NURS 5461 CV Disorders – Questions Answered
With Expert Insight
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Terms in this set (21)
• In healthy older adults, age-related changes have
modest clinically relevant effects on cardiac
hemodynamics and performance at rest • Resting heart
rate, ejection fraction, stroke volume, and cardiac
CLINICAL EFFECTS OF CV
output are well preserved even at very advanced age •
CHANGES
Ability to respond to increased demands associated
with exercise or illness (either cardiac or noncardiac)
declines progressively with advancing age • Peak
aerobic capacity declines inexorably with age
• Four major risk factors for • Hypertension • Diabetes mellitus • Dyslipidemia •
CVD: Smoking
Systolic BP increase with age, diastolic BP declines
thereafter • Pulse pressure (the difference between
systolic and diastolic BP) increases with age,
HYPERTENSION systolic hypertension dominant form of hypertension in
older adults, especially women • increased diastolic BP
raises CVD risk independent of systolic BP, particularly
in men
• Prevalence increases with age at least up to age 80 •
Approx. 50% of pts with diabetes in the US are ≥65 yr
old • As in younger patients, the impact of diabetes on
CVD risk is greater in older women than in older men •
DIABETES MELLITUS In the Framingham Heart Study, for example: • The
adjusted risk for incident CHD for older patients with
diabetes was 2.1 in women and 1.4 in men • The excess
risk associated with diabetes was greater in both men
and women >65 yr old than in younger individuals
, • The strength of the association between total
cholesterol and LDL cholesterol levels and incident
CAD ↓ with age, especially after age 80 • But low HDL
cholesterol levels (<40 mg/dL in men, <50 mg/dL in
women) and high ratios of total cholesterol to HDL
DYSLIPIDEMIA
cholesterol (≥5.5 in men, ≥5 in women) remain
independently associated with coronary events even
among people >80 yr old • Clinical trials have
demonstrated benefits of statin therapy in moderate-
risk and high-risk patients up to 85 yr of age
• Prevalence of smoking declines with age, partly due to
successful smoking cessation, partly due to premature
deaths in smokers • Among older smokers, smoking
cessation is associated with substantial reductions in
SMOKING
CVD risk within 2−6 years relative to continued smoking
• In most studies, smoking remains a strong and
independent risk factor for fatal and nonfatal CV events
among older adults
Whether the following are important risk factors for
CVD among older adults is unclear: • Obesity •
ADDITIONAL RISK
Increased levels of C-reactive protein, fibrinogen, D-
FACTORS?
dimer, and plasmin-antiplasmin complex • Coronary
artery calcium content on CT
The acute coronary syndromes (ACS): • Unstable angina
ACUTE CORONARY
• Non-ST-elevation MI (NSTEMI) • ST-elevation MI
SYNDROMES
(STEMI)
Shortness of breath is the most common initial symptom
in patients >80−85 years old • Older ACS patients are
more likely than younger patients to present with
ACS: PRESENTATION
altered mental status, confusion, dizziness, or syncope •
Presentation delays, altered symptomatology, and
nondiagnostic ECGs often delay initiation of treatment
• A: ASA and antianginal therapy • B: Beta-blockers and
ABCs of ACS blood pressure • C: Cigarette smoking and cholesterol •
D: Diet and diabetes • E: Education and exercise
With Expert Insight
Save
Terms in this set (21)
• In healthy older adults, age-related changes have
modest clinically relevant effects on cardiac
hemodynamics and performance at rest • Resting heart
rate, ejection fraction, stroke volume, and cardiac
CLINICAL EFFECTS OF CV
output are well preserved even at very advanced age •
CHANGES
Ability to respond to increased demands associated
with exercise or illness (either cardiac or noncardiac)
declines progressively with advancing age • Peak
aerobic capacity declines inexorably with age
• Four major risk factors for • Hypertension • Diabetes mellitus • Dyslipidemia •
CVD: Smoking
Systolic BP increase with age, diastolic BP declines
thereafter • Pulse pressure (the difference between
systolic and diastolic BP) increases with age,
HYPERTENSION systolic hypertension dominant form of hypertension in
older adults, especially women • increased diastolic BP
raises CVD risk independent of systolic BP, particularly
in men
• Prevalence increases with age at least up to age 80 •
Approx. 50% of pts with diabetes in the US are ≥65 yr
old • As in younger patients, the impact of diabetes on
CVD risk is greater in older women than in older men •
DIABETES MELLITUS In the Framingham Heart Study, for example: • The
adjusted risk for incident CHD for older patients with
diabetes was 2.1 in women and 1.4 in men • The excess
risk associated with diabetes was greater in both men
and women >65 yr old than in younger individuals
, • The strength of the association between total
cholesterol and LDL cholesterol levels and incident
CAD ↓ with age, especially after age 80 • But low HDL
cholesterol levels (<40 mg/dL in men, <50 mg/dL in
women) and high ratios of total cholesterol to HDL
DYSLIPIDEMIA
cholesterol (≥5.5 in men, ≥5 in women) remain
independently associated with coronary events even
among people >80 yr old • Clinical trials have
demonstrated benefits of statin therapy in moderate-
risk and high-risk patients up to 85 yr of age
• Prevalence of smoking declines with age, partly due to
successful smoking cessation, partly due to premature
deaths in smokers • Among older smokers, smoking
cessation is associated with substantial reductions in
SMOKING
CVD risk within 2−6 years relative to continued smoking
• In most studies, smoking remains a strong and
independent risk factor for fatal and nonfatal CV events
among older adults
Whether the following are important risk factors for
CVD among older adults is unclear: • Obesity •
ADDITIONAL RISK
Increased levels of C-reactive protein, fibrinogen, D-
FACTORS?
dimer, and plasmin-antiplasmin complex • Coronary
artery calcium content on CT
The acute coronary syndromes (ACS): • Unstable angina
ACUTE CORONARY
• Non-ST-elevation MI (NSTEMI) • ST-elevation MI
SYNDROMES
(STEMI)
Shortness of breath is the most common initial symptom
in patients >80−85 years old • Older ACS patients are
more likely than younger patients to present with
ACS: PRESENTATION
altered mental status, confusion, dizziness, or syncope •
Presentation delays, altered symptomatology, and
nondiagnostic ECGs often delay initiation of treatment
• A: ASA and antianginal therapy • B: Beta-blockers and
ABCs of ACS blood pressure • C: Cigarette smoking and cholesterol •
D: Diet and diabetes • E: Education and exercise
