Aging changes in the heart and blood vessels
Alternative Names
Heart disease - aging;
Atherosclerosis - aging
Information
Some changes in the heart and
blood vessels normally occur with age, but many others are
modifiable factors that, if not treated, can lead to heart
disease.
BACKGROUND
The heart has two sides. The
right side pumps blood to the lungs to receive oxygen and get rid
of carbon dioxide. The left side pumps oxygen-rich blood to the
body.
Blood flows out of the heart
through arteries, which branch out and get smaller and smaller as
they go into the tissues. In the tissues, they become tiny
capillaries.
Capillaries are where the blood
gives up oxygen and nutrients to the tissues, and receives carbon
dioxide and wastes back from the tissues. Then, the vessels begin
to collect together into larger and larger veins, which return
blood to the heart.
Aging causes changes in the heart
and in the blood vessels. Heart and blood vessel diseases are some
of the most common disorders in the elderly.
AGING CHANGES
Heart
- The heart has a natural
pacemaker system that controls the heartbeat. Some of the pathways
of this system may develop fibrous tissue and fat deposits. The
natural pacemaker (the SA node) loses some of its cells. These
changes may result in a slightly slower heart rate.
- A slight increase in the size of
the heart, especially the left ventricle, is not uncommon. The
heart wall thickens, so the amount of blood that the chamber can
hold may actually decrease despite the increased overall heart
size. The heart may fill more slowly.
- Heart changes cause the ECG of a normal, healthy, older person to be
slightly different than the ECG of a healthy younger adult.
Abnormal rhythms (arrhythmias) such
as atrial fibrillation are common in
older people. They may be caused by heart disease.
- Normal changes in the heart
include deposits of the "aging pigment," lipofuscin. The heart muscle cells
degenerate slightly. The valves inside the heart, which control the
direction of blood flow, thicken and become stiffer. A heart murmur
caused by valve stiffness is fairly common in the
elderly.
Blood vessels
- Receptors, called baroreceptors,
monitor the blood pressure and make changes to help maintain a
fairly constant blood pressure when a person changes positions or
activities. The baroreceptors become less sensitive with aging.
This may explain why many older people have orthostatic
hypotension, a condition in which the blood pressure falls when a
person goes from lying or sitting to standing. This causes dizziness because there is less blood flow
to the brain.
- The capillary walls thicken
slightly. This may cause a slightly slower rate of exchange of
nutrients and wastes.
- The main artery from the heart
(aorta) becomes thicker, stiffer, and less flexible. This is
probably related to changes in the connective tissue of the blood
vessel wall. This makes the blood
pressure higher and makes the heart work harder, which may lead
to hypertrophy (thickening of the heart muscle). The other arteries
also thicken and stiffen. In general, most elderly people
experience a moderate increase in blood pressure.
Blood
- The blood itself changes
slightly with age. Normal aging causes a reduction in total body
water. As part of this, there is less fluid in the bloodstream, so
blood volume decreases.
- The number of red blood cells
(and correspondingly, the hemoglobin
and hematocrit levels) are reduced.
This contributes to fatigue. Most of the white blood cells stay at
the same levels, although certain white blood cells important to
immunity (lymphocytes) decrease in
number and ability to fight off bacteria. This reduces the ability
to resist infection.
EFFECT OF CHANGES
Under normal circumstances, the
heart continues to adequately supply all parts of the body.
However, an aging heart may be slightly less able to tolerate
increased workloads, because changes reduce this extra pumping
ability (reserve heart function).
Some of the things that can
increase heart workload include illness, infections, emotional
stress, injuries, extreme physical exertion, and certain
medications.
COMMON PROBLEMS
- Angina (chest pain caused by temporarily
reduced blood flow to the heart muscle), shortness of breath with
exertion and heart attack can result
from coronary artery disease.
- Abnormal heart rhythms
(arrhythmias) of various types can occur.
- Anemia may occur, possibly related to
malnutrition, chronic infections, blood loss from the
gastrointestinal tract, or as a complication of other diseases or
medications.
- Arteriosclerosis (hardening of the arteries)
is very common. Fatty plaque deposits inside the blood vessels
cause them to narrow and can totally block blood
vessels.
- Congestiveheart failure is also very common in the
elderly. In people older than 75, congestive heart failure occurs
10 times more often than in younger adults.
- Coronary artery disease is fairly common. It
is often a result of arteriosclerosis.
- Heart and blood vessel diseases
are fairly common in older people. Common disorders include high
blood pressure and orthostatic hypotension.
- Transient ischemic attacks
(TIA) or strokes can occur if blood
flow to the brain is disrupted.
- Valve diseases are fairly
common. Aortic stenosis, or
narrowing of the aortic valve, is the most common valve disease in
the elderly.
Other problems with the heart and
blood vessels include the following:
PREVENTION
You can help your circulatory
system (heart and blood vessels). Heart disease risk factors that
you have some control over include high blood pressure, cholesterol
levels, diabetes, obesity, and smoking.
- Eat a heart-healthy diet with
reduced amounts of saturated fat and
cholesterol, and control your
weight. Follow your health care provider's recommendations for
treatment of high blood pressure, high
cholesterol, or diabetes. Minimize or stop smoking.
- Exercise may help prevent
obesity and helps people with diabetes control their blood
sugar.
- Exercise may help you maintain
your maximum abilities as much as possible and reduces
stress.
- Have regular check-ups for your
heart:
- Have your blood pressure checked
every year. If you have diabetes, heart disease, kidney problems,
or certain other conditions, your blood pressure may need to be
monitored more closely.
- If your cholesterol level is
normal, heave it rechecked every 3-5 years. If you have diabetes,
heart disease, kidney problems, or certain other conditions, your
cholesterol may need to be monitored more closely.
- Moderate exercise is one of the
best things you can do to keep your heart, and the rest of your
body, healthy. Consult with your health care provider before
beginning a new exercise program. Exercise moderately and within
your capabilities, but do it regularly.
- People who exercise usually have
less body fat and smoke less than people who do not exercise. They
also tend to have fewer blood pressure problems and less heart
disease.
RELATED TOPICS
References
Schwartz JB, Zipes DP.
Cardiovascular Disease in the Elderly. In: Libby P, Bonow RO, Mann
DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of
Cardiovascular Medicine. 8th ed. Philadelphia, Pa; Saunders
Elsevier; 2007: chap 75.
Review Date: 8/10/2008
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine,
Division of General Medicine, Department of Medicine, University of
Washington School of Medicine. Also reviewed by David Zieve, MD,
MHA, Medical Director, A.D.A.M., Inc.
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