Chapter 65: Cardiovascular Disease in the Elderly: Pathophysiology and Clinical Implications
Which of the following is not an effect of aging on the gross anatomy of the heart?
A. Endocardial thickening and sclerosis
B. Increased left atrial size
C. Valvular fibrosis and sclerosis
D. Decreased epicardial fat
The answer is D. (Hurst’s The Heart, 14th Edition, Chap. 65) The effects of aging on the gross anatomy of the heart are: increased left ventricular wall thickness and decreased cavity size, endocardial thickening and sclerosis (option A), increased left atrial size (option B), valvular fibrosis and sclerosis (option C), and increased (not decreased) epicardial fat (option D).
Which of the following is a cardiovascular effect associated with aging?
B. Bleeding complications with antiplatelet, anticoagulant, and fibrinolytic agents
D. Altered pharmacodynamics
The answer is E. (Hurst’s The Heart, 14th Edition, Chap. 65) With increasing age, changes in the hemostatic system shift the intrinsic balance between thrombosis and fibrinolysis in the direction of thrombosis (option A). As a result, older adults are at increased risk for both venous thromboembolic disease (ie, deep venous thrombosis and pulmonary embolism) and thrombosis in the arterial system, including myocardial infarction (MI), left atrial appendage thrombus in AF, and stroke. Despite these changes, and perhaps paradoxically, older adults are also at increased risk for bleeding complications with all antiplatelet, anticoagulant, and fibrinolytic agents (option B), as exemplified by the increased incidence of intracranial hemorrhage in older adults receiving prasugrel or fibrinolytic agents. In addition, age-associated declines in muscular mass (sarcopenia) and bone mass (osteopenia) contribute to reductions in exercise tolerance, adversely affect balance, and predispose to injurious falls (option C). Further, aging is associated with altered pharmacokinetics and pharmacodynamics of almost all medications (option D), so that drug dosages tested in clinical trials involving predominantly younger and healthier patients may not be appropriate for the majority of older adults.
Which of the following statements about multimorbidity is true?
A. The most common pattern of multimorbidity is the coexistence of a cardiometabolic condition and osteoarthritis
B. The dyad of hypertension and hyperlipidemia is rare among Medicare beneficiaries
C. Over 50% of Medicare beneficiaries with HF, stroke, or ...