Heart failure in the elderly

Heart failure in the elderly is due to a complex of structural and functional changes in various organs and systems. These changes, on the one hand, are inherent in an aging organism, serve as a manifestation of natural physiological aging, and on the other hand, are caused by diseases that existed in adulthood and middle age or joined in later periods. This layering of age and pathophysiological mechanisms, among which the main role is played by atherosclerosis, leads to significant changes in the structure and function of the heart and vessels, disturbances in metabolic processes in the cardiac muscle.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]

How is heart failure manifested in the elderly?

Heart failure in the elderly depends on the degree of reduction of cerebral circulation due to age and sclerotic changes. An important role is played by the severity of age-related emphysema, pneumosclerosis, causing a decrease in functional lung reserves and increased vascular resistance, changes in blood circulation in the nights, functional shifts in their activity.

Often, signs of deterioration of the blood supply to the brain due to a decrease in the shock volume of the heart (SOS) occur much earlier than the phenomenon of stagnation in other organs and systems. To reduce the level of moegovogo blood flow indicate a violation of sleep, general fatigue, dizziness, tinnitus. Confusion, excitement and motor anxiety, increasing at night and often accompanied by insomnia, may be early symptoms of cerebral circulatory insufficiency, associated with a decrease in cardiac output.

An early sign of weakness of the left ventricle and stagnation in the lungs can also be a slight cough, which often appears or intensifies after physical exertion or when moving from a vertical position to a horizontal one. The appearance of dyspnoea with physical exertion is usually considered one of the earliest functional signs of developing cardiac decompensation. When evaluating this symptom in geriatric practice, one should take into account the physiologically decreasing functional capabilities of not only the cardiovascular system but also the respiratory system. Shortness of breath in old people can be due to concomitant lung diseases as well. Not by the weakness of the heart. As we age, the threshold of its appearance decreases with physical activity. Shortness of breath is the result of irritation of the respiratory center by the excess of carbon dioxide, which occurs when oxygen saturation is insufficient in connection with blood flow in the vessels of the lungs (stagnation in the small circle of blood circulation). The most common cause of suffocation in elderly and old people with atherosclerosis of the heart and blood vessels is a sudden increase in blood pressure (hypertensive crisis), a violation of blood circulation in the coronary vessels (angina pectoris, myocardial infarction), dramatically changing contractile capacity of the heart muscle. With an attack of cardiac arrest, breathing is difficult, that is, there is shortness of inspiration, in contrast to the expiratory one, in which exhalation is difficult, for example, in bronchial asthma.

The patient with severe form of dyspnea in the absence of collapse should be transferred to a semi-sitting position with lowered lower limbs (the amount of circulating blood decreases, the diaphragm is lowered), and oxygen access (intensive ventilation or oxygen therapy as prescribed by the doctor). If the attack occurred in a patient in hospital treatment, the sister, after calling the doctor, urgently prepares syringes and needles for intravenous manipulation, tows for imposing on the limbs, necessary medications (omnopon, morphine hydrochloride, strophanthin K, euphyllin, glucose, dibazol, nitroglycerin, but-shpu or papaverine hydrochloride, cordiamine, mezaton, etc.). Medical therapy is performed taking into account the level of arterial pressure.

With right ventricular failure, patients complain of lack of appetite, nausea, sometimes vomiting, bloating, heaviness in the right hypochondrium due to congestion in the liver; pasty in the ankles and feet.

Peripheral edema and, in particular, edema on the lower limbs, may not in themselves be early signs of heart failure; they are often associated with a decrease in protein content (hypoproteinemia), a decrease in skin turgor, a decrease in tissue oncotic pressure. Propensity to edema increases with age.

At objective research the displacement of the cardiac dullness boundaries is marked mainly to the left, the apical impulse diffused; heart sounds are weakened. With sinus rhythm, systolic murmur over the apex of the heart is often heard. Significantly more often than in people of a younger age, there are irregularities in rhythm - atrial fibrillation. Often it occurs simultaneously with myocardial insufficiency. The appearance of cardiac decompensation of atrial fibrillation is a prognostically bad sign.

How is heart failure treated in the elderly?

Treatment for heart failure in the elderly should be integrated.

The main directions of pathogenetic treatment of heart failure are:

• increased myocardial contractility;
• reduction of sodium and water retention in the body;
• decreased load and postnagruzki on the heart. For these purposes, the following groups of drugs are used:
• vasodilators:
  • with a predominant effect on the tone of the veins (nitrates, cordite, molsidomine);
  • with the primary effect on the tone of arterioles (hydralazine, phentolamine, nifedipine, corinfar);
  • with a simultaneous effect on the tone of arterioles and veins - a mixed effect (prazozin, captopril);
• cardiac glycosides (korglikon, digoxin);
• diuretics (hypothiazide, triampur, veroshpiron, furosemide, ureitis).

Heart failure in the elderly: the characteristics of care

Patients with chronic heart failure, in addition to regular intake of medications (cardiac glycosides, diuretics, etc.), also need careful care. Conditions of the current: emotional rest, control of diet number 10, the amount of drunk and secreted fluid. Bed rest in old age does more harm than good, as it leads to congestive pneumonia, thromboembolism, and pressure sores. Therefore, it is only necessary to limit physical activity, conduct training exercises "to the fatigue of the patient." To reduce stagnation in a small circle of blood circulation, patients should be given a bed in a position with an elevated headboard.

The volume of the liquid should not be more than 1500-1600 ml / day. The diet is low-calorie with enough proteins, fats, carbohydrates, potassium and magnesium salts, restriction of table salt to 6-7 g / day. Taking into account that such patients are prescribed cardiac glycosides and diuretic drugs that promote the excretion of potassium from the body, foods rich in potassium (dried apricots, raisins, baked potatoes and bananas, etc.) are included in the diet.

It is necessary to regularly monitor the dynamics of edema. The indicator of the increase in fluid retention in the body is the prevalence of the amount of fluid taken during the day, over the daily diuresis. There must be a definite correspondence between the restriction of table salt and the amount of liquid administered. In order to combat severe swelling, the intake of liquid (up to 1 liter per day) and the intake of table salt to 5 g per day are limited. When discharging from the hospital or at home, the patient and his relatives need to explain the need to take into account the amount of liquid drunk, including all liquid food (soup, compote, kissel, fruit, milk, tea, water, etc.), and daily diuresis in order to maintain a certain equilibrium in the exchange of water. These data the patient should inform the attending physician and the nurse when they visit.

Prolonged existing swelling leads, in some cases, to secondary changes in the skin, which at the same time change their color, thin out, and lose elasticity. Therefore, skin care and the prevention of the formation of pressure sores become very important. A good effect is given by grinding and massage, which must be done very carefully, given the thinness and vulnerability of the skin in elderly patients. In the elderly, often the dryness of the skin, causing severe itching, the appearance of calluses, limiting the motor activity of patients. Dry areas of the skin should be lubricated with special creams with moisturizing and bactericidal action; you need to remove corns in a timely manner.

In the presence of a significant amount of fluid in the abdominal or pleural cavity, which violates the functions of the organs, puncture is performed, in elderly and old people this procedure requires great care, due to significant restructuring of the circulation after elimination of mechanical compression of the vessels by the released fluid and with the possibility of acute vascular insufficiency collapse). Before puncture, especially for people with normal or low blood pressure, it is necessary to enter cardiac funds that support vascular tone (cordiamin, mezaton). It is necessary to slowly withdraw the edematous fluid from the cavities. The amount of fluid released should be indicated in the medical history. We need a laboratory study of it to determine the nature of the pathological process (cardiac decompensation, renal edema, fluid accumulation in the tumor process - lesions of the pleura or abdominal organs with metastases of cancer, etc.).

Elderly patients with circulatory failure are very sensitive to lack of oxygen, so the air in the room where they are should be fresh, sufficient moisture. If necessary, in cases of severe dyspnea, inhalation of the oxygen mixture passed through the defoamer (40-95 ° alcohol or 10% alcohol solution of antifosilane) is used.