Heart problem in elderly patients up at annual meet
Cardiovascular disease does not have to be part of growing older. While aging does put the elderly at greater risk for health conditions such as coronary heart disease, stroke, heart failure, rheumatic heart disease and high blood pressure (hypertension), many adults 60 years old and above can be healthy and active well into their advancing years.
“Disease and disability were once considered an inevitable part of growing older, but that is no longer true. In fact, the demographics of the world population show that there has been a steady increase in life expectancy, which in the middle part of the 19th century was about 40 years compared to 80 years at present,” noted Dr. Adolfo Bellosillo, founding president, Foundation for Lay Education on Heart Diseases Inc. (FLEHD).
By 2050, the World Health Organization projects that there would be 1.5 billion people aged 65 and older (representing 16 percent of the world’s population), nearly triple the figure of 2010, which was 524 million or just 8 percent of the world’s population.
“It is predicted that the elderly will eventually comprise a greater proportion of the population. However, this rapid growth carries with it the burden of high mortality, morbidity and disability rates consequent to the preponderance of cardiovascular diseases in this particular age group,” said Bellosillo who also heads the Cardiac Rehabilitation and Preventive Cardiology Unit of the Makati Medical Center.
He reported that coronary artery disease occupies a high position in the list of diseases common in the elderly population. While it is claimed that one-fourth of them have symptoms of coronary artery disease, it is estimated that three-fourths of documented heart attacks occur in them.
Initiative
Bellosillo explained that FLEHD has taken the initiative of bringing to the fore the many characteristics, peculiarities, presentations, etc. exhibited by the elderly with cardiovascular diseased.
Bellosillo said: “All these will be taken up and discussed extensively on the upcoming 14th National Annual Convention on Preventive Cardiology for Physicians, which is slated from Jan. 24 to 25 at the auditorium of the Makati Medical Center (Tower 2). Doctors who will be attending may obtain substantial benefits considering that more and more of their clinical practices now involve patients past the age of 60. Registration is free as this is a public service of FLEHD.”
He said that there has been reports from fellow doctors of encountering geriatric patients with coronary artery disease but with complaints not observed in younger individuals with similar condition.
“Frequently, the chest discomfort may be painless necessitating therefore of a higher index of suspicion,” Bellosillo said. “Because of [their] sedentary lifestyle, the elderly coronary patients may less likely present with effort-related chest discomfort.”
Complaints
Bellosillo noted that instead, these patients often complain of easy fatigue, shortness of breath with slight effort, bouts of dizziness and light headedness, loss of consciousness, agitation, restlessness, altered mental states, deteriorating kidney function, etc. “In many instances the initial manifestation of the existence of coronary artery disease in them is heart attack if not sudden death,” lamented the doctor.
Following closely in terms of morbidity and mortality, and in the number of patients admitted to the hospital is congestive heart failure, the incidence of which has likewise remarkably increased during the past decades. Other clinical conditions associated with the aging process are hypertension, stroke, peripheral vascular disease, serious cardiac dysrhythmias, aortic sclerosis and mitral annular calcification.
Another issue that will be highlighted during the convention is the high systolic (top number) blood pressure, but a normal diastolic (bottom number).
More important
“For years, doctors focused primarily on diastolic blood pressure. The theory was that the body could tolerate occasional increases in systolic blood pressure. However, more and more doctors now know that high systolic pressure is as important as high diastolic pressure—and even more important in elderly individuals,” he said.
It was later found that isolated systolic hypertension, when combined with other risk factors such as poor diet and lack of exercise, can lead to serious health problems, including stroke, heart disease, chronic kidney disease, and dementia (symptoms of cognitive decline such as forgetfulness).
“The upcoming convention for physicians is important considering that in many ways, the care of the geriatric population afflicted with cardiovascular problems necessitates a closer look at the many anatomic, pathologic, physiologic changes, and that responses to medical and interventional procedures are different from their younger counterparts,” Bellosillo said.
