Modificările sistemului cardiovascular la vârstnici

Abstract

Background: Aging leads to significant modifications in the cardiovascular system. Arterial changes include lumen enlargement, wall thickening and increased stiffness. The main mechanisms of increased arterial stiffness are: increased collagen content decreased elastin, accumulation of advanced glycation end-products, oxidative stress, increased concentration of proinflammatory cytokines, deteriorations of nitric oxide pathway. In the myocardium there is a loss of cardiomyocytes, due to necrotic or apoptotic cell death, hyperplasia of myocardial cells, increased collagen content, which results in systolic and diastolic dysfunction. Aging affects the neurohormonal mechanisms that control the cardiovascular system. Due to decrease in parasympathetic modulation of cardiovascular system there is depression of respiratory sinus arrhythmia, reduction in heart rate responses to deep breathing, Valsalva maneuver and to standing. Aging also decreases cardiovascular response to sympathetic nervous stimulation (reduced vasodilatation response to β-agonists, vasoconstriction response to α-agonists, reduced chronotropic and inotropic response to catehcolamines). Degenerative changes of the cardiac conduction system lead to arrhythmias and heart block. Conclusions: Paraclinical preoperative assesement of patient will be selectively considered based on recommendations of evidence based protocols and guidelines.