Geriatric cardiomyopathy

Introduction to senile cardiomyopathy Senile cardiomyopathy (senilecardiomyopathy) is a degenerative disease of unexplained myocardium in the aging process of the elderly. It is an important cause of heart failure in the elderly and one of the diseases that cause death in the elderly. basic knowledge Proportion of the disease: the incidence rate is 0.06520% in elderly patients Susceptible people: the elderly Mode of infection: non-infectious Complications: arrhythmia heart failure

Causes of senile cardiomyopathy

(1) Causes of the disease

With the increase of age, the elderly patients with coronary atherosclerotic heart disease and hypertensive heart disease also increased, and their incidence is significantly increased. They are a common cause of chronic heart failure in the elderly, but not old. In the category of human cardiomyopathy, myocardial diffuse fibrosis and myocardial fibrotic degeneration may be major factors in chronic heart failure in elderly patients with cardiomyopathy.

(two) pathogenesis

1. Afterload:

The post-load is the resistance of the systolic bloodshot, which depends mainly on the state of the arterial system and hemodynamics. As the age increases, the changes in the structure of the arterial wall of the arteries include the loss and destruction of the elastic tissue in the middle of the blood vessels. Calcium deposition in the vessel wall, changes in the amount and composition of collagen in the wall, and changes in the structure of these vessels can increase the afterload. This is one of the main causes of cardiovascular structure and physiological changes in the elderly. There are two indicators that reflect the heart. In the case of post-load, the former is called peripheral vascular resistance (PVR), which is the mean blood flow resistance. It is measured by the average cardiac output and pressure. The latter is called the characteristic vascular impedance (CVI). It is the resistance of blood flow during pulsation, which is measured by the time change of intra-aortic pressure and blood flow.

2. Front load:

Preload refers to endocardial endocardial blood volume, increased ventricular end-diastolic blood volume, sarcomere extension, increased sensitivity of contractile protein to calcium, and increased contractility, which is the basis of the ventricular contraction curve, consistent with Frank-Starling's law. Myocardial contractile strength is closely related to ventricular end-diastolic blood volume. Radionuclide imaging and echocardiographic data show that there is no significant difference in ventricular volume between the elderly and young people at rest, indicating that the preload does not change with age at rest. Although the preload in the resting state is unchanged, the diastolic filling changes with age, mainly myocardial structure and biochemical changes, ventricular wall stiffness increases, ventricular compliance decreases, early diastolic filling is limited, data show that 20 ~ 80 The early filling of diastolic dilation is reduced by 50%. The rate of active relaxation during initial diastolic and diastolic contraction determines the degree of early diastolic filling. Aortic dilation occurs in the isovolumic diastolic phase, which is a process of energy demand, contractile protein, myosin and Myofibin position recovery, at this stage, the cytoplasmic calcium concentration is reduced, calcium and troponin are separated Prevent further interaction between myosin and actin, diastolic, animal studies demonstrate the following points:

1 Long-term exercise can reverse the excitatory contraction coupling and cause related cell changes without relying on myocardial weight changes;

2 In the young rats with experimentally induced cardiac hypertrophy, even more than the degree of cardiac hypertrophy in the elderly, the contraction and diastolic duration are not prolonged because there is no change in myocardial myosin ATPase V1 to V3;

3 There are similar cell changes in the right ventricular papillary muscle of aged rats without cardiac hypertrophy. From the above results, it is concluded that the excitatory coupling changes are not related to ventricular hypertrophy. The data suggest that aging may be independent of cardiac hypertrophy, leading to excitatory contraction coupling. The main factors of joint change, other factors, such as long-term exercise can also regulate the mechanism of excitatory contraction coupling in the elderly.

Elderly cardiomyopathy prevention

1. Physical exercise can improve the physiological function of the elderly cardiovascular system. The long-term physical exercise of the elderly increases the maximum oxygen intake by 30%, the cardiac output increases, the heart rate, vascular resistance and blood pressure decrease, and the cardiac reserve function increases. Older people should be encouraged to participate in tolerable physical activities, which have a greater effect on the prevention and treatment of senile cardiomyopathy.

2. Preoperative evaluation of elderly patients should consider the existence of senile cardiomyopathy. During the operation, postoperative cardiac monitoring should be strengthened, and early cardiac dysfunction should be identified and effectively treated.

3. For the elderly infusion, the blood transfusion rate should be slow to prevent the occurrence of senile cardiac insufficiency.

Elderly cardiomyopathy Complications arrhythmia heart failure

There may be complications such as arrhythmia and heart failure.

Symptoms of senile cardiomyopathy Common symptoms Heart palpitations Short heart failure Arrhythmia Diffuse steatosis Hypertension Heart sounds Weak heart enlargement Hyperthermia

1. Elderly cardiomyopathy has a long course of disease, which can be relatively stable for many years, and then recurrent chronic heart failure for several years or more. Once severe heart failure occurs, the prognosis is poor. When the elderly have unexplained heart failure, check whether Other causes (such as hypertension, ischemic heart disease, valvular disease, etc.) should be considered, and the possibility of senile cardiomyopathy should be considered. The most common clinical manifestations are decreased cardiac reserve function and cardiac insufficiency, simply due to senile cardiomyopathy. Heart failure may be uncommon. Often under stressful conditions such as hyperthyroidism, anemia, surgery, infection, fatigue, and excessive heat, there may be clinical manifestations of cardiac insufficiency. The most important manifestation of senile cardiomyopathy is potential. Cardiac dysfunction, under normal conditions, severe cardiac insufficiency or heart failure is not obvious, often in the infection, infusion speed and overwork when induced heart failure, senile cardiomyopathy often combined with other heart disease, such as merger In valvular heart disease, hypertension, and ischemic heart disease, hemodynamic abnormalities, clinical symptoms sometimes Single cardiomyopathy is more likely to manifest. Older cardiomyopathy patients have more severe cardiac dysfunction than younger patients. There is no uniform specific diagnostic criteria for elderly cardiomyopathy, and other organic heart disease is often excluded to establish a diagnosis.

2. Symptoms and signs of senile cardiomyopathy are similar to dilated cardiomyopathy. Jiang has proposed the diagnostic criteria for senile dilated cardiomyopathy. It can be used as reference: 1. Age > 60 years old, 2. Post-activity palpitations, shortness of breath, clinical intention Incomplete performance (heart function NYHA-II, III).

3. Physical examination, X-ray and UCG have heart enlargement, heart/chest ratio>0.55, 4. Cardiac auscultation first heart sound is weakened, pathological S3, S4, 5. History of syncope or arterial embolism, 6. Heart rhythm Abnormal, and diversity, variability, myocardial damage, abnormal Q wave, 7. Exclude other organic heart disease and secondary heart disease.

Examination of senile cardiomyopathy

Corresponding laboratory examination changes involving other geriatric conditions may occur.

1. X-ray and echocardiography: visible heart shadow increased, chest ratio > 0.55.

2. Electrocardiogram: There may be ST-T changes and abnormal Q waves.

Diagnosis and diagnosis of senile cardiomyopathy

Elderly cardiomyopathy should be differentiated from coronary heart disease, rheumatic heart disease, and senile amyloidosis.

Coronary heart disease

In patients with severe coronary heart disease, the degree of myocardial ischemia is obvious. There are multiple myocardial infarction areas or extensive myocardial fibrosis. The heart enlargement of each compartment is accompanied by chronic cardiac insufficiency. The performance is similar to that of elderly cardiomyopathy, but coronary heart disease has typical angina symptoms. There is a clear history of myocardial infarction; echocardiography shows myocardial segmental motor attenuated or reversed motion; coronary angiography and radionuclide examination are helpful in differential diagnosis.

2. Rheumatic heart disease

Most of them are characterized by mitral stenosis, with characteristic mitral diastolic rumbling-like murmurs. Echocardiography has characteristic mitral stenosis and is generally easy to identify.

3. Senile cardiac amyloidosis

For focal depositional lesions, clinically common and not harmful, a few critically ill patients, systolic, diastolic dysfunction, orthostatic hypotension, multiple arrhythmias, abnormal electrocardiogram Q wave, congestive heart failure, sometimes Confused with senile cardiomyopathy, but the heart muscle hypertrophy does not significantly expand, two-dimensional echocardiography can see the appearance of "small spots", which is helpful for differential diagnosis.

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