1. The Ageing Cardiovascular System Jennifer Inglis 12 th December 2006

2. Overview Why is it important to understand ageing of the cardiovascular system? What changes in cardiovascular structure and function are associated with ageing? How might this affect our practice?

3. Why? Prevalence of cardiovascular disease amongst elderly populations “It’s just my age, doctor” Impact on our assessment and treatment of elderly patients

4. What changes occur? Vascular changes Postural changes Cardiac changes at rest Cardiac changes on exercise

6. Vascular Changes Aorta and large elastic arteries -  wall thickness, dilation and stiffening  in mean systemic arterial pressure in most, but not all Systolic BP rises more than diastolic – increasing chance of isolated systolic hypertension

7. Postural Changes Blunting of  in HR Slowed baroreceptor response to postural change May be reduced vasoconstriction in response to reduced BP Increase the chance of postural hypotension

9. Cardiac Changes at Rest Minor  in HR CO output maintained by  SV  ejection of blood during late systole  early diastolic filling rate EDV not  - enhanced atrial contribution to LV filling – beware AF, particularly if tachycardic

10. During exercise…  in maximum HR (  response to β- adrenergic stimuli)  in cardiac output - reduced by 30% between ages 20 and 80 Maximum SV not reduced – but maintained in different manner Frank Starling mechanism

11. Frank Starling Mechanism  EDV, due to: Longer diastolic interval (  HR)  EF -  amount of blood in LV at start of diastole

12. Summary of changes HRSVCOEDVEF At rest  === Exercise  = 

14. Some Practical Points Beware of increased risk of hypertension… …and postural hypotension Elderly patients unlikely to tolerate tachycardia or AF as well as younger patients Caution with beta blockers

15. In summary… Ageing does alter the structure and function of the cardiovascular system Changes more evident during exercise These effects may contribute to earlier decompensation when unwell …and remember your erect and supine BPs!

16. Comments? Or easy questions?