An Ageing Heart

A 100m sprint becomes increasingly strenuous as we get older, as the heart has to work much harder to pump blood to supply our muscles with adequate oxygen. By age 65, our hearts would have done an astounding amount of work. As with other organs, the heart undergoes physiological changes over time, even in the absence of disease. It loses efficiency, its vessels become less elastic and its walls thicken. These changes make the elderly more susceptible to cardiovascular diseases.

COMMON AGEING HEART PROBLEMS

1.Hypertension

By 70, 1 in 2 people may have hypertension. Two forms of this are where: systolic pressure is elevated; and the walls of the left ventricle – the heart’s main pumping chamber – begin to thicken. Both can lead to heart failure.

2. Coronary artery disease

Some 50% of all victims are over 65. Middle-aged men and post-menopausal women face a higher rate of coronary heart disease. Heart attacks often result in more complications, longer hospital stays and slower recovery for older patients. Silent heart attacks are more common among the elderly.

3. Heart valvular disorders

The prevalent valve problem in old age is aortic valve disease. Aortic sclerosis is the process of thickening and stiffening in the valve. It affects up to one-third of all elderly people. In aortic stenosis, the aortic valve becomes narrow and blocked by calcified deposits.

4. CARDIAC ARRHYTHMIA & RHYTHM DISORDERS

• Bradycardia

This is when the heart’s rhythm is too slow. Over the years, the electrical system that carries the signal to trigger the heart’s timely contractions may start to malfunction. Sick sinus syndrome occurs when a patch of electrically active cardiac tissue that acts as the heart’s internal pacemaker malfunctions. Slow heartbeats cause blood pressure to fall, leading to fatigue, confusion and fainting spells. Sick sinus syndrome may be treated with an electronic pacemaker.

• Tachycardia

This is when the heart’s rhythm is too fast. A rapid and irregular rhythm in the heart’s upper chambers is known as atrial fibrillation. Affecting up to 10% of the older population, it is managed with medication. Elderly patients are at increased risk of developing blood clots in the heart that may travel and block blood vessels elsewhere. The main risk is of embolic stroke. Anti-coagulant medications may be prescribed to reduce the incidence of these events.

TREATMENT DECISIONS

If an exercise stress test is too difficult, non-invasive testing such as CT coronary angiogram and nuclear heart scan can be used to diagnose the heart problem. Invasive procedure like balloon angioplasty and coronary bypass surgery are relatively safe for older patients. Post-operative care is important as older people are more prone to infections in the ICU setting.

Invasive procedures

Balloon angioplasty and coronary bypass surgery are relatively safe for older patients. Angioplasty mortality is estimated at 1% while the bypass surgery mortality rate is estimated at 5-10% in elective operations for octogenarians.

Post-operative care

This is important as older people are more prone to infections in the ICU setting.

Medication

Metabolic changes make older people more likely to experience the side-effects of drugs.