Aging Of

Cardiovascular System
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Proses Aging
A maturational process that includes a series of
genetically programmed events that are influenced by
external factors
Kemajuan medis usia harapan hidup bertambah
Peran PMR mempertahankan dan restorasi fungsi dari
pasien yang sudah menua
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Downey, Darling;Physiological Basis of Rehabilitation Medicine,3rd ed.New York;2001
Aging Sistem Kardiovaskuler
Jantung
Penebalan dinding ventrikel kiri (>> pada hipertensi )
Pembesaran ukuran sel otot jantung (myocyte)
Pembuluh Darah
Dinding aorta lebih kaku
Aorta terdilatasi dan memanjang (elongasi)
perubahan elastin dan kolagen, deposit kalsium
5/30/2014 Aging of Cardiovascular System
Downey, Darling;Physiological Basis of Rehabilitation Medicine,3rd ed.New York;2001
Aging Sistem Kardiovaskuler
Fungsi Kardiovaskuler
Kecepatan pengisian diastolik awal secara progresif
EDV bisa tetap pada geriatri yang sehat
TD sistolik
EF
Menurunnya sensitivitas Baroreseptor
menurunnya refleks takikardia saat bangun dari
posisi terlentang orthostatic hypotension

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Carotid barochemoreceptor pathological findings
regarding carotid plaque status and aging
Jos Milei, MD PhD,
1
Anna M Lavezzi, MD PhD,
2
Barbara Bruni,
MD,
2
Daniel R Grana, VMD,
1
Francisco Azzato, MD,
1
and Luigi Matturri,
MD PhD
2
METHODS:
Patients (n=23) who had suffered and died from stroke, with and without
complicated internal carotid atheromatosis, were divided by age (group 1:
older than 80 years; group 2: 65 to 80 years; and group 3: younger than 65
years). Carotid segments were obtained at autopsy. The specimens were
stained for light microscopy and immunohistochemistry.

RESULTS:
Carotid glomus presented from moderate-to-severe atrophy and fibrosis. A
focal decrease in vascularization (CD34-positive) of the glomus (greater than
50%) was observed in areas of atrophy and fibrosis. Damaged nerve endings
(S100 protein-positive) were observed at the media of the carotid sinus.
Morphometric data showed no differences between groups for glomus area,
number of type 1 and 2 cells, and the wall to lumen arteriole ratio. No
statistical differences were demonstrated in the pathological findings of the
carotid glomus when comparing complicated with noncomplicated plaques or
age groups.

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Efek pada Latihan
Kapasitas latihan max dan VO2 max pada geriatri
akan
Geriatri dengan kondisi fisik yang baik dapat memiliki
kapasitas aerobik = lebih muda
Kapasitas aerobik dapat ditingkatkan dengan latihan
endurance
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Perubahan akibat Aging pada
Aorta dan Arteri
Penebalan fibrous yang progresif
pada tunika intima
Fibrosis dan timbulnya skar pada
otot atau elastic media
Bertumpuknya substansi yang
kaya mukopolisakarida
Fragmentasi pada elastik lamina
Efek dari perubahan ini = kekuatan
dan elastisitas dinding pembuluh
darah.
Dilatasi progresif merupakan fenomena
penuaan pada aorta dan pembuluh
darah koroner.

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Underwood and Cross;General and Systemic pathology 5th ed;2009
Penyakit Jantung Koroner (1)
Penyakit jantung koroner = penyakit yang
disebabkan kegagalan arteri koroner untuk
menyuplai darah ke otot jantung sehingga
kebutuhan O2 tidak terpenuhi.
Penyakit jantung koroner terjadi karena adanya
penyempitan/penyumbatan di dinding arteri
koroner .
Penyakit jantung koroner bisa menyebabkan
iskemik miokard yang bisa menyebabkan infark
miokard.
Penyakit multifaktorial yg dipengaruhi oleh
proses aging intrinsik, faktor lingkungan dan
genetik.


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Penyakit Jantung Koroner (2)

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Teori terbentuknya
Atherosklerosis
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Pembentukan Aterosklerosis
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Faktor Risiko
Mayor :
Merokok
Hipertensi
Diabetes Mellitus
Hiperkolesterol
Familial

Minor :
Obesitas
Low exercise
Stress
Usia Lanjut
Pemakaian obat-obatan
tertentu (steroid)
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Association of Cardiovascular Burden with Mobility Limitation
among Elderly People: A Population-Based Study
Anna-Karin Welmer,
1,2,*
Sara Angleman,
1
Elisabeth Rydwik,
1,3
Laura
Fratiglioni,
1,4
andChengxuan Qiu
1,*
Background : Cardiovascular risk factors (CRFs) such as smoking and diabetes have
been associated with mobility limitations among older adults. We seek to examine to
what extent individual and aggregated CRFs and cardiovascular diseases (CVDs) are
associated with mobility limitation.
Methods : The study sample included 2725 participants (age 60 years, mean age 72.7
years, 62% women) in the Swedish National Study on Aging and Care in the
Kungsholmen district of central Stockholm, Sweden, who were living either at their own
home or in institutions. Data on demographic features, CRFs, and CVDs were collected
through interview, clinical examination, self-reported history, laboratory tests, and
inpatient register. Mobility limitation was defined as walking speed <0.8 m/s. Data were
analyzed using multiple logistic models controlling for potential confounders.
Results : Of the 2725 participants, 581 (21.3%) had mobility limitation. The likelihood
of mobility limitation increased linearly with the increasing number of CRFs (i.e.,
hypertension, high C-reactive protein, obesity, diabetes and smoking) (p for linear
trend<0.010) and of CVDs (i.e., ischemic heart disease, atrial fibrillation, heart failure
and stroke) (p for linear trend<0.001). There were statistical interactions of aggregated
CRFs with age and APOE 4 allele on mobility limitation (p
interaction
<0.05), such that the
association of mobility limitation with aggregated CRFs was statistically evident only
among people aged <80 years and among carriers of the APOE 4 allele.
Conclusion : Aggregations of multiple CRFs and CVDs are associated with an increased
likelihood of mobility limitation among older adults; however the associations of CRFs
with mobility limitation vary by age and genetic susceptibility.

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Gejala Penyakit
Nyeri dada dengan perasaan berat, seperti ditindih,
dada seperti terbakar.
Gejala lain :
Nafas pendek
Palpitasi
Lemah, pusing
Nausea
Berkeringat
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Gejala pada Geriatri
Pasien geriatri memiliki gejala PJK yang atipikal dibanding pasien
yang lebih muda. Nyeri dada yang khas seringkali tidak
didapatkan melainkan yang sering dikeluhkan pernafasan yang
sedikit memberat, nyeri abdomen, fatigue, confusion, malaise
Gejala atipikal penatalaksanaan yang tidak sesuai dalam
medikasi, kateterisasi, dan mortalitas dan morbiditas meningkat
Worcester Heart Attack Study pasien > 75 years of age,
keterlambatan pre hospital, banyak diluar Golden Hour (6 jam)
untuk terapi fibrinolitik
Warning system impaired delay dalam gejala PJK
Delay prognosis lebih jelek
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Hazzards Geriatric Medicine and Gerontology, 6th ed.
TERIMA KASIH
5/30/2014 Aging of Cardiovascular System