Coronary heart disease (coronary artery disease) in the elderly may be atypical and the symptoms may be non-specific. The multiplicity of diseases and the general condition related to age have specific consequences in terms of risk factors, symptoms and management strategies for ischemic heart disease in seniors. It is worth finding out what exactly these differences are and what they have practical significance.

Contents:

  1. Causes of ischemic disease in seniors
  2. Risk factors of coronary artery disease in seniors
  3. Coronary heart disease in the elderly: symptoms
  4. Ischemic disease in the elderly: diagnosis
  5. Ischemic disease prevention
  6. Coronary heart disease treatment

Coronary heart disease in the elderlyis a slightly different disease entity than in younger age groups. The differences are related to the manifestation - symptoms, but also to diagnostics and treatment - pharmacological and surgical. All these aspects are significantly influenced by the multi-morbidity of elderly people.

Coronary heart disease in old age is therefore a major challenge for the attending physician in terms of making the correct diagnosis and then selecting the appropriate treatment. This difficulty results from the balance between the occurring side effects of drugs, which the elderly are particularly exposed to, and the appropriate selection of treatment, so that the ischemic disease does not develop and the symptoms are not bothersome.

Causes of ischemic disease in seniors

The cause of coronary artery disease in all age groups is, in the vast majority of cases, coronary atherosclerosis. It is one of the many aging processes of the circulatory system - both the heart and all arteries in the body.

The process of cholesterol deposition in the vascular walls begins at a young age and gradually progresses, if it affects the coronary arteries and causes them to narrow, coronary heart disease develops. Its symptoms result from insufficient blood supply with oxygen and nutrients to the cardiomyocytes, which prevents them from having enough energy to contract efficiently.

Disease risk factorscoronary disease in seniors

Elderly people are at risk of developing ischemic disease not only because of their age, but also because of their other diseases. There is a certain group of risk factors, independent of age, they are:

  • incorrect diet
  • smoking
  • little physical activity

their relationship with age is that they occur as a result of long-established habits that are difficult to change in older people. In addition, risk factors for ischemic disease are:

  • hypertension
  • diabetes
  • abnormal cholesterol
  • inflammatory diseases (e.g. RA - rheumatoid arthritis)

they result directly from the aforementioned risk factors, but in older people these diseases are much more common than in younger people.

Unfortunately, it has been proven that age itself is also a factor that increases the probability of ischemic disease, although it results from the above-described conditions. This is due to the fact that throughout our lives we are exposed, on the one hand, to an incorrect lifestyle (smoking or lack of physical activity), but also to the occurrence of many diseases, e.g. hypertension or diabetes, and the accumulation of these factors reaches its peak in old age.

Coronary heart disease more often affects men over 45 and women over 55, but it is believed that cardiovascular risk increases rapidly only in old age: in women over 70, and in men over 65, then it is defined as high, while smoking accelerates it by another 5 years.

Coronary heart disease in the elderly: symptoms

The course of ischemic heart disease in the elderly may be atypical, the symptoms are often non-specific. The classic ailment occurring in ischemic disease, i.e. chest pain radiating to the arm and increasing with exertion, may not occur in the elderly at all.

It also happens that the manifestation of this disease is completely different: the pain is completely unusual or there are so-called masks, i.e. symptoms typically found in other diseases, such as

  • shortness of breath
  • fatigue
  • nausea
  • palpitations

In this case, the diagnosis is focused on other diseases and, unfortunately, it is very easy to miss ischemic heart disease. In addition, little physical activity may mean that symptoms may not appear at all, this is due to the fact that symptoms associated with atherosclerosis of the coronary arteries typically worsen with exercise.

Moreover, the multitude of diseases in seniors means that many of the reported ailments, unusual for ischemic heart disease, may be attributed to respiratory diseases, gastroesophageal reflux disease, or even anemia. An additional difficulty is dementia in a fairly large group of elderly people, which makes it difficult to describe and communicate the symptoms to a doctor.

Ischemic disease in the elderly: diagnosis

The diagnostic methods are basically the same in all age groups - they are based on the execution

  • EKG
  • laboratory tests
  • followed by heart echoes
  • less frequent computed tomography and exercise testing

The results of all these studies may be distorted by illnesses and their various consequences, which makes their interpretation much more difficult. The last mentioned - an exercise test is not always possible due to the physical capacity and mobility of older patients. More advanced studies are computed tomography of the coronary arteries and coronary angiography, there are also some limitations in their scope.

Both tests involve the administration of contrast to the vessels, it is an agent that can damage the kidneys, which is especially dangerous in people already suffering from them, because it can lead to worsening of kidney failure. Unfortunately, seniors are the age group where kidney failure is particularly common.

Moreover, it has been proven that coronary angiography in the elderly is associated with a higher risk of complications, not only in terms of kidney damage, but also vessel damage or bleeding after the procedure.

This study, however, remains the standard of care for advanced ischemic disease, regardless of age.

Ischemic disease prevention

In elderly people, appropriate treatment of other diseases, especially high blood pressure and diabetes, is crucial, as it reduces the risk of coronary heart disease and its progression. So let's regularly measure your blood pressure, blood glucose (blood sugar) and cholesterol tests.

Coronary heart disease treatment

The basic treatment of ischemic heart disease does not depend on age, it is primarily the use of an appropriate diet and lifestyle modification - stopping smoking, increasing physical activity. It is an essential way to fight atherosclerosis, improve quality of life and improve prognosis.

Drug treatment is based on acidacetylsalicylic acid, especially important in the elderly, because they have more active platelets, and thus a greater risk of thrombosis. The benefits of using this drug have been proven to be greater in the elderly than in younger age groups, on the other hand, acetylsalicylic acid contributes little to bleeding.

Another extremely important drug are the so-called statins, i.e. drugs that lower cholesterol. They facilitate the control of cholesterol values, the admissible concentration of which is individually adjusted depending on the age and the presence of other diseases. Unfortunately, the elderly are exposed to side effects of these drugs - liver and muscle damage, which is manifested by muscle pain and hematuria.

In addition, the so-called angiotensin converting enzyme inhibitors are often used in the treatment of ischemic disease, regardless of the age group. In the elderly, beta-blockers are also especially recommended due to other diseases occurring in the elderly - cardiac arrhythmias or heart failure. On the other hand, there are some limitations of their use in seniors, contraindications are often occurring:

  • bradycardia (slow heart rate)
  • sick bay syndrome
  • lung diseases - e.g. COPD
  • asthma

The above-described aspects of treatment are only part of the multi-faceted therapy of ischemic heart disease, therefore it is an extremely difficult issue that requires extensive knowledge and experience.

Invasive treatment is now widely used in all age groups. However, also in the elderly, this method of therapy has its own differences, and age determines to some extent the method of surgical treatment. The elderly, especially after the age of 75, are slightly more prone to complications related to the procedures - percutaneous coronary angioplasty (stenting) and coronary bypass surgery. This is due to the coexistence of other diseases: blood vessels, kidneys and lungs.

In most cases, when an atherosclerotic lesion is found in the coronary artery, coronary angioplasty is the best course of action, but under certain specific conditions, this method is equal to surgery. Then a team of doctors - cardiologists and cardiac surgeons decide on the method of treatment, they assess the risks associated with both methods of treatment and decide on the best course of action.

It is worth remembering that the bypass operation is more burdensome for the body and is associated with longer rehabilitation.

Therefore, in the eventneeds, seniors more often decide to perform several stages of percutaneous coronary angioplasty - sten implantation. The introduction of a widely available option of performing coronary angioplasty has improved the safety of invasive treatment and the effects of treatment of ischemic heart disease.

About the authorBow. Maciej GrymuzaA graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań. He graduated from university with an over good result. Currently, he is a doctor in the field of cardiology and a doctoral student. He is particularly interested in invasive cardiology and implantable devices (stimulators).

Category:

Geriatrics