Interpreting Echocardiographic Changes - #24
Take QuizLearn practical interpretations of echocardiographic changes.
Changes occurring in the aging heart can be broadly categorized into the following categories: myocardial, valvular, conduction, and hemodynamic. Echocardiography can demonstrate changes in the myocardium as well as valvular changes, which in turn may have implications on overall hemodynamics. Echocardiography is a non-invasive test that may help to determine treatment of any current conditions as well as provide information regarding overall cardiac morbidity and mortality.
| Myocardial Changes with Age: | Echocardiographic Findings: | ||
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Left ventricular hypertrophy: Thickening of the myocardium (muscle) of the left ventricle ↓ |
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| Decreased left ventricular end diastolic volume | |||
| Amyloid deposition (up to 50% of individuals >70 years) |
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May show NO echocardiographic changes and NO functional loss | |
| Parameter | Echocardiographic Change with Age | |||
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Valvular Changes with Age:
The valvular apparatus gradually degenerates and dilates with age. The most common areas affected are the aortic and mitral valves and the papillary muscles.
With echocardiography in the elderly, one can see calcific deposits in the following areas:
- Aortic valve cusps (47% of those aged 80-90 years)
- Mitral annulus (39%)
- Left ventricular papillary muscles (25%)
Causing:
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Impaired mobility of the individual aortic cusps
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Calcific aortic stenosis
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Mitral stenosis
Which lead to:
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Systolic heart failure
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Need for surgery or more invasive procedures
Implications on Morbidity and Mortality:
Increased left ventricular mass has been associated with increased mortality. Concentric hypertrophy has increased mortality in the elderly as compared with normal or eccentric hypertrophy.
Decreased ejection fraction has been found to be an independent predictor of 5-year mortality, further supporting that normative aging is associated with a preserved EF.
Diastolic dysfunction (severe) has been shown to be a predictor of mortality in a hospitalized cohort of the very elderly (mean age 86 yrs).
Elderly patient seen in an outpatient or inpatient setting, and an echo has been obtained or will be obtained.
Determine significance of echocardiographic changes in an aging heart. What is normal, and what is not normal aging of the heart?
Cardiovascular disease is both the most frequent diagnosis and the leading cause of death in adults older than 65 years. Hypertension occurs in one half to two thirds of people older than 65 years, and heart failure is the most frequent hospital discharge diagnosis among older Americans. More than 80% of deaths attributable to cardiovascular disease occur in people over 65 years. Normal cardiac aging, as well as many cardiovascular disease conditions, may be diagnosed through changes seen on echocardiography (See reference 1).
- List the echocardiographic changes that occur in the aging heart.
- Describe how these changes are reflected in echocardiographic parameters.
- Explain the implications of echocardiographic changes to morbidity and mortality.
Review of Systems (ROS)
Geriatric Topics
ACGME Compentencies
Science Principles
- Leibowitz D, Gilon D. Echocardiography and the Aging Heart. Current Cardiovascular Imaging Reports 2012; 5(6):501-506.
- Brocklehurst’s textbook of geriatric medicine and gerontology. Philadelphia, PA: Saunders/Elsevier. 2010.
- Shioi T, Inuzuka Y. Aging as a substrate for heart failure. J Cardiol 2012; 60(6): 423-8.
- Pugh K, Wei J. Clinical Implications of Physiological Changes in the Aging Heart. Drugs & Aging 2001; 18(4):263-76.
Users are free to download and distribute Geriatric Fast Facts for informational, educational, and research purposes only. Citation: Nicholas Dreger, Guru Krishnan, Kathryn Denson, Catharine Malmsten, Fast Fact #24: Interpreting Echocardiographic Changes of an Aging Heart, March, 2013.
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