By Donald D. Tresch, Wilbert S. Aronow
Contributors sixty five years of age or older presently account for over 80 percentage of all cardiovascular disease-related deaths. With advances and breakthroughs in glossy medication which are permitting humans to reside longer, the variety of older adults during this nation will keep growing exponentially over the subsequent a number of many years. Cardiologists, geriatricians, and different clinicians taking care of the aged will require—at the very least—a simple realizing of cardiovascular problems that regularly have an effect on the older sufferer. within the Fourth variation of this vintage textual content, every one bankruptcy has been completely up-to-date to supply a finished, but readable evaluate of the epidemiology, pathophysiology, evaluate, and therapy of cardiovascular issues in older adults. heart problems within the aged: presents an in-depth dialogue of the aged sufferer within the scientific surroundings considers the impression of a number of coexisting stipulations, frailty, polypharmacy, and sufferer personal tastes in optimizing illness administration each one bankruptcy written by way of well-known specialists within the evaluate and administration of older people with heart problems
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Extra resources for Cardiovascular Disease in the Elderly, Fourth Edition (Fundamental and Clinical Cardiology)
This finding, coupled with the increase in systolic blood pressure that occurs over time even in healthy individuals, has led to consideration of aging as a muted form of hypertension. In older rodent hearts, which demonstrate a similar increase in LV mass and myocyte size as observed in humans, a stretching of cardiac myocytes and fibroblasts releases growth factors such as angiotension II, a known stimulus for apoptosis (81). In addition, enhanced secretion of atrial natriuretic (82) and opioid (83) peptides is observed.
The accepted standard for aerobic fitness is maximum oxygen consumption rate (VO2max), the product of cardiac output (the central component) and arteriovenous oxygen difference (the peripheral component). In healthy adults, VO2max is up to 15 times greater than VO2 at rest. This is accomplished by a four- to fivefold increase in cardiac output and up to a threefold widening of the arteriovenous oxygen difference; the latter is due to both a dramatic increase in the relative proportion of cardiac output delivered to working muscles and an increased oxygen extraction by these muscles.
A blunting of high-frequency oscillations in apparently healthy older volunteers is predictive of future coronary events (130) and total mortality (131). Time domain indices of heart rate variability also decline substantially with age; the pattern of decline varies with the specific time domain measure (132). Younger men generally display higher time domain indices than younger women, but this gender difference narrows or disappears at older ages. In a Swiss population of healthy persons aged 50 years and older, CV risk factors, such as hypertension, smoking, non-high-density lipoprotein cholesterol, and C-reactive protein, were each associated with reduced heart rate variability during 24-hour ECG recordings (133).
Cardiovascular Disease in the Elderly, Fourth Edition (Fundamental and Clinical Cardiology) by Donald D. Tresch, Wilbert S. Aronow