The ageing heart


Heart diseases are common among the very old. But it is sad that even the middle-aged and young are facing heart problems, thanks to their unhealthy lifestyle, writes Dr Ramamurthy Bingi 

Aging is an inevitable phenomenon. Some age rapidly, some slowly. This has brought in the concept of inappropriate aging or premature aging. Incidence and prevalence of hypertension, coronary artery disease, congestive heart failure, stroke arterial aneurysms and atrial fibrillation are increasing steeply with advancing age.

There are some common cardiac disorders and problems that set foot during middle age. Age is an important and strong risk factor for coronary heart diseases. 

As age advances, heart becomes stiffened and shows thickening which may be concentric or eccentric. Arteries may become stiff, lose elasticity, and become dilated.

Arterial stiffness along with altered pulse pressure as well as pulse reflectivity is responsible for hypertension. Elderly have special form of hypertension called isolated systolic hypertension. Any value above 140/90 is abnormal.

In aged only systolic pressure is elevated. Hypertension needs to be managed aggressively since uncontrolled hypertension has impact on heart kidney and brain. Coronary disease is extensive and carries high mortality. The symptoms are under-appreciated as they are often atypical or silent.

In chronic cases, time-tested treatment strategies are all useful and well accepted. Coronary angioplasty as well as coronary artery bypass surgery are both feasible in selected cases, though at a higher complication rate. 

Aortic valve sclerosis is the most common disorder. It also progresses and produces aortic stenosis. Aortic stenosis is a valvular disease which remains relatively asymptomatic. It is one of the causes of sudden death and heart failure in elderly. Both established aortic valve replacement as well as emerging transcutaneous aortic valve replacement are possible in these cases, if they are identified early on. 

Heart failure increases as age advances. About 10% of the aged have heart failure. Drug therapy as well as CRT (Cardiac Resynchronization Therapy) are feasible.

It is not surprising when the old suffer from heart problems. But when the middle-aged, and of late, even the young suffer from heart diseases, it is a candid proof of the unhealthy lifestyle they follow. Good dietary habits, regular exercises, and avoidance of stress are definitely important. Healthy habits are even cost-effective, keeping quality of life in mind.

(The writer is a cardiologist) 

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