Aging & the Cardiovascular System

1. Aging & the Cardiovascular System Content for this module provided by The John A. Hartford Foundation, Institute for Geriatric Nursing, Online Gerontological Nursing Certification Review Course http://www.nyu.edu/education/nursing/hartford.institute/course/ Support for this project provided to School of Nursing, University of Washington by the John A. Hartford Foundation, Geriatric Nursing Education Grant and Nursing School Geriatric Investment Program Grant.

2. Normal Cardiovascular Changes Difficult to differentiate between age-related changes and those related to an inactive lifestyle or disuse Are the changes normal 'wear and tear' or cardiovascular disease?

3. Normal Heart Muscle Changes Anatomical changes • Thickening of the left ventricular wall • collagen, elastin

4. Normal Heart Valve Changes Anatomical changes • thickness • flexibility • Aortic & mitral valve calcification Mitral valve Aortic valve

5. Normal SA Node & Intranodal Atrial Tract Changes Anatomical changes •  # of pacemaker cells • Fibrous tissue infiltration of conductive system

6. Normal Artery Changes Anatomical changes • Peripheral arteries less resilient • Large arteries stiffer, less elastic,  elastin • Calcifications in artery walls, including aorta • Calcifications +  elastin +  collagen = stiffer vessels = more difficult to dilate

7. Normal Vein Changes Anatomical changes • Veins dilate & stretch with  elasticity • Intima & muscular walls thicken and become less elastic

8. Normal Coronary Artery Changes • Coronary artery blood flow  between ages 20 & 60 • Effect:  oxygen delivery to the heart muscle, thus  ability to increase activity

9. Normal Changes: Aorta • May become dilated, elongated, rigid • May develop calcifications and become tortuous •  elastin,  collagen = calcification =  stiffness,  compliance

10. Normal Cardiovascular Physiologic Changes Summary - changes occur in: • heart rate • blood pressure • myocardial function • cardiac output • valvular function

11. Normal Cardiac Output Changes Decreased cardiac output in response to exercise or stress (effects are influenced by associated heart disease & level of baseline physical activity)

12. Normal Valvular Function Changes Systolic and diastolic murmurs may result from incomplete valve closures

13. Normal Myocardial Function Changes •  contractile strength & efficiency •  cardiac output •  cardiac reserve

14. Normal Heart Rate Changes cardiac responsiveness rate with exercise Heart may take longer to return to baseline rate

15. Normal SA Node & Intranodal Atrial Tract Changes Physiological changes Irritability of the myocardium may result in extra systoles, along with sinus arrhythmias & sinus bradycardia

16. Normal Blood Pressure Changes Systolic blood pressure may rise disproportionately higher than diastolic

17. CV Links to Other Organs Changes in the cardiovascular system have direct effects on other organs Example: atherosclerotic changes in blood vessels that occur in patients with hypertension may result in loss of renal function, vision impairment

18. Functional Implications of Normal Age-Related Changes* •  response to stress • Activity intolerance • Orthostatic hypotension • Dizziness w/position changes *Influenced by presence of disease & lifestyle variations

19. Hypertension Smoking Dyslipidemia low HDL elevated LDL elevated triglycerides Diabetes mellitus Physical inactivity Obesity Stress Post-menopausal hormone therapy Excess alcohol intake Modifiable CV Risk Factors

20. Nursing Interventions Normal aging changes may be difficult to differentiate from changes r/t inactive lifestyle and/or CV disease

21. Nursing Interventions • Education about cardiovascular risk factors, preventive measures & treatment regimens • Physical activity & smoking cessation are interventions that have impacts on CV health, as well as general health & healthy aging