HEART FAILURE INHEART FAILURE IN THE GERIATRIC …

HEART 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

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SBCO0074 - LC - PCP

Identifying the Patient With

Heart Failure

? Symptoms (more vague/difficult in the elderly)

¨C Exertional dyspnea or fatigue

¨C Orthopnea, paroxysmal nocturnal dyspnea

? Physical findings

¨C 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

¨C Echocardiography

g p y remains best

assessment of EF/valve

disease/pericardial

p

disease

¨C Role of BNP is expanding (although may

be less helpful

p in the elderly)

y)

5

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