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Advanced Age Geriatric Care pp 113–130Cite as

Cardiovascular Diseases in the Very Elderly

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Abstract

The percentage of the elderly above the age of 85 years is expected to more than double in the next 40 years. As age advances, there are alterations in structure and function of the heart and vasculature. This age group is especially at risk for cardiovascular diseases. This review summarises the main group of cardiac disorders with the focus on the prevalence and diagnosis. It will highlight the improvements that have occurred in clinical care and the current evidence for some therapeutic strategies, their effects and/or adverse effects in the extreme elderly. Not many subjects of this age group have been included in major cardiovascular clinical trials. In males more than 75 years, about 75% have systolic hypertension. Elderly tend to have more complex coronary disease. Heart failure is a common cause of hospital admission in elderly. More than 10% of the 80 plus age group have significant arrhythmia. Aortic stenosis and mitral regurgitation are the commonest valvular dysfunctions encountered in the very elderly. Due to increased number of elderly having pacemakers and prosthetic valves, the potential pool for endocarditis has been increasing.

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Author information

Authors and Affiliations

  1. Royal North Shore, Ryde, North Shore Private and Macquarie University Hospitals, University of Sydney, St. Leonards, NSW, Australia

    Logan Kanagaratnam

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  1. Logan Kanagaratnam
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Editor information

Editors and Affiliations

  1. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Nages Nagaratnam

  2. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Kujan Nagaratnam

  3. Rehabilitation and Aged Care Service, Blacktown-Mt Druitt Hospital, Blacktown, NSW, Australia

    Gary Cheuk

Multiple Choice Questions

Multiple Choice Questions

  1. 1.

    Which of the following statements regarding hypertension is true?

    1. A.

      In the very elderly patients the target systolic blood pressure should be 130 mm Hg or less.

    2. B.

      Resistant hypertension is when maximal doses of two medications are not adequate to control the blood pressure.

    3. C.

      Systolic hypertension in the elderly has been associated with cognitive decline.

    4. D.

      Combination therapy should be avoided in the elderly.

  2. 2.

    Which of the following statements regarding ischaemic heart disease is false?

    1. A.

      Compared to younger patients, elderly have more complex coronary artery disease.

    2. B.

      Elderly patients presenting with NSTEMI may be treated with percutaneous intervention or with thrombolytic therapy.

    3. C.

      In octogenarians left main stent implantation has worse outcome when compared to bypass surgery.

    4. D.

      Prasugrel is best avoided in patients older than 75 years.

  3. 3.

    With regard to heart failure, which of the following is false?

    1. A.

      Elderly patients with heart failure may present with confusion or weakness.

    2. B.

      Beta blockers have been shown to reduce mortality.

    3. C.

      Hydralazine and nitrates may be alternative to patients who cannot take and ACE inhibitor or ARB.

    4. D.

      Digoxin therapy has been shown to reduce mortality in heart failure.

  4. 4.

    With regard to atrial fibrillation/flutter, which of the following is false?

    1. A.

      Elderly should not be treated with novel oral anticoagulants (NOACs).

    2. B.

      Medical therapy of atrial flutter is similar to that of atrial fibrillation.

    3. C.

      Flecainide should be combined with an AV nodal blocking agent.

    4. D.

      Sotalol dosage will be influenced by the patient’s renal function.

Answers

  1. 1.

    C

  2. 2.

    C

  3. 3.

    D

  4. 4.

    A

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Kanagaratnam, L. (2019). Cardiovascular Diseases in the Very Elderly. In: Nagaratnam, N., Nagaratnam, K., Cheuk, G. (eds) Advanced Age Geriatric Care. Springer, Cham. https://doi.org/10.1007/978-3-319-96998-5_15

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