Manifestation of Novel Social Challenges of the
European Union
in the Teaching Material of
Medical Biotechnology Master’s Programmes
at the University of Pécs and at the University
of Debrecen
Identification number: TÁMOP-4.1.2-08/1/A-2009-0011
Manifestation of Novel Social Challenges of the
European Union
in the Teaching Material of
Medical Biotechnology Master’s Programmes
at the University of Pécs and at the University
of Debrecen
Identification number: TÁMOP-4.1.2-08/1/A-2009-0011
Miklós Székely and Márta Balaskó
Molecular and Clinical Basics of Gerontology – Lecture
9
CHARACTERISTICS OF
THE CARDIOVASCULAR
SYSTEM,
ABNORMALITIES AND
DISEASES PART 2
TÁMOP-4.1.2-08/1/A-2009-0011
Volume-pressure diagrams 1
Ventricular pressure
(mmHg)
Young
250
200
systolic
pressure
150
100
ejectio
n
SV
isovolumi
c
relaxatio
0
n
0
50
50
ventricul
ar
diastolic
pressure
isovolumi
c
contracti
on
10
15
200
250
ventricula
0
0
Left
ventricular
volume (ml)
r filling
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Volume-pressure diagrams 2
Ventricular pressure
(mmHg)
1st case
250
systolic
pressure
200
150
100
SV
50
0
0
50
ventricul
ar
diastolic
pressure
10
15
200
250
0
0
Left
ventricular
volume (ml)
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Volume-pressure diagrams 3
Ventricular pressure
(mmHg)
2nd case
250
systolic
pressure
200
150
100
SV
50
0
0
50
ventricul
ar
diastolic
pressure
10
15
200
250
0
0
Left
ventricular
volume (ml)
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Volume-pressure diagrams 4
Ventricular pressure
(mmHg)
3rd case
250
systolic
pressure
200
150
SV
100
ventricul
ar
diastolic
pressure
50
0
0
50
10
15
200
250
0
0
Left
ventricular
volume (ml)
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Volume-pressure diagrams 5
Ventricular pressure
(mmHg)
4th case
250
systolic
pressure
200
150
SV
100
ventricul
ar
diastolic
pressure
50
0
0
50
10
15
200
250
0
0
Left
ventricular
volume (ml)
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Exercise in the elderly
• There is a higher sympathetic
tone even at rest
• Diminished contractility
• Tachycardia develops sooner and
easier, but its maximum is
limited
• EDV increases quickly, but here
the EDp also increases
significantly
• TPR is higher and grows (both the
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Maximal heart rate vs. age
Heart rate
(bpm)
200
190
Trained
180
170
Mean
Non-trained
160
150
140
20
30
40
50
Age (years)
60
70
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Age-related alterations in
major cardiac parameters
• Impaired coronary perfusion have only a small
influence on myocardial function in healthy old people
(of course, severe atherosclerosis does have!)
• Ejection fraction of healthy old women and men does
not decrease at rest (when the end systolic and end
diastolic volumes are comparable to those in young
people)
• Stroke volume: SV × heart rate – does not change with
age, even in case of a slight (still physiological)
increase in the systolic pressure. (The stroke volume
would rather increase a little.)
• Heart rate: resting heart rate (horizontal position)
in healthy men is not age-dependent. The respirationinduced changes in heart rate decrease though. The
increase of the heart-rate is age-dependent: 220-age
(The elderly responds to the same stress with smaller
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Maximal oxygen consumption
and endurance times
according to age
4.
0
13
3.
0
11
12
Time (minutes)
VO2
max
(l/min)
Maximal oxygen consumption vs. Endurance
age
times according to ag
10
2.
0
1.
0
0.
00
9
8
7
6
5
10 20
30
40 50
Age (years)
60
70
mal
e
4-5 6-7 8-910-12
14-15
16-18
femal
e
25
Age (years)
35
45
55 65
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Atherosclerosis
• One of the most significant
diseases of the elderly
• Clinical picture includes:
pectoral angina, AMI, TIA,
stroke, dementia,
arteriosclerosis obliterans
Risk factors of
atherosclerosis 1
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Intrinsic risk factors
• Age: male 45, female above 55
years
• Gender: estrogen provides some
protection (TG, lower LDL
cholesterol, higher HDL), after
menopausa the protection
diappears: by the age of 60 the
risks of the females exceed the
risks of the male
Risk factors of
atherosclerosis 2
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Extrinsic risk factors
• Smoking (a pack a day increases
the risk 2×)
• Hypertension
• Dyslipoproteinemia
• Hyperglycemia, diabetes mellitus
• Obesity
• Homocystinuria
• Hyperuricemia
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Regulation
• The sensitivity of the baroreceptor reflex
decreases (hypertension or orthostatic
hypotension)
• The serum levels of the catecholamines
increase (increased release, diminished
elimination)
• The efficacy of the sympathetic tone
decreases
• The carotids are more rigid (cardiovagal
reflex decreases)
• Vestibulosympathic reflex efficacy also
decreases (adaptation to gravitational
forces) – orthostatic hypotension (upon
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Pectoral angina
• Above 70 years the prevalence of
coronary heart disease reaches
70%
• The prevalence of “silent
ischemia” increases, especially
in females and in diabetics
(autonomic neuropathy)
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Arrhythmias
• Atrial fibrillation – with heart
failure
• AV-nodal re-entry tachycardia
• Multifocal ventricular premature
beats (polymorphic)
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Hypertension 1
• Age-related hypertension is mostly
isolated systolic hypertension (18-24
years 2.6%, above 75 70.3%, 50%
undetected, above 80 the BP decreases)
• Due to the loss of elasticity in the
aorta the pulse wave returns too early,
disturbing the systole and increasing
the systolic blood pressure too much
• The pulse-pressure increases, the
diastolic pressure decreases.
• This increased pulse-amplitude is one
Mean aortic pressure and
aortic pulse wave velocity
vs. age
11
0
10
5
10
0
95
Urban
Rural
1,20
0
1,00
0
90
800
85
80
600
20
40
Age (years)
60
80
Aortic pulse wave velocity
(cm/sec) ●, ○
Mean aortic pressure (mmHg) ▲, ∆
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Hypertension 2
• With age not only the amount of collagen
increases but also the rigidity of the
collagen – progressive fibrosis
• The vascular diameter decreases relative to
the vessel wall + endothelial damage
decreases the vasodilatory activity
• RAAS activity decreases (decreased
sympathetic tone, decreased
responsiveness).
• Plasma norepinephrine increases, but the βreceptor responsiveness and sensitivity is
down
• There is, on average, a 1% annual decrease
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Hypertension 3
• Age-related hypertension is saltsensitive – the nephron number
decreases from the original 800,000 to
400,000 by the age of 80. The salt
excretion is also decreased.
• This is explained partly through the
decreased glomerular function, partly
by a decreased production of
natriuretic substances (PGE2,
bradykinin)
• The impaired activity of the Na-K ATPase pump may contribute to
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Hypotension
• Decreased baroreceptor reflex + more
rigid carotid leads to a tendency for
orthostatic hypotension and an
excessive HR increase upon standing up
• The BP of the elderly must be measured
when sitting and after standing up (BP
fall > 20 mmHg)
• Tendency to develop hypovolemia
(decreased thirst, lower ECV, decreased
responsiveness of regulatory hormones)
may promote hypotension and increase
mortality
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Hypertension and therapy
• Decreased filtration surface (decreased
endogenous creatinine clearance) Na retention
and the need to apply thiazide diuretics.
• The renal and hepatic clearance of drugs
decrease – drug doses have to be adjusted
• The side effects are less tolerated by the
elderly – therapeutic compliance is decreased
(ACE inhibitors – 30% cough, Ca-channel
blockers – 25% swelling of the legs, combined –
dizziness)
Therapy
ACE inhibitors (Angiotensin II type 1 receptor
blockers) and channel blockers (in the elderly
appropriate therapy may increase the well-being