Orthostatic hypotension in elderly women with congestive heart failure.

Orthostatic hypotension is common in the elderly and could be the cause of impaired vision, dizziness, fainting spells and falls. To date, studies on orthostatic hypotension have chiefly concentrated on elderly patients in nursing homes, outpatients or healthy subjects. Congestive heart failure (CHF) is one of the most common causes of hospitalization and pharmacotherapy in the elderly, but little is known about the orthostatic hypotension in patients with CHF. The aim of this study was to evaluate the prevalence of orthostatic hypotension and associated symptoms in elderly females hospitalized for CHF. The study group included 36 women aged 70-100 years (mean 82.2), admitted to hospital for congestive heart failure. The control group consisted of 15 women aged 71-95 years (mean 82.5) with no symptoms of heart failure or other diseases, who underwent earlier epidemiological studies on Cracow's elderly population. In all subjects a tilt test was performed (60 degree tilt for 10 minutes) under standardized conditions (fasting patients, 12 hours after the last administration of medications, between 8:00 and 10:00 a.m.). Orthostatic hypotension was defined as a decline of 20 mmHg or more in systolic blood pressure, or 10 mmHg or more in diastolic blood pressure on assumption of the upright position. Orthostatic hypotension was detected in 83.3% of CHF women, and 43.3% of them manifested clinical symptoms associated with it. In the control group, orthostatic hypotension was noted in 53.3% of women, but none was symptomatic. In particular, the CHF patients showed a decreased ability to develop compensatory tachycardia during hypotension. Moreover, reduction in systolic blood pressure was more pronounced in CHF patients, and diastolic blood pressure increase was less significant as compared with the control group.

Echocardiographic assessment of left ventricular structure and function in elderly women with congestive heart failure.

The aim of this investigation was an echocardiographic assessment of left ventricular structure and function in elderly women who were hospitalized due to congestive heart failure. Sixty-three women with heart failure aged 70-100 years (mean age, 82 years) were studied; medical histories were taken, medical examinations and chest X-ray studies, along with ECG and M-mode, 2D-mode and Doppler echocardiography were performed. Echocardiography revealed that the predominant structural lesions involved the cardiac valves; in the majority of cases, there was thickening and calcification of the mitral and aortic valves, but calcification of the mitral and aortic annulus was also frequent. Mitral regurgitation was noted in 84.1% of patients, and tricuspid regurgitation in 50.8%. More than one type of valvular dysfunction was characteristic of 57.1% of women. Among the evaluated cardiac dimensions, left atrial enlargement was observed in 84.1% of women, and ventricular septal hypertrophy in 60.3%. In the majority of patients (55.6%), the values of left ventricular ejection fraction ranged from 51% to 82%, while in the remaining 44.4% they oscillated between 18% and 50%. The most often detected underlying etiological factor in our elderly females with heart failure was coronary artery disease diagnosed in 88.9% of patients, followed by arterial hypertension (54%), and valvular defects (22.2%). In conclusion, the results indicate the presence of some characteristic lesions revealed by echocardiography in elderly patients treated for heart failure; valvular and annular degenerative lesions are commonly detected, valvular dysfunction is frequent, and in the majority of patients (55.6%) left ventricular systolic function is not impaired.

Correlation between aortic pulse wave velocity and norepinephrine, epinephrine, aldosterone and plasma renin activity in very elderly subjects and in patients with congestive heart failure.

The expression of cardiovascular disease in older patients results from the interaction between age-related changes and the disease process itself. It is still unclear whether the physiologic and pathophysiologic changes that occur with advanced age accelerate or compound the factors responsible for congestive heart failure (CHF). Whether, and to what extent, arterial compliance is altered in CHF in the elderly is not clear. It is also unknown whether the plasma levels of neurohumoral factors in the healthy elderly and in CHF patients are associated with changes in arterial compliance. The aim of this study was to evaluate the aortic pulse wave velocity (PWV) in the aorta of elderly healthy subjects and CHF patients, and establish the correlation between PWV and plasma levels of norepinephrine, epinephrine, aldosterone, and renin activity. The study group consisted of 63 females aged 70-100 years (mean, 82 years) with CHF, and 15 age-matched healthy women. Aortic PWV in patients with heart failure did not differ significantly from figures in the age-matched healthy group (12.42 m/sec vs 11.86 m/sec). No statistically significant correlations were found between plasma levels of norepinephrine, epinephrine, aldosterone and renin activity, and aortic compliance measured as PWV. These results suggest that age-associated arterial stiffening is a predominant factor in the development of reduced arterial compliance in elderly patients with CHF.

[Blood morphology in elderly persons over 90 years old]. / Morfologia krwi u osób po 90 roku zycia.

In order to assess blood cell count in a late senescence we examined 56 persons (44 women and 12 men) in age 90-99, in a good condition. Over 70% of obtained results were in normal range. The most frequent abnormalities were: anemia (28.6%), leukopenia < 4,000 in 1 mm3 16.1%, thrombocytopenia < 125,000 in 1 mm3 -10.7% of subjects. In a white blood count low value of rod neutrophils and monocytes were found. The results show that the haematological diagnosis in elderly does not require any special references intervals.

[Serum lipids in persons over 90 years of age]. / Lipidy surowicy u osób po 90 roku zycia.

UNLABELLED: Because of different views on the significance of the serum lipids as a risk factor of atherosclerosis in the elderly we evaluated the levels of total cholesterol (CH), HDL-cholesterol (HDL-CH) and triglyceride (TG) in the group of 56 very old (over the 90), who were in a good health condition. Desirable values of lipids were found respectively: CH in 55.4% of subjects, HDL-CH in 85.7% and TG in 89.3%. In the elderly with hypercholesterolemia (CH > 250 mg/dl) we simultaneously found high level of HDL-CH (x = 69.3 mg/dl). CONCLUSIONS: The serum lipids levels in the elderly over 90 were generally within the limit of desirable values. On the other hand subjects who had higher level of cholesterol had also high level of HDL-CH (69.3 mg/dl). Considering our results we came to the conclusion that high level of HDL-CH is one of the favoring factors to reach an advanced age.

Prevalence of autoantibodies in the very elderly: association with symptoms of ischemic heart disease.

The mechanisms leading to the increased expression of autoantibodies in the elderly are poorly understood. The aim of this study was to investigate whether the presence of ischemic heart disease (IHD) is associated with the prevalence of autoantibodies in the elderly over 85 years of age. Anti-nuclear (ANA), anti-smooth muscle (SMA), anti-mitochondrial (AMA), thyroid anti-microsomal autoantibodies (anti-Tg) and antibodies to gastric parietal cells (PCA) were determined in selected groups of healthy subjects and patients with IHD. In IHD patients, the following autoantibodies were detected: ANA in 42.1% of subjects, SMA in 10.5%, AMA in 5.3%, anti-Tg in 5.3%, and PCA in 5.3%. In control healthy subjects, ANA were detected in 10%, AMA in 5%, and PCA in 15%. In conclusion, autoantibodies were more common in patients with IHD than in control healthy subjects, but no significant differences were found.

[Prevalence of autoantibodies in serum of healthy persons over 85 years of age]. / Czestosc wystepowania autoprzeciwcial w surowicy osób zdrowych, po 85 roku zycia.

Aging is believed to be associated with the increase in the frequency of autoantibodies. However, as the recent studies suggest the immunological defects are not the consequence of the aging process but they could be a result of underlying diseases. We investigated the prevalence of the anti-nuclear (ANA), anti-mitochondrial (AMA), anti-smooth muscle (SMA), antibodies to gastric parietal cells (PCA) and thyroid anti-microsomal autoantibodies (anti-Tg) in the sera of the selected healthy elderly over 85 years of age. We discovered ANA in 10% of subjects, AMA-5% and PCA in 15% in the group that we examined. Anti-smooth muscle and thyroid anti-microsomal antibodies have not been observed. Autoantibodies were less frequent than in other studies, but our results have shown slight increase of some autoantibodies in the healthy elderly.

[Rhythm and conduction disorders among the adult population. Epidemiologic data]. / Zaburzenia rytmu i przewodnictwa w populacji osób doroslych. Dane epidemiologiczne.

2.487 resting ECG were examined which is 61.3% of randomly chosen group of inhabitants of Cracow, aged from 20 to 93. There were: sinus tachycardia (HR 100)--4.2%, extrasystole--2.7%, fibrillatio atriorum 1.4%, blocks A-VI0--0.9%, intraventricular conduction defects--3.6% (most often LAH). Prevalence of disturbances of rhythm and conduction increases with age, mainly after 60.

[Response of the cardiovascular system in elderly patients to intravenous infusion of isoproterenol and adrenaline]. / Odpowiedz ukladu sercowo-naczyniowego osób w wieku podeszlym na dozylna infuzje izoproterenolu i adrenaliny.

The effect of gradually increasing doses of catecholamines on the heart rate, arterial pressure and the left heart ventricle systolic time intervals has been studied in the group of 30 aged subjects (70 to 95 years old) and the control group aged 23 to 30 years. The initial resting QS2I, LVETI, PEPI, heart rate and diastolic pressure were similar in both groups studied whereas the chronotropic and inotropic response as well as the vasodilatation were weaker in the aged. The disturbed mechanisms of adaptation in the aged could be caused by limited response of the circulatory system to adrenalin secreted during the stress states.

[Polycardiographic evaluation of left ventricular function in the elderly]. / Polikardiograficzna ocena czynnosci lewej komory serca u osób w wieku podeszlym.

Polycardiographic recordings have been carried out in 57 individuals (16 men and 41 women), aged between 70 and 97 years (mean age 78.3 years), both at rest and during the stimulation of circulatory system by the cooling of hand. Systolic time intervals of the left ventricle and QT/QS2 ratio have been evaluated. It was found, that systolic time intervals at rest did not differ significantly from those given by Weissler. Cooling of hand has been manifested by: prolongation of LVETI, decrease in PEP/LVET, prolongation of QS2I, and decrease in QT/QS2. Results suggest indirectly that myocardium of the elderly adapts to the stimulation through Frank-Sterling mechanism.

[Electrocardiography in elderly inhabitants of Krakow. Epidemiological study]. / Elektrokardiogramy u starszych wiekiem mieszkanców krakowa. Badania epidemiologiczne.

The electrocardiographic records were performed in the randomly chosen area of Cracow. The results were obtained from 512 persons (153 M and 359 F) aged 70-93 years. Normal electrocardiograms observed in 25.4% of the studied population. The prevalence of electrocardiographic abnormalities was as follows: ST segment depression--40.0%, patterns of infarction--17.2% and left ventricular hypertrophy--10.4%. On the contrary right axis deviation, bradycardia, sinus arrest, II and III of a-v blocks were rarely observed. The prevalence of electrocardiographic abnormalities in the aged in Cracow is in the accordance with the findings observed in the countries with high risk of cardiovascular diseases.

[The state of the circulatory system in the elderly]. / Stan ukladu krazenia u osób dlugowiecznych.

Fifty six persons (15 men and 41 women) aged between 90 and 99 years were examined to assess their health determining longevity. Circulatory system was evaluated with the aid of anamnesis, physical examination, chest X-ray and ECG. Clinical symptoms of the circulatory disease were diagnosed in 55.4% of tested persons, including: ischaemic heart disease in 42.9%, arterial hypertension in 35.7%, and circulatory failure in 23.2%. Normal ECG records were noted in 10.7% of the tested elderly persons. The most frequent electrographic abnormalities included: decrease in ST, LAH and atrio-ventricular block of the I degree. Incidence of ECG abnormalities did not depend upon the clinical state. An advanced age (over 90 years) is achieved also by the persons with marked circulatory disorders.