Cardiovacular disease in the elderly

With increasing life expectancy, the importance of geriatric medicine is increasing. Even in old age, the most common causes of death are cardiovascular diseases (ischemic heart disease and myocardial infarction). However, for older age groups, there occur specific changes in the heart: aortic valve calcification, annular calcification, and senile amyloid of the heart.

Aortic valve calcification
This is the calcification of a normal tricuspid valve. The etiology of it is not yet known, probably due to long-term use of the valve from mechanical stress (blood, pressure, repeated valve flexion), biochemical stress (hypercholesterolemia, hypercalcemia). The 'process begins at the base of the valve and increases with age. The deposits gradually enlarge, with the maximum located on the aortic valve. The valves then become harder and less mobile. In more severe cases, there is also a narrowing of the valve, which results in aortic stenosis.

Annular calcification
Calcification is formed at an angle between the mitral valve and the left ventricular wall, i.e. below the site of valve attachment - submitrally. The process begins at the posterior tip as small nodules, then larger nodules to a continuous calcium ring with a diameter of 10 mm. However, the valve itself is normal. Calcification can also penetrate the left ventricular or myocardium septum. It can even damage the transmission system and cause atrial conduction blockages. This type of calcification is probably formed due to:
 * increased left ventricular pressure caused by arterial hypertension, aortic stenosis or hypertrophic cardiomyopathy;
 * diabetes mellitus;
 * hypercholesterolemia.

All three factors are also at risk for atherosclerosis.



Senile cardiac amyloidosis
It is rare in the elderly and middle-aged. However, in old age it is relatively common, in people over 75 it occurs in up to 85% of individuals. The precursor for amyloid is ANP - atrial natriuretic peptide. Clinically, senile amyloid manifests as restrictive cardiomyopathy. The microscope shows very small deposits of amyloid "subendocardially" in both atria, which can only be demonstrated by specific staining (Saturn red or Congo red).

In 3% of people, amyloid is more massive and also affects the ventricular myocardium (systemic cardiac amyloid) and it can lead to heart failure. In this type, the precursor is prealbumin.

Related links

 * Calcification
 * Geriatric syndromes
 * Amyloidosis