Far Eastern University

Institute of Nursing
SY. 2016-2017

Geriatric Nursing

HEART
DISEASE
Buenaflor, Miguel
De Leon, Alyana N.
Del Rosario, Charlene V.
King, Angelica
Rapisora, Catleya
Sacasas, John Ezekiel

AGING AND DISEASES OF THE HEART

1. Alterations induced by advancing age:

Alterations in the arteries

Decreased elasticity
Decrease in compliance
Atherosclerosis
Alterations in the heart
Fibrosis
Increase in mass
Calcification

2. Consequences of age-induced alterations:

Increased blood pressure
Angina pectoris
Heart attack
Heart failure
3. Frequent symptoms in old age:
Shortness of breath
Fatigue
Palpitations
Chest pain or discomfort
Dizziness
4. In old age:
Typical angina is less frequent
Heart attack may be silent
ECGs are less representative

HYPERTENSION
Geriatric hypertension is generally of a salt-sensitive nature, with a disproportionate frequency of ISH. Agerelated increases in salt sensitivity result, in part, from a reduced ability to appropriately excrete a salt load,
which is due to a decline in renal function and to a reduced generation of natriuretic substances, such as
prostaglandin E2 and dopamine. Age-associated declines in the activity of membrane sodium/potassiumadenosine triphosphatase (Na+-K+-ATPase) may also contribute to geriatric hypertension because this results in
increased intracellular sodium that may cause reduced sodium-calcium exchange and thereby increase
intracellular calcium and vascular resistance.

EPIDEMIOLOGY OF HYPERTENSION WITH AGING

By the year 2060, people living into their 8th, 9th and 10th decade of life will dominate our patient
population. Of those individuals born today in the U.S., it may well be that upwards of 50% of persons will reach
their 100th year. Given a high prevalence of hypertension (up to 80% of those >60 years old) and its rising
incidence over time, treatment of hypertension in this growing elderly population will be challenging. The
economic burden of hypertension is well established, the result of adverse effects on cardiovascular outcomes
including heart failure, myocardial infarction, and stroke. The effective and safe management of hypertension in
this elderly cohort will be critical, both to improve patient outcomes and to reduce health care costs.
Major overviews of observational studies have shown a continuous and positive relationship between
cardiovascular events and usual blood pressure above a baseline level of approximately 115/75 mmHg at all ages
and in both sexes.

Although the strength of the association weakens with age, the absolute difference in cardiovascular risk
between the highest and lowest usual blood pressure levels is much greater in older subjects. Thus, the burden of
disease that is potentially avoidable by blood pressure-lowering treatment would be expected to be greater in
older individuals.

MECHANISMS OF HYPERTENSION
a) Aging is associated with reduction in arterial compliance as a result of both structural and functional changes
primarily affecting the intima and media of large compliance arteries.
b) Collagen becomes increasingly rigid, causing sclerosis and fibrosis of various tissues, including the blood
vessels; the elastic fibers of the media gradually decrease in number as the collagen matrix increases,
reducing the elasticity of large arteries.
c) There are increases in the relative wall thickness-to-vessel lumen ratio, together with reductions in luminal
cross-sectional area. The renin-aldosterone-angiotensin system becomes less responsive with aging, partially
as a result of reduced activity of the sympathetic nervous system; plasma renin activity, angiotensin II and
aldosterone levels decrease.
d) Although plasma norepinephrine levels increase with age, there is a decrease in beta receptor sensitivity as
well as in a receptor responsiveness; there is also a decrease in myocardial catecholamine concentration,
which may explain the decreased myocardial contractility seen in the aged.

SIGNS AND SYMPTOMS

Chest pain (angina)

Tightness or pressure in the chest
Shortness of breath
Fatigue
Pain in the neck, back, arms, or shoulders
Persistent cough
Loss of appetite
Foot or ankle swelling

DIAGNOSIS

ELECTROCARDIOGRAM: monitors and records your hearts electrical activity. Your doctor will attach
patches to your chest, legs, and arms. The results will be visible on a screen, and your doctor will interpret them.
ECHOCARDIOGRAM: takes a detailed picture of your heart and using ultrasound
CORONARY ANGIOGRAPHY: examines the flow of blood through your heart. A thin tube called a catheter is
inserted through your groin or an artery in your arm and up into the heart.
EXERCISE STRESS TEST: looks at how exercise affects your heart. You may be asked to pedal an exercise
bike or walk on a treadmill.
NUCLEAR STRESS TEST: examines the flow of blood into the heart. The test is usually conducted while
youre resting and exercising.

TREATMENT

Water pills to help lower blood pressure

Nitrates to treat chest pain
Statins to treat high cholesterol
Beta-blockers to lower blood pressure and reduce the amount of oxygen used by the heart
Aspirin to prevent blood clots

CORONARY HEART DISEASE

Hypertension, dyslipidemia, impaired glucose tolerance, and obesity remain the major modifiable risk factors
for most of the coronary disease afflicting the elderly. The relative risk associated with these established risk
factors diminishes with advancing age, but this is offset by a greater absolute and attributable risk. Diabetes is
increasing alarmingly in prevalence and operates more powerfully in women, eliminating their coronary disease
resistance (relative to men). Interest in this entity now focuses on the insulin resistance syndrome promoted by
abdominal obesity that has become so common in the elderly. The isolated systolic hypertension and large pulse
pressure that predominate in the elderly is now recognized as a coronary disease hazard.

SIGNS AND SYMPTOMS

A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if
an area of your heart muscle doesn't get enough oxygen-rich blood.

Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw,
or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with
rest. Emotional stress also can trigger the pain.

Another common symptom of CHD is shortness of breath. This symptom occurs if CHD causes heart failure.
When you have heart failure, your heart can't pump enough blood to meet your bodys needs. Fluid builds up in
your lungs, making it hard to breathe.
The severity of these symptoms varies. They may get more severe as the buildup of plaque continues to narrow
the coronary arteries.

DIAGNOSIS

EKG (Electrocardiogram)
Stress Testing
Echocardiography
Chest X Ray
Blood Tests
Coronary Angiography and Cardiac Catheterization

TREATMENT

Treatments for coronary heart disease include heart-healthy lifestyle changes, medicines,medical procedures and
surgery, and cardiac rehabilitation. Treatment goals may include:
Lowering the risk of blood clots forming (blood clots can cause a heart attack)
Preventing complications of coronary heart disease
Reducing risk factors in an effort to slow, stop, or reverse the buildup of plaque

Relieving symptoms
Widening or bypassing clogged arteries