume pressure diagrams 4

Volume-pressure diagrams4

3rd case

250

systolic pressure

200

150

Ventricular pressure (mmHg)

SV

100

ventricular diastolic pressure

50

0

0

50

100

150

200

250

Left ventricular volume (ml)


Volume pressure diagrams 5

Volume-pressure diagrams5

4th case

250

systolic pressure

200

150

Ventricular pressure (mmHg)

SV

100

ventricular diastolic pressure

50

0

0

50

100

150

200

250

Left ventricular volume (ml)


Exercise in the elderly

Exercise in the elderly

  • There is a higher sympathetic tone even at rest

  • Diminished contractility

  • Tachycardia develops sooner and easier, butits maximum is limited

  • EDV increases quickly, but here the EDp also increases significantly

  • TPR is higher and grows (both the syst. and diast. pressures increase quickly)

  • Stagnation develops quite early (dyspnoe)


Maximal heart rate vs age

Maximal heart rate vs. age

Heart rate (bpm)

200

190

Trained

180

170

Mean

Non-trained

160

150

140

20

30

40

50

60

70

Age (years)


Age related alterations in major cardiac parameters

Age-relatedalterationsin major cardiacparameters

  • Impaired coronary perfusion have only a small influence on myocardial function in healthy old people (of course, severe atherosclerosis does have!)

  • Ejection fraction of healthy old women and men does not decrease at rest (when the endsystolic and enddiastolic volumes are comparable to those in young people)

  • Stroke volume: SV × heart rate – does not change with age, even in case of a slight (still physiological) increase in the systolic pressure. (The stroke volumewouldratherincrease a little.)

  • Heart rate: resting heart rate (horizontal position) in healthy men is not age-dependent. The respiration-induced changes in heart rate decrease though. The increase of the heart-rate is age-dependent: 220-age (The elderly responds to the same stress with smaller increase in heart rate -120-130 frequency is already submaximal tachycardia)

  • Intrinsic sinus rhythm (by symp. and parasymp. blockade)-significantly decreased with age: at 20-y it is104/min, at 45-55-y 92/min


Maximal oxygen consumption and endurance times according to age

Maximal oxygen consumption and endurance times according to age

Maximal oxygen consumption vs. age

Endurance times according to age

4.0

13

12

11

3.0

10

9

Time(minutes)

VO2 max(l/min)

2.0

8

7

1.0

6

5

0.0

4-5

6-7

8-9

10-12

14-15

16-18

25

35

45

55

65

0

10

20

30

40

50

60

70

Age (years)

Age (years)

male

female


Atherosclerosis

Atherosclerosis

  • One of the most significant diseases of the elderly

  • Clinical picture includes: pectoral angina, AMI, TIA, stroke, dementia, arteriosclerosis obliterans


Risk factors of atherosclerosis 1

Risk factors of atherosclerosis 1

Intrinsic risk factors

  • Age: male 45, female above 55 years

  • Gender: estrogen provides some protection (TG, lower LDL cholesterol, higher HDL), after menopausa the protection diappears: by the age of 60 the risks of the females exceed the risks of the male

  • Genetic factors: familial appearance, inherited disorders of the lipid metabolism


Risk factors of atherosclerosis 2

Risk factors of atherosclerosis 2

Extrinsic risk factors

  • Smoking (a pack a day increases the risk 2×)

  • Hypertension

  • Dyslipoproteinemia

  • Hyperglycemia, diabetes mellitus

  • Obesity

  • Homocystinuria

  • Hyperuricemia


Regulation

Regulation

  • The sensitivity of the baroreceptor reflex decreases (hypertension or orthostatic hypotension)

  • The serum levels of the catecholamines increase (increased release, diminished elimination)

  • The efficacy of the sympathetic tone decreases

  • The carotids are more rigid (cardiovagal reflex decreases)

  • Vestibulosympathic reflex efficacy also decreases (adaptation to gravitational forces) – orthostatic hypotension (upon standing up a blood pressure fall greater than 20 mmHg)

  • The venes are more rigid – decreased CVP (decreased venous stagnation)

  • The activity of the plasma renin decreases


Pectoral a ngina

Pectoral angina

  • Above 70 years the prevalence of coronary heart disease reaches 70%

  • The prevalence of “silent ischemia” increases, especially in females and in diabetics (autonomic neuropathy)


Arrhythmias

Arrhythmias

  • Atrial fibrillation – with heart failure

  • AV-nodal re-entry tachycardia

  • Multifocal ventricular premature beats (polymorphic)


Hypertension 1

Hypertension1

  • Age-related hypertension is mostly isolated systolic hypertension(18-24 years 2.6%, above 75 70.3%, 50% undetected, above 80 the BP decreases)

  • Due to the loss of elasticity in the aorta the pulse wave returns too early, disturbing the systole and increasing the systolic blood pressure too much

  • The pulse-pressure increases, the diastolic pressure decreases.

  • This increased pulse-amplitude is one of the main cardiovascular risk factors in the elderly


Mean aortic pressure and aortic pulse wave velocity vs age

Mean aortic pressure andaortic pulse wave velocity vs. age

Urban

110

1,200

Rural

105

100

1,000

95

Aortic pulse wave velocity (cm/sec) ●, ○

Mean aortic pressure (mmHg) ▲, ∆

90

800

85

80

600

40

60

20

80

Age (years)


Hypertension 2

Hypertension2

  • With age not only the amount of collagen increases but also the rigidity of the collagen – progressive fibrosis

  • The vascular diameter decreases relative to the vessel wall + endothelial damage decreases the vasodilatory activity

  • RAAS activity decreases (decreased sympathetic tone, decreased responsiveness).

  • Plasma norepinephrine increases, but theβ-receptor responsiveness and sensitivity is down

  • There is, on average, a 1% annual decrease in the cardiac output.

  • The proportional increase in total peripheral resistance counteracts this decrease, but the adaptation capacity is impaired.


Hypertension 3

Hypertension3

  • Age-relatedhypertension is salt-sensitive – thenephron number decreases fromtheoriginal 800,000 to 400,000 bytheage of 80. The saltexcretion is alsodecreased.

  • This is explainedpartlythroughthedecreasedglomerularfunction, partlyby a decreasedproduction of natriureticsubstances (PGE2, bradykinin)

  • The impairedactivity of the Na-K ATP-asepumpmaycontributetohypertension– IC Na – Na+/Ca++exchange – higher IC Ca – highervasculartone


Hypotension

Hypotension

  • Decreased baroreceptor reflex + more rigid carotidleads to a tendency for orthostatic hypotensionand an excessive HR increase upon standing up

  • The BP of the elderly must be measured when sitting and after standing up (BP fall > 20 mmHg)

  • Tendency to develop hypovolemia (decreased thirst, lower ECV, decreased responsiveness of regulatory hormones) may promote hypotension and increase mortality


Hypertension and therapy

Hypertension and therapy

  • Decreased filtration surface (decreased endogenous creatinine clearance) Na retention and the need to apply thiazide diuretics.

  • The renal and hepatic clearance of drugs decrease – drug doses have to be adjusted

  • The side effects are less tolerated by the elderly – therapeutic compliance is decreased (ACE inhibitors – 30% cough, Ca-channel blockers – 25% swelling of the legs, combined – dizziness)

    Therapy

  • ACE inhibitors (Angiotensin II type 1 receptor blockers) and channel blockers (in the elderly appropriate therapy may increase the well-being of the patient more effectively)

  • ACE inhibitors and β-blockers (-25% new DM)

    General outcome: -19 – -26% stroke, -25% coronary incident


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