Old age is not a joy, or how age-related changes in the cardiovascular system manifest themselves. Diseases of the cardiovascular system in the elderly Age-related changes in the human circulatory system

09.01.2024 Cytomegalovirus

Abstract on the topic:

Features of CVS in older people.

Made by: Mingazheva Elvira 401g

Checked by: Evdokimov V.V.

Arterial hypertension in old age

Increasing life expectancy entails an increase in the elderly population.
The prevalence of arterial hypertension (AH) increases with age, affecting approximately 60% of older people. Blood pressure level is a risk factor, the elimination of which significantly reduces the risk of developing cardiovascular diseases and death, the frequency of which among older people is significantly higher than among young people.
With age, blood pressure increases: SBP - up to 70-80 years, DBP - up to 50-60 years; subsequently, stabilization or even a decrease in DBP is noted. Increasing SBP in older people significantly increases the risk of developing cardiovascular complications, such as coronary heart disease (CHD), cerebrovascular diseases, heart and kidney failure, and death from them. In accordance with the results of recent studies, pulse blood pressure (the difference between systolic and diastolic blood pressure) is considered as the most accurate predictor of cardiovascular complications in patients over 60 years of age due to the fact that it reflects the pathological stiffness of the arterial walls. The most convincing results are from a meta-analysis based on three studies: EWPНE, SYST-EUR and SYST-CHINA. They provided evidence that the higher the systolic blood pressure and the lower the diastolic blood pressure, i.e., the higher the pulse blood pressure, the worse the prognosis for cardiovascular morbidity and mortality.
At present, normal values for pulse blood pressure are not clearly defined, although most studies show a significant increase in cardiovascular risk with pulse blood pressure above 65 mm Hg. Art.

Pathogenetic mechanisms of hypertension in old age
The following structural and functional changes in the cardiovascular system during aging should be noted.
Anatomical changes
Heart:
enlargement of the cavities of the left atrium and left ventricle;
calcification of the mitral and aortic valve rings.
Vessels:
increase in the diameter and length of the aorta;
thickening of the aortic wall.
Physiological changes
Heart:
decreased compliance of the left ventricle;
impaired diastolic filling of the left ventricle (decreased early filling and increased filling during atrial systole).
Vessels:
decreased elasticity;
increase in pulse wave speed;
increase in SBP.

Histophysiological changes
Increased content of lipids, collagen, lipofuscin, amyloid in tissues.
A decrease in the number of myocytes with an increase in their size.
Decreased rate of myocyte relaxation.
Decreased sensitivity of β-adrenergic receptors.
Increased duration of myocyte contraction.

Features of examination of elderly patients with hypertension
In addition to routine testing, which is performed in all patients with hypertension, patients over 60 years of age should be assessed for the presence of pseudohypertension, white-coat hypertension, orthostatic hypotension, and secondary hypertension.
Great attention should be paid to the correct measurement of blood pressure. It should be carried out in a sitting position after a 5-10 minute rest. Blood pressure is defined as the average of two or more measurements.
Sometimes, when measuring blood pressure in elderly people, false results can be obtained due to an “auscultatory failure” - the absence of tones for a certain period after the first sound characterizing SBP appears. This can lead to a decrease in systolic blood pressure by 40-50 mm Hg. Art. To avoid errors and register a tone that appears before the “auscultatory dip,” it is recommended to inflate the cuff to 250 mm Hg. Art. and slowly release the air. The diagnosis of hypertension is established if SBP is >140 mmHg. Art. or DBP >90 mm Hg. Art. during several examinations.
Hypertension in the elderly is often accompanied by increased stiffness of the arterial wall due to its thickening and calcification. In some cases, this contributes to an overestimation of blood pressure readings, since the cuff cannot compress the stiff artery. In such a situation, the blood pressure level when measured using a cuff (indirect method) may be 10-50 mm Hg. Art. higher than using an intra-arterial catheter (direct method). This phenomenon is called pseudohypertension. The Osler test sometimes helps to diagnose it: determining the pulsation on a. radialis or a. brachialis distal to the cuff after inflating approximately to the patient's SBP level. If the pulse is palpable despite strong compression of the brachial artery, this indicates the presence of pseudohypertension. It should be suspected in cases where, against the background of high blood pressure numbers, there are no other signs of target organ damage. If an elderly person with pseudohypertension is prescribed antihypertensive therapy, he or she may have clinical signs of an excessive decrease in blood pressure, although hypotension is not measured when measured.
High blood pressure variability is another sign of increased stiffness of large arteries.

Clinical manifestations of increased blood pressure variability may include:
orthostatic decrease in blood pressure;
decreased blood pressure after eating;
enhanced hypotensive response to antihypertensive therapy;
increased hypertensive response to isometric and other types of stress;
"White coat hypertension"
Patients with complaints of severe changes in blood pressure, a history of dizziness and fainting, or patients with high blood pressure at a doctor's appointment and no signs of target organ damage are advised to undergo ambulatory 24-hour blood pressure monitoring or measure blood pressure at home 4-5 times a day. In addition, elderly patients with hypertension often experience disturbances in the circadian rhythm of blood pressure, which require identification and correction, as they can cause cardiovascular complications.
To diagnose orthostatic hypotension, all patients over 50 years of age are recommended to measure blood pressure while lying down, and after 1 and 5 minutes - while standing. The normal response of blood pressure to the transition from a lying position to a standing position is a slight increase in DBP and a decrease in SBP. Orthostatic hypotension occurs when SBP decreases by more than 20 mm Hg. Art. or DBP increases by more than 10 mm Hg. Art. The causes of orthostatic hypotension, as mentioned above, are a decrease in blood volume, baroreceptor dysfunction, disruption of the autonomic nervous system, as well as the use of antihypertensive drugs with a pronounced vasodilating effect (a-blockers and combined a- and b-blockers). Diuretics, nitrates, tricyclic antidepressants, sedatives and levodopa can also worsen orthostatic hypotension.
To reduce the severity of orthostatic hypotension, it is recommended to adhere to the following rules:
lie on a high pillow or raise the head of the bed;
rise from a lying position slowly;
before moving, if possible, perform isometric exercises, for example, squeezing a rubber ball in your hand, and drink at least a glass of liquid;
eat food in small portions.
Another important point in the examination of elderly patients with hypertension is the exclusion of secondary hypertension. The most common causes of secondary hypertension in elderly patients are renal failure and renovascular hypertension. The latter, as a possible cause of increased blood pressure, is recorded in 6.5% of hypertensive patients aged 60-69 years and in less than 2% of patients aged 18-39 years.

Treatment of elderly people with arterial hypertension
The goal of treating elderly patients with hypertension is to reduce blood pressure below 140/90 mmHg. Art.
Non-drug therapy is a mandatory component of the treatment of elderly patients with hypertension. In patients with mild hypertension, it can lead to normalization of blood pressure; in patients with more severe hypertension, it can reduce the number of antihypertensive drugs taken and their dosage. Non-drug treatment consists of lifestyle changes.
Reducing body weight in case of excess and obesity helps reduce blood pressure and improves the metabolic profile in these patients.
Reducing table salt intake to 100 mEq Na, or 6 g of table salt per day, can have a significant effect on BP in older adults. Overall, controlled studies show a small but consistent reduction in BP in response to limiting salt intake to 4-6 g/day
An increase in physical activity (35-40 minutes per day of dynamic exercise, for example, brisk walking) also has an antihypertensive effect and has a number of other positive effects, in particular metabolic ones.
Reducing alcohol consumption per day to 30 ml of pure ethanol (maximum 60 ml of vodka, 300 ml of wine or 720 ml of beer) for men and 15 ml for women and men with low body weight also helps reduce blood pressure.
Inclusion in the diet of foods high in potassium (approximately 90 mmol/day). The effect of potassium on blood pressure levels has not been conclusively proven, however, given its effect on the prevention of strokes and the course of arrhythmias, elderly patients with hypertension are recommended to consume vegetables and fruits rich in this element.
Enriching the diet with calcium and magnesium has a beneficial effect on the general condition of the body, and calcium also slows down the progression of osteoporosis.
Quitting smoking and reducing the proportion of saturated fats and cholesterol in the diet help improve the condition of the cardiovascular system.
It must be remembered that one of the reasons for increased blood pressure in old age may be the treatment of concomitant diseases with non-steroidal anti-inflammatory drugs, so it is necessary to reduce their use.

Drug therapy
In cases where non-drug treatment does not normalize blood pressure, it is necessary to consider prescribing antihypertensive drug therapy.
Patients with SBP levels above 140 mmHg. Art. and concomitant diabetes mellitus, angina pectoris, cardiac, renal failure or left ventricular hypertrophy, treatment of hypertension should begin with pharmacotherapy along with lifestyle changes.
The medication regimen should be simple and understandable for the patient; treatment should begin with low doses (half as much as in young people), gradually increasing them until the target blood pressure is reached - 140/90 mm Hg. Art. This approach helps prevent orthostatic and postprandial (after eating) hypotension.
A forced decrease in blood pressure can worsen cerebral and coronary blood flow against the background of obliterating atherosclerotic vascular lesions.
Pharmacotherapy used in elderly patients with hypertension does not differ from that prescribed for young patients. Diuretics and long-acting dihydropyridine calcium antagonists are drugs effective in preventing stroke and major cardiovascular complications.
Thus, the algorithm for managing elderly patients with hypertension is as follows:
establishing a diagnosis (excluding the secondary nature of hypertension, “white coat hypertension” and pseudohypertension);
risk assessment taking into account the presence of concomitant diseases;
non-drug treatment;
drug therapy.
However, it must be remembered that only an individual approach to the examination and treatment of elderly patients can improve their quality of life and the prognosis of a particular patient.

Cardiac ischemia

Coronary heart disease is myocardial damage caused by impaired blood flow in the coronary arteries. That is why in medical practice the term coronary heart disease is often used.

Typically, in people suffering from coronary artery disease, symptoms appear after 50 years of age. They only occur during physical activity. Typical manifestations of the disease are:

pain in the middle of the chest (angina);

feeling of shortness of breath and difficulty breathing;

circulatory arrest due to too frequent heart contractions (300 or more per minute). This is often the first and last manifestation of the disease.

Some patients suffering from coronary heart disease do not experience any pain or lack of air even during a myocardial infarction.

The more risk factors a person has, the more likely they are to have the disease. The influence of most risk factors can be reduced, thereby preventing the development of the disease and the occurrence of its complications. Such risk factors include smoking, high cholesterol and blood pressure, and diabetes.

Diagnostic methods: recording an electrocardiogram at rest and during a stepwise increase in physical activity (stress test), chest x-ray, biochemical blood test (with determination of cholesterol and blood glucose levels). If there is severe damage to the coronary arteries requiring surgery, then coronary angiography. Depending on the condition of the coronary arteries and the number of affected vessels, the treatment, in addition to medications, is angioplasty or coronary artery bypass surgery. If you consult a doctor on time, they will prescribe medications that help reduce the impact of risk factors, improve quality of life and prevent the development of myocardial infarction and other complications:

statins to lower cholesterol;
beta blockers and angiotensin-converting enzyme inhibitors to lower blood pressure;
aspirin to prevent blood clots;
nitrates to help relieve pain during an angina attack
do not smoke. It's the most important. Nonsmokers have a significantly lower risk of myocardial infarction and death than smokers;
eat foods low in cholesterol;
Do physical activity regularly, every day for 30 minutes (walking at an average pace);
reduce your stress levels.

Atherosclerosis

Atherosclerosis (from the Greek athera - gruel and sclerosis), a chronic disease characterized by hardening and loss of elasticity of the walls of the arteries, narrowing of their lumen with subsequent disruption of the blood supply to the organs; The entire arterial system of the body is usually affected (albeit unevenly). A. older people get sick more often. External manifestations of the disease are usually preceded by a many-year asymptomatic period; To some extent, many young people have atherosclerotic changes. Men are 3-5 times more likely to suffer from A. than women. In the development of the disease, hereditary predisposition, as well as the individual characteristics of the body, play a role. Diabetes mellitus, obesity, gout, cholelithiasis, etc. contribute to the development of A. A diet with an excess amount of animal fat plays a significant role as a factor predisposing to A., but not as the root cause of A. Low physical activity is known to be important in the origin of A. An important reason should be considered psycho-emotional stress, traumatic to the nervous system, the influence of a busy pace of life, noise, some specific working conditions, etc.

The mechanism of development of the disease is a disturbance in the metabolism of lipids (fat-like substances), especially cholesterol, changes in the structure and function of the vascular wall, and the state of the blood coagulation and anticoagulation systems. When cholesterol metabolism is disrupted, the cholesterol content in the blood increases, which over time becomes an important (albeit optional) link in the development of the disease. Apparently, with A. not only is the degree of utilization and elimination of excess dietary cholesterol reduced, but its synthesis in the body is also increased. Metabolic disorders are associated with a disorder of its regulation - the nervous and endocrine systems.

With A., atherosclerotic plaques form in the vascular wall - more or less dense thickenings of the inner lining of the artery. First, the protein substance of the inner lining of the artery swells. Subsequently, its permeability increases: cholesterol penetrates the vessel wall. Accumulations of cholesterol in the walls of arteries cause secondary changes in the vessels, expressed in the proliferation of connective tissue. Subsequently, atherosclerotic plaques undergo a number of changes: they can disintegrate with the formation of a mushy mass (hence the name A.), lime is deposited in them (calcification) or a translucent homogeneous substance (hyaline) is formed. The process is progressive. The lumens of blood vessels narrow. Due to the circular arrangement of plaques, the vessels lose their ability to expand, which, in turn, disrupts the regulation of blood supply to organs during intense work. Irregularities inside the vessels in A. contribute to the formation of blood clots and thrombi, which aggravate circulatory disorders until they completely stop. The development of blood clots is also facilitated by a decrease in the intensity of anti-clotting processes observed in A. Some researchers associate the onset of A. development with a violation of blood clotting, the accumulation of thrombotic masses in the walls of the vessel, followed by their obesity, loss of cholesterol and connective tissue reaction.

With the predominance of atherosclerotic changes in the vessels of the heart, brain, kidneys, lower extremities, in the organ that experiences a lack of blood supply as a result of A., disturbances occur that determine the clinical picture of the disease. A. heart vessels is expressed by coronary insufficiency or myocardial infarction. A. cerebral vessels leads to disorders of mental activity, and in severe degrees - to various types of paralysis. A. renal arteries usually manifests as persistent hypertension. A. blood vessels of the legs can be the cause of intermittent claudication (see Endarteritis obliterans), the development of ulcers, gangrene, etc.

Treatment and prevention of A. are aimed at regulating general and cholesterol metabolism. At the same time, measures to normalize working and living conditions (observance of work and rest schedules, physical education, etc.) are important. Nutrition should not be excessive, especially in relation to animal fats and carbohydrates. The diet includes foods containing vitamins and vegetable oils. Among the medicinal drugs used are some vitamins, hormonal agents, drugs that inhibit cholesterol synthesis, promote its elimination, and other drugs that prevent blood clotting - anticoagulants, as well as vasodilators. Treatment is carried out on a strictly individual basis with mandatory medical supervision.

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Karaganda State Medical University

Department of Histology

Test

Features of the cardiovascular system in elderly people

Completed: Art. 3072gr. Novozhenova V.

Checked by: teacher Abeldinova G.K.

Karaganda 2014

Introduction

1. Cardiac system

2. Vascular system

Bibliography

Introduction

The aging process is characterized by gradual involutive changes in most organs, which entails changes in their functions due to the gradual disappearance of active parenchyma in the organ due to its replacement with inactive tissue (adipose or connective tissue) or a progressive decrease in the size of the organ. Old age is a holistic process, since the phenomena of old age and involution develop in all organs and systems of the body.

Purpose of the study: to consider and study the morphology of the blood system and its age-related features.

To achieve this goal, the following tasks were solved:

1. Consider the components of the cardiovascular system and their morphology.

2. Determine age-related characteristics of the cardiovascular system.

1. Cardiac system

cardiomyocyte thrombogenic blood arterial

Significant changes with age occur in the heart itself. Over the course of 70 years of human life, the heart pumps 165 million liters of blood. Its contractility depends, first of all, on the state of the myocardial cells. Such cardiomyocyte cells in mature and elderly people are not renewed and the number of cardiomyocytes decreases with age. When they die, they are replaced by connective tissue. But the body tries to compensate for the loss of myocardial cells by increasing the mass (and therefore strength) of each working myocardial cell. Naturally, this process is not unlimited, and gradually the contractility of the heart muscle decreases.

With age, the valvular apparatus of the heart also suffers, and changes in the bicuspid (mitral) valve and aortic valve are more pronounced than in the valves of the right chambers of the heart. In old age, valve flaps lose their elasticity and calcium can be deposited in them. As a result, valve insufficiency develops, which to a greater or lesser extent disrupts the coordinated movement of blood through the parts of the heart. Rhythmic and consistent contractions of the heart are provided by special cells of the cardiac conduction system.

They are also called pacemakers, i.e. cells capable of generating impulses that create heart rhythm. The number of cells of the conducting system begins to decrease from the age of 20, and in old age their number is only 10% of the original. This process certainly creates the preconditions for the development of heart rhythm disturbances.

2. Vascular system

The main changes that occur in large arterial trunks are sclerotic compaction of the inner membrane (intima), atrophy of the muscle layer, and decreased elasticity. Physiological hardening of arteries decreases towards the periphery. All other things being equal, changes in the vascular system are more pronounced in the lower extremities than in the upper extremities. Morphological studies are confirmed by clinical observations. When considering age-related changes in the speed of propagation of the pulse wave in various areas of large arterial vessels, it was noted that with age there is a natural increase in its elasticity modulus. Therefore, an increase in the speed of pulse wave propagation, exceeding age standards, is an important diagnostic sign of atherosclerosis.

Age-related changes in arterial vessels cause their insufficient ability not only to expand, but also to narrow. All this, along with the altered regulation of vascular tone in general, disrupts the adaptive abilities of the circulatory system. First of all, and to a greater extent, the large arterial vessels of the systemic circulation, especially the aorta, change, and only in older ages does the elasticity of the pulmonary artery and its large trunks decrease. Along with an increase in the rigidity of arterial vessels and loss of elasticity, there is an increase in the volume and capacity of the arterial elastic reservoir, especially the aorta, which to a certain extent compensates for the impaired functions of the elastic reservoir. However, in later life, the increase in volume does not parallel the decrease in elasticity. This disrupts the adaptive abilities of both the systemic and pulmonary circulation.

They become crimped and elongated. The spastic form of capillary loops with narrowing of the arterial and venous branches predominates, and the spastic-atonic form - with narrowing of the arterial and expansion of the venous branches. These changes in capillaries, along with age-related changes in the rheological properties of blood, cause a decrease in capillary circulation and thereby oxygen supply to tissues. On the one hand, a slowdown in capillary blood flow, and on the other, an increase in the intercapillary distance, both as a consequence of a decrease in the number of functioning capillaries and a thickening of the basement membrane due to its multilayered nature, significantly worsen the conditions for the diffusion of oxygen into the tissue.

A significant decrease in muscle blood flow, both at rest (RMB) and maximum muscle blood flow (MMB) when performing dosed physical activity, has been established during human aging. Such a decrease in MMC indicates a significant limitation of the functionality of the microcirculatory system in skeletal muscles, which is one of the reasons for limiting muscle performance. When considering the reasons for the decrease in muscle blood flow during aging, the following circumstances should be taken into account: age-related changes in central hemodynamics play a certain role - a decrease in cardiac output, processes of physiological arteriosclerosis of arterial vessels, deterioration of the rheological properties of blood. However, age-related changes in the microcirculatory link are of leading importance in this phenomenon: obliteration of arterioles and a decrease in muscle capillarization.

With age, starting from the fourth decade, endothelial dysfunction increases, both in large arterial vessels and at the level of the microvasculature. A decrease in endothelial function significantly affects changes in intravascular hemostasis, increasing the thrombogenic potential of the blood. These changes, along with age-related slowing of blood flow, predispose to the development of intravascular thrombosis and the formation of atherosclerotic plaque.

With age, there is a slight increase in blood pressure, mostly systolic, terminal and average dynamic. Lateral, shock and pulse pressure also increases. An increase in blood pressure is mainly associated with age-related changes in the vascular system - loss of elasticity of large arterial trunks, an increase in peripheral vascular resistance. The absence of a significant increase in blood pressure, primarily systolic, is largely due to the fact that with aging, along with the loss of elasticity of large arterial trunks, especially the aorta, its volume increases and cardiac output decreases. In old age, the coordinated relationship between various parts of the circulatory system is disrupted, which manifests itself as an inadequate response of arterioles to changes in circulation volume. Expansion of the venous bed, decrease in tone, and elasticity of the venous wall are the determining factors in the decrease in venous blood pressure with age.

The progressive decrease in the lumen of small peripheral arteries, on the one hand, reduces blood circulation in the tissues, and on the other, causes an increase in peripheral vascular resistance. It should be noted, however, that the same type of changes in general peripheral vascular resistance hides its different topography of shifts in regional tone. Thus, in elderly and old people, the total renal vascular resistance of the blood increases to a greater extent than the total peripheral vascular resistance.

As a result of the loss of elasticity of large arterial trunks, the activity of the heart becomes less economical with age. This is confirmed by the following facts: firstly, in the elderly and old, compared with young people, there is an increased energy consumption by the left ventricle of the heart per 1 liter of minute blood flow (MCV); secondly, with age, the IOC decreases significantly, but the work performed by the left ventricle in 1 minute remains virtually unchanged; thirdly, the ratio between total elastic resistance (Eo) and peripheral vascular resistance (W) changes. According to the literature, the indicator (Eo/W) characterizes the relationship between the amount of energy that is spent by the heart directly on moving blood through the vessels, and the amount that is accumulated by the walls of blood vessels.

Thus, the presented facts show that due to age-related changes in large arterial vessels, a loss of their elasticity occurs and thereby creates conditions under which the heart spends more energy on moving blood. These changes are especially pronounced in the systemic circulation and cause the development of compensatory hypertrophy of the left ventricle and an increase in heart mass.

Bibliography

1. Study by O.V. Korkushko. State Institution "Institute of Gerontology of the Academy of Medical Sciences of Ukraine", Kyiv.

2. Age histology Publisher: Pulikov A.S. Phoenix, 2006.

3. Volkova O. V., Pekarsky M. I. Embryogenesis and age-related histology of human internal organs M.: Medicine, 1976

4. Age histology: Textbook Editor: Mikhailenko A., Guseva E. Phoenix, 2006

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Age-related changes in the heart

The heart has a natural pacing system that controls the heartbeat. Some of the pathways in this system may develop fibrous tissue and fatty deposits (cholesterol). The heart muscle loses some of its cells.

These changes can cause your heart rate to slow.

A slight increase in the size of the heart, especially the left ventricle, is not uncommon. The wall of the heart thickens, so the amount of blood the chamber can hold may actually decrease despite the overall size of the heart increasing. The heart may fill with blood more slowly.

Cardiac changes usually cause changes in the ECG. The ECG of a normal, healthy elderly person will be slightly different from the ECG of a healthy young adult. Rhythm abnormalities (arrhythmias), such as atrial fibrillation, are more common in older people. They may be caused by heart disease.

Normal changes in the heart also relate to the accumulation of the “aging pigment” lipofuscin in it. The heart muscle cells degenerate slightly. The valves inside the heart that control the direction of blood flow thicken and become stiffer. Heart murmurs are caused by stiffness of the valves quite often in old age.

Age-related changes in blood vessels

Receptors called baroreceptors monitor blood pressure and make changes to help the body keep blood pressure essentially the same when a person changes position or pace of activity. Baroreceptors become less sensitive with aging. This may explain why many older people suffer from orthostatic hypotension, a condition in which blood pressure drops when a person moves from lying or sitting to standing. This leads to dizziness because blood flow to the brain is reduced.

The walls of the capillaries thicken slightly. This may result in slightly slower rates of metabolism and waste.

The main artery of the heart (aorta) becomes thicker, stiffer, and less flexible. This is probably due to changes in the connective tissue of the walls of blood vessels. This raises blood pressure and causes the heart to pump harder, which can cause the heart muscle to thicken (hypertrophy). Other arteries also thicken and become stiffer. In general, most older people experience a mild increase in blood pressure.

Age-related changes in blood

The blood itself changes slightly with age. Normal aging leads to a decrease in the total amount of water in the body. As part of this, the fluid participating in the blood flow is reduced, so the blood volume is slightly reduced.

The number of red blood cells in the blood (and, accordingly, hemoglobin and hematocrit) decreases. This contributes to rapid fatigue. Most white blood cells remain the same, although some white blood cells responsible for immunity (lymphocytes) decrease in number, reducing their ability to fight bacteria. This reduces the body's ability to resist infection.

Impact of age-related changes

Under normal circumstances, the heart continues to supply sufficient blood to all parts of the body. However, aging of the heart may somewhat reduce the ability to tolerate increased stress, since age-related changes have reduced the ability to pump additional blood into the heart, thus reducing the reserve functions of the heart.

Some factors that can increase the workload of the heart:

Some medications
- Emotional stress
- Extreme physical activity
- Disease
- Infections
- Injuries

Angina (chest pain caused by a temporary decrease in blood flow to the heart muscle), shortness of breath on exertion, and heart attacks can lead to coronary artery disease.

Various types of abnormal heart rhythms (arrhythmia) may occur.

Anemia is also possible due to malnutrition, chronic infections, loss of blood from the gastrointestinal tract, or complications of other diseases or side effects of various medications.

Atherosclerosis (hardening of the arteries) is a very common phenomenon. Fatty deposits (cholesterol plaques) inside blood vessels cause them to narrow and can completely block the blood vessels.

Heart failure is also very common among older people. In people over 75 years of age, congestive heart failure is 10 times more common than in younger adults.

Coronary heart disease is quite common, very often resulting from atherosclerosis.

Diseases of the heart and blood vessels are also quite common in older people. Common disorders include high blood pressure and orthostatic hypotension.

Heart valve diseases are quite common. Aortic stenosis, or narrowing of the aortic valve, is the most common valve disease in old age.

A transient ischemic attack (TIA) or stroke can occur if blood flow to the brain is disrupted.

Other heart and blood vessel problems include the following:

Blood clots
- Deep vein thrombosis
- Thrombophlebitis
- Peripheral vascular disease, resulting in intermittent pain in the legs when walking (claudication)
- Varicose veins

Prevention of age-related changes in the cardiovascular system

You can help your circulatory system (heart and blood vessels). Cardiovascular disease has risk factors that you should monitor and try to reduce:

High blood pressure,
- cholesterol level,
- diabetes,
- obesity
- smoking.

Eat heart-healthy foods that are low in saturated fat and cholesterol, and control your weight. Follow your doctor's recommendations for treating high blood pressure, high cholesterol, or diabetes. Reduce your tobacco consumption or quit smoking altogether.

Exercise can help prevent obesity, and it helps people with diabetes control their blood sugar levels. Exercise can help you maintain your abilities for as long as possible and reduce stress.

Regular examinations and examinations of your heart are necessary:

Check your blood pressure. If you have diabetes, heart disease, kidney disease, or other medical conditions, your blood pressure should be checked more closely.
- If your cholesterol level is normal, you should have it checked every 5 years or more often. If you have diabetes, heart disease, kidney disease, or other medical conditions, your cholesterol levels should be checked more closely.
- Moderate exercise is one of the best things you can do to keep your heart and the rest of your body healthy for as long as possible. Check with your healthcare provider before starting a new exercise program.
- Exercise moderately and within your capabilities, but do it regularly.
- People who eat less fat and smoke less tend to have fewer blood pressure problems and less heart disease than smokers who eat fatty foods.

O.V. Korkushko.

State Institution "Institute of Gerontology of the Academy of Medical Sciences of Ukraine", Kyiv.

Interest in the study of age-related characteristics of the cardiovascular system - structure, function and regulation of its activity - is explained primarily by the fact that developing age-related changes in the circulatory system, while not being primary in the genesis of aging, largely determine the nature and rate of aging of the body. They, firstly, significantly limit the adaptive capabilities of an aging organism, and secondly, they create the preconditions for the development of pathology, which is the main cause of human death: atherosclerosis, arterial hypertension, coronary heart and brain disease.

The parameters of age-related changes in the cardiovascular system we present below are based on a study of physiologically aging people of various ages specially selected at the Institute of Gerontology of the Academy of Medical Sciences.

Vascular system. The main changes that occur in large arterial trunks are sclerotic compaction of the inner membrane (intima), atrophy of the muscle layer, and decreased elasticity. Physiological hardening of arteries decreases towards the periphery. All other things being equal, changes in the vascular system are more pronounced in the lower extremities than in the upper extremities. Morphological studies are confirmed by clinical observations. When considering age-related changes in the speed of propagation of the pulse wave in various areas of large arterial vessels, it was noted that with age there is a natural increase in its elasticity modulus. Therefore, an increase in the speed of pulse wave propagation, exceeding age standards, is an important diagnostic sign of atherosclerosis. Age-related changes in arterial vessels cause their insufficient ability not only to expand, but also to narrow. All this, along with the altered regulation of vascular tone in general, disrupts the adaptive abilities of the circulatory system. First of all, and to a greater extent, the large arterial vessels of the systemic circulation, especially the aorta, change, and only in older ages does the elasticity of the pulmonary artery and its large trunks decrease. Along with an increase in the rigidity of arterial vessels and loss of elasticity, there is an increase in the volume and capacity of the arterial elastic reservoir, especially the aorta, which to a certain extent compensates for the impaired functions of the elastic reservoir. However, in later life, the increase in volume does not parallel the decrease in elasticity. This disrupts the adaptive abilities of both the systemic and pulmonary circulation.

A significant contribution to the study of elastic-viscous properties of arterial vessels was made by rheography of peripheral vessels and rheoencephalography. It has been established that with age, the elastic properties of peripheral arterial vessels and cerebral vessels decrease, as evidenced by a change in the shape of the rheogram curve and its time indicators (a decrease in the amplitude of the rheographic wave, its slow rise, a rounded, often arched apex, smoothness of the dicrotic wave, an increase in the speed of propagation pulse wave, etc.). Along with large arterial vessels, the capillary network is also subject to age-related restructuring. Pre- and postcapillaries, as well as the capillaries themselves, are characterized by fibrosis and hyaline degeneration, which can lead to complete obliteration of their lumen. With increasing age, the number of functioning capillaries per unit of tissue decreases, and the capillary reserve also decreases significantly. However, on the lower extremities the changes are more pronounced. Zones devoid of capillary loops are often found - areas of “baldness”. The sign in question is associated with complete obliteration of the capillaries, which is confirmed by histological studies of the skin. Similar changes are noted in the capillaries during microscopy of the conjunctiva of the eyeball. With aging, the shape of capillaries changes. They become crimped and elongated. The spastic form of capillary loops with narrowing of the arterial and venous branches predominates, and the spastic-atonic form - with narrowing of the arterial and expansion of the venous branches. These changes in capillaries, along with age-related changes in the rheological properties of blood, cause a decrease in capillary circulation and thereby oxygen supply to tissues. On the one hand, a slowdown in capillary blood flow, and on the other, an increase in the intercapillary distance, both as a consequence of a decrease in the number of functioning capillaries and a thickening of the basement membrane due to its multilayered nature (electron microscopy data), significantly worsen the conditions for the diffusion of oxygen into the tissue.

Conducted jointly with K.G. Sarkisov, A.S. Stupina (1978) studies of the state of capillaries in skin biopsies using electron microscopy showed that with age, thickening of the basement membrane of capillaries, collagenization of fibrils, a decrease in pore diameter, and a decrease in the activity of pinocytosis occur. These changes lead to a decrease in the intensity of transcapillary exchange. In this regard, one can agree with the statements of P. Bastai (1955) and M. Burger (1960), who put forward changes in the microcirculation system as one of the causes of aging. We have shown a significant decrease in renal blood circulation with aging, which is directly related to a decrease in microvascularization. Endoscopic examination of the gastric mucosa and biopsy samples revealed a decrease in the number of microvessels. It was also found that during human aging, a significant decrease in muscle blood flow, both at rest (RMB) and in maximum muscle blood flow (MBC) when performing dosed physical activity. Studies of muscle blood flow were carried out using the Xe133 local clearance method using a Xenon radiometric installation. Such a decrease in MMC indicates a significant limitation of the functionality of the microcirculatory system in skeletal muscles, which is one of the reasons for limiting muscle performance. When considering the reasons for the decrease in muscle blood flow during aging, the following circumstances should be taken into account: age-related changes in central hemodynamics play a certain role - a decrease in cardiac output, processes of physiological arteriosclerosis of arterial vessels, deterioration of the rheological properties of blood. However, age-related changes in the microcirculatory link are of leading importance in this phenomenon: obliteration of arterioles and a decrease in muscle capillarization.

As a result of the loss of elasticity of large arterial trunks, the activity of the heart becomes less economical with age. This is confirmed by the following facts: firstly, in the elderly and old, compared with young people, there is an increased energy consumption by the left ventricle of the heart per 1 liter of minute blood flow (MCV); secondly, with age, the IOC decreases significantly, but the work performed by the left ventricle in 1 min remains virtually unchanged ((61.78±0.98) J in 20–40 years and (59.82±3.92) J at 90–99 years old); thirdly, the ratio between total elastic resistance (Eo) and peripheral vascular resistance (W) changes. According to the literature, the indicator (Eo/W) characterizes the relationship between the amount of energy that is spent by the heart directly on moving blood through the vessels, and the amount that is accumulated by the walls of blood vessels. With age, this ratio naturally increases, averaging 0.650±0.075 for 20–40 years; for the seventh decade – 0.77±0.06; for the eighth – 0.86±0.05; for the ninth – 0.930±0.044; for the tenth – 1.090±0.075 (P<0,01).

Reflexes on the cardiovascular system and the state of the hemodynamic center. Research shows that with aging, conditioned reflex influences on the cardiovascular system in elderly and old people are weakened - they are slower to consolidate and quickly fade away. Thus, to develop a conditioned reflex to blood vessels (based on thermal stimuli), young people need 3–4 combinations, and old people need 9–12 combinations. The weakening of conditioned reflex influences is also expressed in the fact that in older people, shifts in vascular tone, blood pressure and heart rate when warning them about upcoming work are much less pronounced.

With aging, unconditioned reflexes to blood circulation also change.

A simple vegetative-vascular test, which allows one to judge to a certain extent the functional ability of capillaries to respond to mechanical stimuli, is the determination of dermographism. Using a dosed spring dermograph with a pressure gradation from 100 to 400 g, it was shown that when irritation was applied to the skin with a force of 100 g in young people (18–25 years old), the latent period of the reaction was (6.80 ± 0.39) s, in persons 60–69 years old – (8.88±0.47) s, 70–79 years old – (9.77±0.48) s, 90 years and older – (12.5±0.51) s. With an increase in the applied load, the duration of the latent period decreased, but in elderly and old people it was still significantly longer than in young people under the same conditions.

Inertness of vascular reactions (extension of the latent period, time of the entire reaction, recovery period) in older people is also observed during other functional tests. When studying vascular reactivity in response to thermal stimuli (heat, cold), approximately half of all those examined over the age of 60 years show an inadequate reaction. Moreover, changes in the state of vascular tone and blood pressure in the case of both an adequate and inadequate response are characterized by a protracted recovery period. This is also evidenced by finger photoplethysmography data. In response to the use of thermal stimuli, the majority of examined individuals over 60 years of age had plethysmograms characterized by an inert type of development - an extended latent period, a slow development of the reaction, and a protracted recovery period. Conducted studies of the microcirculation of the nail fold of the hand also showed that the response in elderly and old people when applying a thermal stimulus occurred later, grew slowly and was significantly extended over time. The same pattern was found when studying the functional state of peripheral vessels according to rheographic studies using pharmacological tests.

Adrenergic regulation. Clinical and experimental studies have shown that sympathetic nervous effects on the cardiovascular system weaken with age. Along with the weakening of sympathetic influences on the cardiovascular system, with age there is an increase in its sensitivity to catecholamines (norepinephrine, adrenaline). Observations indicate that with smaller doses of administered humoral substances (adrenaline, norepinephrine), elderly and old people experience pronounced changes in the cardiovascular system - vascular tone, blood pressure, hemodynamics. In elderly and old people, unlike young people, changes in skin microcirculation appeared when catecholamines were administered in low concentrations. An increase in sensitivity to humoral substances is also evidenced by the fact that with age, when an irritant is applied, the latent period for the occurrence of a vascular reaction decreases, while with reflex irritation (cold and heat), the response is significantly delayed. However, the reactivity of the cardiovascular system decreases with age. This feature was discovered under the influence of reflex and humoral stimuli, as well as physical activity.

Cholinergic regulation. During the aging process, the influence of the vagus nerve on the cardiovascular system weakens, but its sensitivity to the cholinergic mediator, acetylcholine, increases. When performing Aschner-Danyini, Chermak, Valsalva, etc. tests on older and older people, which help to increase the tone of the vagus nerve, there was no significant slowdown in the heart rate, as was the case in young people. Moreover, the reaction was often paradoxical and even absent.

In the studies of V.V. Bezrukova (1980) found that in old rabbits changes in blood pressure develop with the administration of lower doses of acetylcholine ((1.4 ± 0.5) μg/kg) than in adults ((9.4 ± 2.7) μg/ kg). We established the same pattern in our study of people. It was noted that a slowdown in heart rate, a decrease in blood pressure, minute volume, and the power of contractions of the left ventricle in 60–69 year old people develops with the administration of 0.025 g of acetylcholine, in young people (20–29 year olds) – 0.075 g. Increased sensitivity to acetylcholine also found on the capillary side. These observations confirm that with age, sensitivity to the mediator of the parasympathetic nervous system, acetylcholine, increases.

The weakening of nervous influences on the cardiovascular system is largely due to destructive changes in the nervous system and shifts in the synthesis of acetylcholine.

Hormonal regulation. It can be assumed that age-related changes in the secretion, metabolism of hormones and the state of cellular receptors largely determine changes in metabolic processes and the function of the cardiovascular system in old age. A decrease in the effective concentration of anabolic hormones (insulin, sex hormones) contributes to the development of insufficiency of functions in old age. This can largely explain the fact that myocardial hypertrophy during coarctation of the aorta in old animals is less pronounced and heart failure develops faster [Frolkis V.V. et al., 1977]. A similar dependence is found in elderly and old people (less pronounced left ventricular hypertrophy) with arterial hypertension. Vasopressin is of great importance in changing blood circulation and vascular tone in old age. We have shown that the concentration of this hormone increases with age, and the sensitivity of the heart and blood vessels to it increases.

When the same dose of vasopressin was administered to older people, compared to young people, more pronounced changes in hemodynamics were observed, and the reaction was protracted. Particularly clear age-related differences were obtained in the study of skin microcirculation. Thus, even small doses of administered pituitrin caused changes in capillary circulation – vasoconstriction. In this case, the reaction occurred much earlier and lasted longer. An increase in the body's sensitivity to vasopressin is also evidenced by the fact that in old animals, with lower doses of the hormone, it is possible to induce experimental hypertension and coronary insufficiency [Frolkis V.V., 1976, 1996]. It has been shown that the concentration of vasopressin increases in the blood of patients with coronary heart disease and arterial hypertension. It is assumed that all these changes in the content and action of vasopressin play a large role in the development of circulatory pathology in old age. It has also been noted that with age, the sensitivity of the cardiovascular system to many other humoral substances, in particular to angiotensin and histamine, increases.

Reflexes from blood vessels and heart. As is known, the adaptation of the cardiovascular system to the constantly changing conditions of the body’s activity is largely achieved thanks to feedback information from the receptors of the heart and blood vessels. At the same time, it has been established that with aging, reflexes from the baroreceptors of the carotid sinus and aortic arch weaken. All this leads to the fact that in old age the range of adaptation possibilities of the cardiovascular system is reduced, and the perfection of the mechanisms for regulating blood pressure decreases.

The weakening of reflexes from vascular baroreceptors is associated with changes in the elastic-viscous properties of the vessel wall, changes in the nerve endings themselves, and shifts in the hemodynamic center. According to modern concepts, the reaction of the cardiovascular system during sinocarotid reflexes is also associated with changes in the activity of the sympathetic nervous system. Therefore, the observed weakening of sympathetic influences with age contributes to the fact that in old age the latent period of development of reflex changes in hemodynamics lengthens and their severity decreases. Experimental data also indicate that in old animals reflexes from the interoceptors of a number of other vascular areas are weakened (Frolkis V.V., 1980, 1996). In particular, in old rabbits, reflexes from the heart baroreceptors, recorded during atrial stretch, are weakened.

In turn, a decrease in depressor effects from the reflexogenic zones of the heart, arterial vessels (carotid sinus and aortic arch) during aging may cause the development of disinhibition hypertension, which is so common in old age.

Regulation of coronary circulation. The studies performed are mainly experimental in nature. This is understandable, since in humans the study of the characteristics of coronary circulation encounters great methodological difficulties. In this regard, the data of V. G. Shevchuk (1980) are of particular interest, who showed that with age the influence of the vagus nerve on coronary circulation weakens. The same dependence was established in relation to the sympathetic nervous system. Thus, the thresholds for stimulation of the sympathetic and vagus nerves by electric current, causing shifts (changes) in the coronary circulation, were higher in old animals than in young ones. Along with this, with aging, the sensitivity of the coronary vessels to humoral substances - adrenaline, norepinephrine, acetylcholine - increases. Often, in old animals, a paradoxical reaction was observed when administering catecholamines and acetylcholine.

The presented data to a certain extent reveal one of the mechanisms of such frequent manifestations of coronary insufficiency in elderly and old people. Thus, a weakening of the nervous influences on the coronary vessels and an increase in their sensitivity to mediators and hormones during aging, the presence of paradoxical reactions to catecholamines can lead to the development of coronary insufficiency even in mild stressful situations.

Regulation of cerebral circulation. Numerous studies have shown that the level of cerebral blood flow is highly stable in relation to changes in general hemodynamics. However, our studies have shown that in elderly and old people, along with a significant decrease in adaptive reactions of hemodynamics, the mechanisms of autoregulation of cerebral circulation are disrupted. Thus, in response to inhalation of pure oxygen, the most pronounced reaction occurred in young people (in young people, cerebral blood flow decreased by (16.9 ± 1.3) ml/100 g min, while in the group of middle-aged people this decrease was by (9.1±0.9), and in the elderly – by (7.0±0.5) ml/100 g·min).

It has been established that in elderly and old people, inhalation of 5% CO2 causes a smaller increase in cerebral blood flow than in young people (40 and 70%, respectively). Such features, it should be assumed, are associated both with morphological changes in blood vessels, leading to a loss of their elasticity, and with a violation of the mechanisms of autoregulation.

So, with aging, changes occur in all parts of the neurohumoral regulation of the cardiovascular system. Along with the manifestation of extinction and disturbances in regulatory influences, important adaptive changes are noted - an increase in the sensitivity of the heart and blood vessels to humoral factors and mediators in conditions of destruction of nerve endings, as well as a weakening of the synthesis of mediators. In other words, with age, in the regulation of the cardiovascular system, the role of physiologically younger regulatory mechanisms—nervous—is weakened, and the importance of older, but at the same time more inert—humoral mechanisms—increases. Common features that are naturally observed during aging are a slow achievement of the maximum response and a protracted recovery period when the cardiovascular system is thrown out of balance. With age, the threshold for blood supply to various organs and systems, and, in particular, the heart and brain, decreases, as a result of which less pronounced changes in hemodynamics with altered neurohumoral regulation can cause frequent disruption of their activity. This position is well illustrated by facts obtained in the process of studying the cardiovascular system under various conditions that were characterized by a drop in blood pressure.

In connection with the above, one should consider the idea that in the process of aging, the human cardiovascular system undergoes a number of structural and functional changes, which in the aggregate significantly limit the range of its functional capabilities, and thereby create the preconditions for faster development of pathology.

Ukrkardio

They significantly limit their adaptive capabilities and create preconditions for the development of diseases.

Changes in blood vessels

The structure of the vascular wall changes with age in each person. The muscle layer of each vessel gradually atrophies and decreases, its elasticity is lost, and sclerotic compactions of the inner wall appear. This greatly limits the ability of blood vessels to expand and narrow, which is already a pathology.

Large arterial trunks, especially the aorta, are primarily affected. In older and older people, the number of active capillaries per unit area decreases significantly. Tissues and organs cease to receive the amount of nutrients and oxygen they need, and this leads to their starvation and the development of various diseases.

Features of hemodynamics in old age

With age, with the loss of elasticity of large vessels and an increase in the peripheral resistance of small vessels, it increases (especially systolic). The venous one decreases. This is due to a weakening of tone, a decrease in the elasticity of the venous walls, which leads to an expansion of the total lumen of the venous bed.

In old and senile age, the cardiac output decreases (minute volume is the amount of blood ejected by the heart in one minute). This decrease is mainly due to a slower heart rate and a decrease in stroke volume. Since basal metabolism decreases with age, a decrease in cardiac output can be considered as a natural reaction of the body to a decrease in tissue demand for oxygen.

In elderly and elderly people, against the background of reduced cardiac output, an active redistribution of regional blood circulation is observed. At the same time, cerebral and coronary circulation remains almost unchanged, while renal and hepatic circulation are significantly reduced.

This restructuring of the hemodynamic system partially compensates for the increase in energy consumption during cardiac operation in conditions of increased resistance to cardiac output associated with increased peripheral vascular resistance.

Decreased contractility of the heart muscle

The older a person gets, the more muscle fibers of the heart muscle atrophy. The so-called “senile heart” develops. Progressive myocardial sclerosis occurs, and in place of the atrophied muscle fibers of the cardiac tissue, fibers of non-working connective tissue develop. The strength of heart contractions gradually decreases, an increasing disturbance of metabolic processes occurs, which creates conditions for energetic-dynamic heart failure in conditions of intense activity,

As a result of all the above processes, the physical performance of the heart decreases with age. This leads to a limitation of the range of reserve capabilities of the body and to a decrease in the efficiency of its work.

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