Cardiovascular diseases and pulmonary diseases in elderly Ahmad Osailan

Heart Disease Due to narrowing or blocking of the coronary arteries. Angina pectoris – painful cramp in chest, arm, neck, or back due to brief blockage of oxygenated blood to the heart. – More often during exercise, stress, cold temperature, digesting large fat meal. – Little or no permanent damage

Heart Disease Myocardium – Muscle tissue inside the layers of heart Myocardium infarction (heart attack) – Prolonged blockage of blood to an area of the heart resulting in muscle tissue damage. Symptoms of a heart attack – Pressure in chest, fullness, squeezing pain. – Pain spreading to shoulders, neck, or arms – Lightheadedness, fainting, sweating, nausea

Who Is At Risk of Heart Disease? Prevalence increases with age, particularly after 45 years of age Prior to 50s, 60s, men at greater risk than women but increases in women after menopause. More women than men are likely to die from a heart attack Blacks at higher risk, Asians at lower risk

Heart Disease Risk Factors High blood pressure Family history Cigarette smoking High LDL and total cholesterol levels Physical inactivity Diabetes Obesity Stress

high blood pressure is dangerous risk factor, WHY? Heart has to work harder. Since heart muscle is working harder, it can become enlarged. Wear and tear on the arterial wall can increase the likelihood of lipid and calcium deposits adhering to the arterial wall. This leads to hardening of the arteries.

Medical Treatment Medications (e.g., beta blockers, calcium channel blockers) to protect heart and improve function. Risk management – Control of high blood pressure – Control of lipid abnormalities

Rehabilitation Promote recovery and reduce risk of another attack Heart disease is chronic condition requiring ongoing management.

Rehabilitation Includes: Exercise – Physiological and psychological benefits Weight management Smoking cessation Lipid and BP management include dietary changes to control lipids Stress management

Rehabilitation Exercise is the key component but: – 50% drop-out rate within first 6 months For those who continue benefits include: – Improved self concept, perceived health, sexual activity, involvement in social activities. Those who stop are more likely to: – Smoke, have poorer cardiac function, have higher body weight, be more sedentary, experience greater anxiety and depression.

Pulmonary diseases

General symptoms of respiratory disease  Hypoxia : Decreased levels of oxygen in the tissues  Hypoxemia : Decreased levels of oxygen in arterial blood  Hypercapnia : Increased levels of CO 2 in the blood  Hypocapnia : Decreased levels of CO 2 in the blood  Dyspnea : Difficulty breathing  Tachypnea : Rapid rate of breathing  Cyanosis : Bluish discoloration of skin and mucous membranes due to poor oxygenation of the blood  Hemoptysis : Blood in the sputum

Obstructive Respiratory Disorders Asthma is a condition characterized by reversible bronchospasm and chronic inflammation of airway passages. The incidence of asthma has been steadily increasing in recent years. Although the exact etiology is still uncertain, there appears to be a definite genetic predisposition to the development of asthma.

Manifestations of asthma :  Coughing, wheezing  Difficulty breathing  Rapid, shallow breathing  Increased respiratory rate  Excess mucus production  Significant anxiety

Possible complications of asthma can include :Severe acute Asthma (status asthmatics), which is a life-threatening condition of prolonged bronchospasm that is often not responsive to drug therapy. Pneumothorax : is also a possible consequence as a result of lung pressure increases that can result from the extreme difficulty involved in expiration during a prolonged asthma attack. Respiratory failure: marked hypoxemia and acidosis might occur.

Bronchitis is an obstructive respiratory disease that may occur in both acute and chronic forms. Inflammation of the bronchial passages most commonly Acute bronchitis: caused by infection with bacteria or viruses. Acute bronchitis is generally a self-limiting condition in healthy individuals but can have much more severe consequences in individuals who are weakened with other illness or who are immunocompromised. Symptoms of acute bronchitis often include productive cough, Dyspnea and possible fever. Bronchitis

Atelectasis is a condition in which there is incomplete expansion of lung tissues due to blockage of the airways or compression of the alveolar sacs. Types of atelectasis: 1. Absorption atelectasis Results when the bronchial passages are blocked with mucus, tumors or edema 2. Compression atelectasis Occurs when lung tissue is compressed externally by air, blood, fluids or a tumor Atelactasis

Manifestations of atelectasis: Dyspnea, cough. Reduced gas exchange. Shunting of blood to areas of the lungs that are inflated. The ventilation– perfusion coupling ability of the lungs will help ensure that blood is directed to areas of the lungs where gas exchange can still occur. Treatment of atelectasis: Removal of airway blockage Removal of air, blood, fluids, tumors, etc. that are compressing lung tissues

Rehabilitation Similar like rehabilitation for cardiovascular diseases Efficiency of rehab for some cases is not significantly evident

Most common skin condition in elderly

Pressure ulcers Damage to the skin caused by pressure, shear or friction or a combination of any of these A new or established area of skin and /or tissue discoloration or damage which persists after the removal of pressure and which is likely to be due to the effect of pressure on the tissues Other risk factors are poor diet, deviation from normal body weight, acute illness perhaps with a fever, and exposure of the skin to urine and or feces for prolonged periods of time.

Pressure ulcers

Pressure ulcer Stage 2

Pressure ulcer Stage 3

Pressure ulcer Stage 4