Coronary artery disease in the elderly:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1996
|
| Schriftenreihe: | Clinics in geriatric medicine
12,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVIII, 236 S. Ill., graph. Darst. |
Internformat
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| 245 | 1 | 0 | |a Coronary artery disease in the elderly |c Wilbert S. Aronow ... guest ed. |
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| 650 | 2 | |a Maladie coronaire - Sujet âgé | |
| 650 | 4 | |a Aged | |
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Datensatz im Suchindex
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| adam_text | CORONARY AKII RY Dfcl ASl l Till: I LI)I:KI Y
CONTENTS
Preface xvii
Wilbert S. Aronow and Donald D. Tresch
Pathophysiology of Coronary Artery Disease 1
Antonio Fernandez Ortiz and Valentin Fuster
Atherogenic risk factors provoke chronic injury to the endothelium
in certain parts of the arterial tree leading to dysfunctional endothe¬
lium. Lipid accumulation, macrophage formation, and smooth mus¬
cle cell proliferation are key events in the initial slow progression of
atherosclerotic lesions (phase 1). If extracellular lipid accumulation
predominates, atherosclerotic process progresses into a more clini¬
cally relevant, advance lipid rich lesion (phase 2)—the pathogenic
basis for plaque rupture and thrombus formation. Small plaque fis¬
sures and mural thrombus formation may be responsible for the
rapid, clinically silent progression of lesions (phase 3). Plaque rup¬
ture with large thrombus formation may be responsible for acute
coronary syndromes (phase 4). Alternatively, if smooth muscle cell
proliferation and collagen matrix synthesis predominate, athero¬
sclerotic lesions may progress into advanced, stable sclerotic lesions
(phase 5).
Smoking and Coronary Artery Disease 23
Donald D. Tresch and Wilbert S. Aronow
This article discusses the specific effects of smoking on the heart and
coronary arteries and demonstrates how these effects increase the
risk for cardiovascular morbidity and mortality. The conflicting re¬
sults of various studies concerning the association of smoking and
coronary heart disease in older persons are reviewed, and possible
~ CLINICS IN GERIATRIC MEDICINE
VOLUME 12 • NUMBER 1 • FEBRUARY 1996 ix
explanations for the discrepancy are given. Recent trends in smoking
habits in the United States and the effects of these changing trends on
cardiovascular mortality are presented. Finally, data are presented
that demonstrate the effects of physician directed cessation pro¬
grams and the health benefits of smoking cessation in elderly and
younger persons.
Dyslipidemia and Coronary Artery Disease in the Elderly 33
John C. LaRosa
Risk factors that predict atherosclerotic cardiovascular disease in
younger individuals also predict risk in older people. Although the
relative risk of cardiovascular disease associated with any given risk
factor may decrease as individuals get older, the absolute risk of
morbidity and mortality increases markedly with age. Because the
elderly carry the greatest burden of atherosclerosis, they should not
be excluded automatically from cholesterol lowering interventions
with either diet or drugs. Such interventions, however, should be
undertaken with special attention to their potential adverse effects
in the older population.
Hypertension and Coronary Artery Disease in the Elderly 41
Franz H. Messerli and Tomasz Grodzicki
Both hypertension and coronary artery disease are common in the
geriatric population, and a variety of pathogenetic links exist be¬
tween the two disorders. In the elderly patient, coronary artery dis¬
ease is often asymptomatic and more difficult to recognize clinically.
Antihypertensive therapy has been shown to reduce morbidity and
mortality from coronary artery disease in the elderly to some extent.
A more specific and individualized approach is more likely to in¬
crease these therapeutic benefits.
Prevention and Reduction of Left Ventricular Hypertrophy
in the Elderly 57
Carl J. Lavie, Richard V. Milani, and Franz H. Messerli
Left ventricular hypertrophy (LVH) is both a target organ response
to arterial hypertension and a disorder that may be responsible for
increasing risk of cardiovascular events, including coronary artery
disease (CAD) events, in the elderly population. Hypertension and
obesity are the strongest risk factors for LVH, and both disorders are
more likely to occur with age. Not surprisingly, the prevalence of
LVH markedly increases with age. Although LVH may initially be
a compensatory mechanism to reduce ventricular wall stress, sub¬
stantial data indicate that as LVH progresses, coronary flow reserve
is reduced, and CAD events are increased. Furthermore, LVH leads
to systolic and particularly, diastolic ventricular dysfunction, and
an increase in the prevalence and complexity of ventricular dys
rhythmias. All types of cardiovascular morbidity and mortality also
are increased in patients with LVH. Pharmacologic and nonpharma
X CONTENTS
cologic strategies that may decrease LVH and potentially reduce car¬
diovascular morbidity and mortality in the elderly are reviewed.
Diabetes Mellitus and Coronary Heart Disease in the Elderly 69
Pantel S. Vokonas and William B. Kannel
Data from epidemiologic studies document the role of clinically
manifest diabetes mellitus as a powerful risk determinant for an
array of atherosclerotic cardiovascular outcomes including coro¬
nary heart disease (CHD), stroke, and peripheral arterial disease,
particularly in the elderly. Although dyslipidemias and hyperten¬
sion are quite prevalent in persons with diabetes mellitus and con¬
tribute heavily to the underlying atherosclerotic process, other fac¬
tors involving alternative pathogenetic mechanisms are necessary
to explain for the dramatic acceleration of atherogenesis observed
in this condition. Myocardial ischemia may be silent and myocardial
infarction (MI) may be either painless or atypical in presentation
which further complicates both the diagnostic and therapeutic man¬
agement of CHD in older diabetic patients. MI, in this context, is
confounded by dual prognostic disadvantages of higher risk for MI
related complications attributable to both advanced age and diabe¬
tes mellitus. Because available evidence has yet to demonstrate that
control of hyperglycemia, either by oral agents or by insulin, effec¬
tively forestalls either the development or complications of athero¬
sclerosis, preventive management in older patients with diabetes
requires critical attention to correcting coexisting cardiovascular
risk factors.
Physical Inactivity and Coronary Heart Disease in Elderly Patients 79
Nanette Kass Wenger
Because physicians are viewed as reliable sources of health informa¬
tion, and owing to the substantial number of physician contacts with
elderly patients either with or without coronary heart disease, physi¬
cian advice regarding the adoption of regular patterns of moderately
intensive physical activity has the potential to decrease coronary risk
in elderly populations. The message should emphasize the adverse
consequences of chronic inactivity and highlight that even modest
increases in the level of habitual physical activity in older adults can
limit the decline in functional reserve, improve functional capacity,
decrease coronary risk, and lessen mortality.
Clinical Manifestations and Diagnosis of Coronary Artery Disease 89
Donald D. Tresch and Wilbert S. Aronow
Coronary atherosclerosis is very common in the elderly population
with autopsy studies demonstrating the prevalence to be at least
70% in persons over the age of 70. These autopsy findings may be
coincidental, with the disease clinically silent throughout the per
CONTENTS xi
son s life, although 20% to 30% of persons over age 65 years will
demonstrate clinical manifestations of coronary heart disease
(CHD). In most elderly persons, the disease will have manifested
itself much earlier in their lives, however, in others the disease will
be entirely silent until the person reaches his or her 70s or 80s. Unfor¬
tunately, even though CHD is prevalent in elderly persons, the dis¬
ease is often not diagnosed or misdiagnosed in this age group. Fail¬
ure to correctly diagnose the disease in the elderly may be due to the
difference in the clinical manifestation in this age group compared
with younger patients. Such differences may reflect a difference in
the disease process between older and younger patients or it may
be related to the superimposition of normal aging changes, plus the
presence of concomitant diseases, which may mask the usual clinical
manifestations.
Stress Testing for Coronary Artery Disease in the Elderly 101
Steven P. Schulman and Jerome L. Fleg
The elderly constitute an increasing percentage of patients evaluated
and treated for coronary artery disease. In addition to clinical evalua¬
tion, noninvasive testing with stress testing is an important part of
the evaluation. Various stress modalities are available to assess the
presence and severity of coronary disease in this age group. The
diagnostic value and use of exercise electrocardiography, radionu
clide imaging techniques, and pharmacologic stress modalities in
the elderly are discussed.
Medical Management of Stable Angina and Unstable Angina in
the Elderly with Coronary Artery Disease 121
Harold G. Olson and Wilbert S. Aronow
Coronary artery disease is a major clinical problem in the elderly.
This article discusses the medical management of stable and unsta¬
ble angina pectoris. A review of the general measures and drug ther¬
apy used to treat these disorders, especially as they relate to the el¬
derly patient are presented. In addition, new insights into the
pathophysiologic mechanisms of chronic stable angina and unstable
angina are reviewed.
Therapy for Acute Myocardial Infarction 141
Michael W. Rich
Older patients with acute myocardial infarction are at increased risk
for a variety of complications, including congestive heart failure,
atrial fibrillation, myocardial rupture, cardiogenic shock, and death.
This article summarizes current approaches to the early manage¬
ment of acute myocardial infarction in the elderly and discusses the
role of thrombolytic therapy, angioplasty, aspirin, beta blockers, and
other pharmacologic agents in these patients. Additional topics of
particular relevance to the elderly, including risk stratification, ethi¬
cal concerns, and individualization of treatment, are also reviewed.
Xii CONTENTS
Management of Postmyocardial Infarction in the Elderly Patient 169
Robert Forman and Wilbert S. Aronow
Elderly patients have a significantly higher mortality and morbidity
compared with younger patients in the postmyocardial infarction
period and thus, with the appropriate management have a greater
potential for benefit compared with younger patients. It has been
shown in the large randomized trials that elderly patients with acute
myocardial infarction benefit significantly from administration of
beta blocking agents and angiotensin converting enzyme inhibi¬
tors. Aspirin and warfarin sodium (Coumadin) have been shown to
benefit patients of all age groups. Secondary prevention with cessa¬
tion of smoking, use of lipid lowering agents, treatment of hyperten¬
sion, and estrogen therapy in the postmenopausal woman have been
shown to be effective. Elderly patients, therefore, who are free of
general noncardiac disability and who can be expected to live mean¬
ingful lives should be offered a comprehensive program to reduce
their cardiac morbidity and mortality after discharge following
acute myocardial infarction.
Percutaneous Transluminal Coronary Angioplasty in the Elderly 181
Randall C. Thompson and David R. Holmes, Jr
Selected elderly patients, even the very elderly, can undergo percu¬
taneous transluminal coronary angioplasty (PTCA) with a high ex¬
pected rate of procedural success; however, procedural mortality is
higher than in younger patients and, although long term survival is
very good, long term relief of angina is less reliable. Patient selection
is the key to optimal outcome.
Coronary Bypass Surgery in the Elderly 195
Melvin D. Cheitlin
The incidence and severity of coronary artery disease increase with
age. Because the mortality and morbidity of patients over the age of
70 are higher than those for younger patients, many earlier studies
comparing the effectiveness of bypass surgery to medical manage¬
ment deliberately excluded patients over the age of 65. Presently,
however, there are many reports on the morbidity and mortality of
patients having coronary bypass sugery who are over the age of 65
and 70 and even in some reports, over the age of 80. Compared with
younger patients, the elderly have more severe disease, frequent
comorbidity, and a slightly higher perioperative mortality and mor¬
bidity. In properly selected patients, that is patients in whom the
major problem is the coronary artery disease and not multisystem
failure, the benefit from coronary artery bypass surgery as far as
relief of angina and improvement of physical activity is concerned
is equal to the benefit that younger patients experience. Unlike
younger patients, in patients over 75 years of age, the goal of surgery
is not necessarily to prolong life, although in the appropriate patients
this probably occurs, but to decrease or eliminate angina and return
the patient to more normal activity and a better quality of life.
CONTENTS Xlii
Exercise Training for Coronary Artery Disease in the Elderly 207
William F. Brechue and Michael L. Pollock
Treatment of the elderly cardiac patient poses a unique problem to
the clinician. In addition to cardiovascular symptoms related to cor¬
onary artery disease, age related decrements in health, and physical
function associated with musculoskeletal decline must also be ad¬
dressed. Exercise training/physical activity has been shown to have
a positive impact on health and function in primary and secondary
prevention in young and elderly clinical populations. Although the
components of and guidelines for prescribing an exercise program
are similar for younger and older cardiac patients, the principles
should be applied to meet the unique goals and demands of the el¬
derly cardiac patient.
Index 231
Subscription Information Inside back cover
xiv CONTENTS
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| spelling | Coronary artery disease in the elderly Wilbert S. Aronow ... guest ed. Philadelphia [u.a.] Saunders 1996 XVIII, 236 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in geriatric medicine 12,1 Maladie coronaire - Sujet âgé Aged Coronary Disease Coronary Vessels pathology Alter (DE-588)4001446-0 gnd rswk-swf Koronare Herzkrankheit (DE-588)4073731-7 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Alter (DE-588)4001446-0 s Koronare Herzkrankheit (DE-588)4073731-7 s DE-604 Aronow, Wilbert S. Sonstige oth Clinics in geriatric medicine 12,1 (DE-604)BV000019839 12,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007165949&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Coronary artery disease in the elderly Clinics in geriatric medicine Maladie coronaire - Sujet âgé Aged Coronary Disease Coronary Vessels pathology Alter (DE-588)4001446-0 gnd Koronare Herzkrankheit (DE-588)4073731-7 gnd |
| subject_GND | (DE-588)4001446-0 (DE-588)4073731-7 (DE-588)4143413-4 |
| title | Coronary artery disease in the elderly |
| title_auth | Coronary artery disease in the elderly |
| title_exact_search | Coronary artery disease in the elderly |
| title_full | Coronary artery disease in the elderly Wilbert S. Aronow ... guest ed. |
| title_fullStr | Coronary artery disease in the elderly Wilbert S. Aronow ... guest ed. |
| title_full_unstemmed | Coronary artery disease in the elderly Wilbert S. Aronow ... guest ed. |
| title_short | Coronary artery disease in the elderly |
| title_sort | coronary artery disease in the elderly |
| topic | Maladie coronaire - Sujet âgé Aged Coronary Disease Coronary Vessels pathology Alter (DE-588)4001446-0 gnd Koronare Herzkrankheit (DE-588)4073731-7 gnd |
| topic_facet | Maladie coronaire - Sujet âgé Aged Coronary Disease Coronary Vessels pathology Alter Koronare Herzkrankheit Aufsatzsammlung |
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