Vascular Changes Aorta and large elastic arteries - wall thickness, dilation and stiffening in mean systemic arterial pressure in most, but not all Systolic BP rises more than diastolic – increasing chance of isolated systolic hypertension
Postural Changes Blunting of in HR Slowed baroreceptor response to postural change May be reduced vasoconstriction in response to reduced BP Increase the chance of postural hypotension
Cardiac Changes at Rest Minor in HR CO output maintained by SV ejection of blood during late systole early diastolic filling rate EDV not - enhanced atrial contribution to LV filling – beware AF, particularly if tachycardic
During exercise… in maximum HR ( response to β- adrenergic stimuli) in cardiac output - reduced by 30% between ages 20 and 80 Maximum SV not reduced – but maintained in different manner Frank Starling mechanism
Frank Starling Mechanism EDV, due to: Longer diastolic interval ( HR) EF - amount of blood in LV at start of diastole
Summary of changes HRSVCOEDVEF At rest === Exercise =
Some Practical Points Beware of increased risk of hypertension… …and postural hypotension Elderly patients unlikely to tolerate tachycardia or AF as well as younger patients Caution with beta blockers
In summary… Ageing does alter the structure and function of the cardiovascular system Changes more evident during exercise These effects may contribute to earlier decompensation when unwell …and remember your erect and supine BPs!