BACKGROUND
The heart is made up of two sides. The right side pumps blood to the lungs to receive oxygen and get rid of carbon dioxide. The left side pumps blood to the body.

Blood flows out of the heart through arteries, which branch out and get smaller and smaller as they go into the tissues. In the tissues, they become tiny capillaries.

Capillaries are where the blood gives up oxygen and nutrients to the tissues, and receives carbon dioxide and wastes from the tissues. Then, the vessels begin to collect together into larger and larger veins, which return blood to the heart.

Aging causes changes in the heart and in the blood vessels. Heart and blood vessel diseases are some of the most common disorders in the elderly.

AGING CHANGES
Heart

• Normal changes in the heart include deposits of the "aging pigment" lipofuscion. The heart muscle cells degenerate slightly. The valves inside the heart, which control the direction of blood flow, thicken and become stiffer. A heart murmur caused by valve stiffness is fairly common in the elderly.
• The heart has a natural pacemaker system that controls heartbeat. Some of the pathways of this system may develop fibrous tissue and fat deposits. The natural pacemaker (SA node) loses some of its cells. These changes may result in a slightly slower heart rate.
• Heart changes cause the ECG of a normal, healthy aged person to be slightly different than the ECG of a healthy younger adult. Abnormal rhythms (arrhythmias) such as atrial fibrillation are common in older people, which may be normal or may be caused by heart disease.
• A slight increase in heart size, especially the lower left side (left ventricle), is not uncommon. The heart wall thickens, so the amount of blood that the chamber can hold may actually decrease despite increased overall heart size. The heart fills slightly slower.

Blood Vessels

• The main artery from the heart (aorta) becomes thicker, stiffer, and less stretchy. This is probably related to changes in the connective tissue of the blood vessel wall. This makes the blood pressure higher, and makes the heart work harder. The other arteries also thicken and stiffen. Overall, most elderly people experience a moderate increase in blood pressure.
• Receptors, called baroreceptors, monitor the blood pressure and make changes to help you maintain a fairly constant blood pressure when you change positions or activities. The baroreceptors become less sensitive with aging. This may explain the relatively common finding of orthostatic hypotension (a condition where the blood pressure falls when you go from lying or sitting to standing, which may result in dizziness when you stand up).
• The wall of the capillaries thickens slightly. This may cause a slightly slower rate of exchange of nutrients and wastes.

Blood

• The blood itself changes slightly with age. Aging causes a normal reduction in total body water. As part of this, there is less fluid in the bloodstream, so blood volume decreases.
• The number of red blood cells (and correspondingly, the hemoglobin and hematocrit levels) are reduced. This contributes to fatigue. Most of the white blood cells stay at the same number, although certain white blood cells important to immunity (lymphocytes) decrease in number and ability to fight off bacteria. This reduces the ability to resist infection.

EFFECT OF CHANGES
Under normal circumstances, your heart continues adequately supply all parts of your body. However, your heart may be slightly less able to tolerate increased workloads because changes reduce the "extra" pumping ability (reserve heart function).

Some of the things that can increase heart workload include illness, infections, emotional stress, injuries, extreme physical exertion, and certain medications.

COMMON PROBLEMS
Heart and blood vessel diseases are fairly common in older people. Common disorders include high blood pressure and orthostatic hypotension.

Arteriosclerosis, or hardening of the arteries, is very common. Fatty plaque deposits inside the blood vessels cause it to narrow and can totally block blood vessels.

Coronary artery disease is fairly common. Angina (chest pain caused by temporarily reduced blood flow to the heart muscle), shortness of breath with exertion, and heart attack can result from coronary artery disease.

Abnormal heart rhythms (arrhythmias) of various types can occur. Heart failure is very common in the elderly. In people over 75 years old, heart failure occurs ten times more often than in younger adults.

Valve diseases are fairly common. Aortic stenosis, or narrowing of the aortic valve is the most common valve disease in the elderly.

Anemia may occur, possibly related to malnutrition, chronic infections, or as a complication of other diseases or medications.

Transient ischemic attacks (TIA) or strokes can occur if blood flow to the brain is disrupted.

Other problems with the heart and blood vessels include peripheral vascular disease, resulting in claudication (intermittent pain in the legs with walking). Varicose veins and blood clots (thrombophlebitis and deep vein thrombosis) also occur fairly often in the elderly.

PREVENTION
You can help your circulatory system (heart and blood vessels). Heart disease risk factors that you have some control over include high blood pressure, cholesterol levels, diabetes, obesity, and smoking.

Eat a "heart healthy" diet that has reduced amounts of saturated fat and cholesterol; and control your weight. Follow your health care provider's recommendations for treatment of high blood pressure, high cholesterol, or diabetes. Minimize or stop smoking.

Moderate exercise is one of the best things you can do to keep your heart, and the rest of your body, healthy. Consult with your health provider before beginning a new exercise program. Exercise moderately and within your capabilities, but do it regularly.

People who exercise have less body fat, smoke less (it is hard to breathe to exercise when you are smoking!), have less blood pressure problems, and have less heart disease than people who do not exercise.

It helps prevent obesity, and helps diabetics control blood sugar. Exercise maintains your maximum abilities as much as possible and reduces stress.

RELATED TOPICS.
aging changes in organs, tissues, and cells
aging changes in the lungs
aging changes in vital signs

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