HEART FAILURE INHEART FAILURE IN THE GERIATRIC …
嚜澦EART FAILURE IN
THE GERIATRIC
POPULATION
Ross Zimmer M.D., F.A.C.C.
Clinical Assistant Professor of Medicine
Director,, Heart Failure Program
g
Medical Director, VAD Program
UPHS/Presb terian Medical Center
UPHS/Presbyterian
Our Aging Population
Projected Increases in the U.S. Population 65 Years of Age or Older.
Data are from the U.S. Census Bureau.
NEJM 2002;347:1349
5/18/2012 2:23:48 PM
SBCO0074 - LC - PCP
Unique Aspects of Aging and Heart
Failure
? Increased myocardial stiffness and diastolic
dysfunction
? More exposure to standard comorbidities that
l d tto CAD and
lead
d systolic
t li d
dysfunction
f
ti
? Less data based decision making
g ((older
population is under represented)
? More dangerous drug-drug-interactions
drug drug interactions
? More complex psycho-social issues
? Greater procedural/surgical risk
3
5/18/2012 2:23:48 PM
SBCO0074 - LC - PCP
Identifying the Patient With
Heart Failure
? Symptoms (more vague/difficult in the elderly)
每 Exertional dyspnea or fatigue
每 Orthopnea, paroxysmal nocturnal dyspnea
? Physical findings
每 Elevated jugular venous pressure, third heart
sound,
d laterally
l t ll di
displaced
l
d apical
i l iimpulse,
l
rales, edema, cardiomegaly on chest X-ray findings may be minimal with more chronic
disease
4
5/18/2012 2:23:48 PM
SBCO0074 - LC - PCP
Identifying the Patient With
Heart Failure
? Assess cardiac function
每 Echocardiography
g p y remains best
assessment of EF/valve
disease/pericardial
p
disease
每 Role of BNP is expanding (although may
be less helpful
p in the elderly)
y)
5
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