Alterations in Circulatory Function

  • Thomas J. Ebert
  • G. Alec Rooke


According to a 2006 statistical update published by the American Heart Association, 37.3% of all deaths in the United States in 2003 were attributable to cardiovascular disease (CVD).1 About 83% of the deaths related to CVD occur in people age 65 and older. The prevalence of CVD in American men and women aged 65–74 are 68.5% and 75%, respectively. For those aged 75+, prevalence is 77.8% and 86.4%, respectively. These numbers demonstrate the strong association between adverse cardiac events and the aging process.


Diastolic Dysfunction Pulse Wave Velocity Respiratory Sinus Arrhythmia Volatile Anesthetic Circulatory Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics—2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006;113:85–151.CrossRefGoogle Scholar
  2. 2.
    Seymour DG, Vaz FG. A prospective study of elderly general surgical patients: II. Post-operative complications. Age Ageing 1989;18:316–326.PubMedCrossRefGoogle Scholar
  3. 3.
    Lakatta EG. Changes in cardiovascular function with aging. Eur Heart J 1990;11:22–29.PubMedGoogle Scholar
  4. 4.
    Bakris GL, Bank AJ, Kass DA, et al. Advanced glycation end-product cross-link breakers. A novel approach to cardiovascular pathologies related to the aging process. Am J Hypertens 2004;17:23S–30S.PubMedCrossRefGoogle Scholar
  5. 5.
    Aronson D, Rayfield EJ. How hyperglycemia promotes atherosclerosis: molecular mechanisms. Cardiovasc Diabetol 2002;1:1–10.PubMedCrossRefGoogle Scholar
  6. 6.
    Yu BP, Chung HY. Oxidative stress and vascular aging. Diabetes Res Clin Pract 2001;54:S73–80.PubMedCrossRefGoogle Scholar
  7. 7.
    Kass DA, Bronzwaer JGF, Paulus WJ. What mechanisms underlie diastolic dysfunction in heart failure? Circ Res 2004;94:1533–1542.PubMedCrossRefGoogle Scholar
  8. 8.
    Rooke GA. Cardiovascular aging and anesthetic implications. J Cardiothorac Vasc Anesth 2003;17:512–523.PubMedCrossRefGoogle Scholar
  9. 9.
    Turner MJ, Mier CM, Spina RJ, et al. Effects of age and gender on cardiovascular responses to phenylephrine. J Gerontol Med Sci 1999;54A:M17–24.Google Scholar
  10. 10.
    Vinch CS, Aurigemma GP, Simon HU, et al. Analysis of left ventricular systolic function using midwall mechanics in patients >60 years of age with hypertensive heart disease and heart failure. Am J Cardiol 2005;96:1299–1303.PubMedCrossRefGoogle Scholar
  11. 11.
    Aronson S, Fontes ML. Hypertension: a new look at an old problem. Curr Opin Anaesthesiol 2006;19:59–64.PubMedCrossRefGoogle Scholar
  12. 12.
    Mottram PM, Haluska BA, Leano R, et al. Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease. Heart 2005;91:1551–1556.PubMedCrossRefGoogle Scholar
  13. 13.
    Rooke GA, Feigl EO. Work as a correlate of canine left ventricular oxygen consumption, and the problem of catecholamine oxygen wasting. Circ Res 1982;50:273–286.PubMedGoogle Scholar
  14. 14.
    Bulpitt CJ, Rajkumar C, Cameron JD. Vascular compliance as a measure of biological age. J Am Geriatr Soc 1999;47: 657–663.PubMedGoogle Scholar
  15. 15.
    Kass DA. Ventricular arterial stiffening—integrating the pathophysiology. Hypertension 2005;46:185–193.PubMedCrossRefGoogle Scholar
  16. 16.
    Najjar SS, Scuteri A, Lakatta EG. Arterial aging—is it an immutable cardiovascular risk factor? Hypertension 2005; 46:454–462.PubMedCrossRefGoogle Scholar
  17. 17.
    Ebert TJ, Morgan BJ, Barney JA, et al. Effects of aging on baroreflex regulation of sympathetic activity in humans. Am J Physiol 1992;263:H798–H803.PubMedGoogle Scholar
  18. 18.
    Brodde O-E, Leineweber K. Autonomic receptor systems in the failing and aging human heart: similarities and differences. Eur J Pharmacol 2004;500:167–176.PubMedCrossRefGoogle Scholar
  19. 19.
    Leineweber K, Wangemann T, Giessler C, et al. Agedependent changes of cardiac neuronal noradrenaline reuptake transport (uptake1) in the human heart. J Am Coll Cardiol 2002;40:1459–1465.PubMedCrossRefGoogle Scholar
  20. 20.
    Hees PS, Fleg JL, Mirza ZA, et al. Effects of normal aging on left ventricular lusitropic, inotropic, and chronotropic responses to dobutamine. J Am Coll Cardiol 2006;47: 1440–1447.PubMedCrossRefGoogle Scholar
  21. 21.
    Alemany R, Perona JS, Sánchez-Dominguez JM, et al. G protein-coupled receptor systems and their lipid environment in health disorders during aging. Biochim Biophys Acta 2007;1768(4):964–975.PubMedCrossRefGoogle Scholar
  22. 22.
    McNamara DM, MacGowan GA, London B. Clinical importance of beta-adrenoceptor polymorphisms in cardiovascular disease. Am J Pharmacogenomics 2002;2:73–78.PubMedCrossRefGoogle Scholar
  23. 23.
    Passmore JC, Rowell PP, Joshua IG, et al. Alpha 1 adrenergic receptor control of renal blood vessels during aging. Can J Physiol Pharmacol 2005;83:335–342.PubMedCrossRefGoogle Scholar
  24. 24.
    Folkow B, Svanborg A. Physiology of cardiovascular aging. Physiol Rev 1993;73:725–764.PubMedGoogle Scholar
  25. 25.
    Talke P, Stapelfeldt C, Lobo E, et al. Effect of á2badrenoceptor polymorphism on peripheral vasoconstriction in healthy volunteers. Anesthesiology 2005;102:536–542.PubMedCrossRefGoogle Scholar
  26. 26.
    Mancia G, Mark AL. Arterial baroreflexes in humans. In: Shepherd JT, ed. The Cardiovascular System. Bethesda, MD: American Physiological Society; 1983:755–793.Google Scholar
  27. 27.
    Brodde O-E, Konschak U, Becker K, et al. Cardiac muscarinic receptors decrease with age. In vitro and in vivo studies. J Clin Invest 1998;101:471–478.PubMedCrossRefGoogle Scholar
  28. 28.
    Liu HR, Zhao RR, Zhi JM, et al. Screening of serum autoantibodies to cardiac beta1-adrenoceptors and M2-muscarinic acetylcholine receptors in 408 healthy subjects of varying ages. Autoimmunity 1999;29:43–51.PubMedCrossRefGoogle Scholar
  29. 29.
    Ferrari AU. Modifications of the cardiovascular system with aging. Am J Geriatr Cardiol 2002;11:30–43.PubMedCrossRefGoogle Scholar
  30. 30.
    Long DA, Mu W, Price KL, et al. Blood vessels and the aging kidney. Nephron Exp Nephrol 2005;101:e95–99.PubMedCrossRefGoogle Scholar
  31. 31.
    Kugler JP, Hustead T. Hyponatremia and hypernatremia in the elderly. Am Fam Physician 2000;15:3623–3630.Google Scholar
  32. 32.
    Podrid PJ. Atrial fibrillation in the elderly. Cardiol Clin 1999;17:173–188.PubMedCrossRefGoogle Scholar
  33. 33.
    Amar D. Perioperative atrial tachyarrhythmias. Anesthesiology 2002;97:1618–1623.PubMedCrossRefGoogle Scholar
  34. 34.
    Gupta AK, Maheshwari A, Tresch DD, et al. Cardiac arrhythmias in the elderly. Card Electrophysiol Rev 2002; 6:120–128.PubMedCrossRefGoogle Scholar
  35. 35.
    Riess ML, Stowe DF, Warltier DC. Cardiac pharmacological preconditioning with volatile anesthetics: from bench to bedside? Am J Physiol 2004;286:H1603–1607.Google Scholar
  36. 36.
    Maybaum S, Ilan M, Mogilevsky J, et al. Improvement in ischemic parameters during repeated exercise testing: a possible model for myocardial preconditioning. Am J Cardiol 1996;78:1087–1091.PubMedGoogle Scholar
  37. 37.
    Abete P, Ferrara N, Cacciatore F, et al. Angina-induced protection against myocardial infarction in adult and elderly patients: a loss of preconditioning mechanism in the aging heart? J Am Coll Cardiol 1997;30:947–954.PubMedCrossRefGoogle Scholar
  38. 38.
    Longobardi G, Abete P, Ferrara N, et al. “Warm-up” phenomenon in adult and elderly patients with coronary artery disease: further evidence of the loss of “ischemic preconditioning” in the aging heart. J Gerontol 2000;55A: M124–129.Google Scholar
  39. 39.
    Sniecinski R, Liu H. Reduced efficacy of volatile anesthetic preconditioning with advanced age in isolated rat myocardium. Anesthesiology 2004;100:589–597.PubMedCrossRefGoogle Scholar
  40. 40.
    Riess ML, Camara AK, Rhodes SS, et al. Increasing heart size and age attenuate anesthetic preconditioning in guinea pig isolated hearts. Anesth Analg 2005;101:1572–1576.PubMedCrossRefGoogle Scholar
  41. 41.
    Shannon RP, Wei JY, Rosa RM, et al. The effect of age and sodium depletion on cardiovascular response to orthostasis. Hypertension 1986;8:438–443.PubMedGoogle Scholar
  42. 42.
    Ebert TJ, Harkin CP, Muzi M. Cardiovascular responses to sevoflurane: a review. Anesth Analg 1995;81:S11–S22.PubMedCrossRefGoogle Scholar
  43. 43.
    Ebert TJ, Muzi M. Propofol and autonomic reflex function in humans. Anesth Analg 1994;78:369–375.PubMedGoogle Scholar
  44. 44.
    Burgos LG, Ebert TJ, Asiddao C, et al. Increased intraoperative cardiovascular morbidity in diabetics with autonomic neuropathy. Anesthesiology 1989;70:591–597.PubMedCrossRefGoogle Scholar
  45. 45.
    Forrest JB, Rehder K, Cahalan MK, et al. Multicenter study of general anesthesia. III. Predictors of severe perioperative adverse outcomes. Anesthesiology 1992;76: 3–15.PubMedCrossRefGoogle Scholar
  46. 46.
    Carpenter RL, Caplan RA, Brown DL, et al. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992;76:906–916.PubMedCrossRefGoogle Scholar
  47. 47.
    Filipovic M, Wang J, Michaux I, et al. Effects of halothane, sevoflurane and propofol on left ventricular diastolic function in humans during spontaneous and mechanical ventilation. Br J Anaesth 2005;94:186–192.PubMedCrossRefGoogle Scholar
  48. 48.
    Rooke GA, Freund PR, Jacobson AF. Hemodynamic response and change in organ blood volume during spinal anesthesia in elderly men with cardiac disease. Anesth Analg 1997;85:99–105.PubMedCrossRefGoogle Scholar
  49. 49.
    Levine WC, Mehta V, Landesberg G. Anesthesia for the elderly: selected topics. Curr Opin Anaesthesiol 2006;19: 320–324.PubMedCrossRefGoogle Scholar
  50. 50.
    Stanton-Hicks M, Hock A, Stuhmeier K-D, et al. Venoconstrictor agents mobilize blood from different sources and increase intrathoracic filling during epidural anesthesia in supine humans. Anesthesiology 1987;66:317–322.PubMedCrossRefGoogle Scholar
  51. 51.
    Smith JS, Roizen MF, Cahalan MK, et al. Does anesthetic technique make a difference? Augmentation of systolic blood pressure during carotid endarterectomy: effects of phenylephrine versus light anesthesia and of isoflurane versus halothane on the incidence of myocardial ischemia. Anesthesiology 1988;69:846–853.PubMedCrossRefGoogle Scholar
  52. 52.
    Tiret L, Desmonts JM, Hatton F, et al. Complications associated with anaesthesia—a prospective survey in France. Can Anaesth Soc J 1986;33:336–344.PubMedGoogle Scholar
  53. 53.
    Ebert TJ, Muzi M, Berens R, et al. Sympathetic responses to induction of anesthesia in humans with propofol or etomidate. Anesthesiology 1992;76:725–733.PubMedCrossRefGoogle Scholar
  54. 54.
    Sear JW, Higham H. Issues in the perioperative management of the elderly patient with cardiovascular disease. Drugs Aging 2002;19:429–451.PubMedCrossRefGoogle Scholar
  55. 55.
    Ebert TJ, Robinson BJ, Uhrich TD, et al. Recovery from sevoflurane anesthesia: a comparison to isoflurane and propofol anesthesia. Anesthesiology 1998;89:1524–1531.PubMedCrossRefGoogle Scholar
  56. 56.
    Mangano DT, Layug EL, Wallace A, et al. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. N Engl J Med 1996;335:1713–1720.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Thomas J. Ebert
    • 1
  • G. Alec Rooke
    • 2
    • 3
  1. 1.Department of AnesthesiologyMedical College of WisconsinMilwaukeeUSA
  2. 2.Department of AnesthesiologyUniversity of Washington and the Veterans Affairs Puget Sound Health Care SystemSeattle
  3. 3.Harvard Medical SchoolBeth Israel Deaconess Medical CenterBostonUSA

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