aging of cardiovascular system.pdf

8/11/2019 Aging of Cardiovascular System.pdf

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ProsesAging

A maturational process that includes a series of

genetically programmed events that are influenced by

external factors

Kemajuan medisusia harapan hidup bertambah

Peran PMR mempertahankan dan restorasi fungsi dari

pasien yang sudah menua

5/30/2014Aging of Cardiovascular System

Downey, Darling;Physiological Basis of Rehabilitation Medicine,3rd ed.New York;2001


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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


Downey, Darling;Physiological Basis of Rehabilitation Medicine,3rd ed.New York;2001


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5/16

Carotid barochemoreceptor pathological findings

regarding carotid plaque status and aging

Jos Milei, MD PhD,1Anna M Lavezzi, MD PhD,2Barbara Bruni,MD,2Daniel R Grana, VMD,1Francisco Azzato, MD,1and Luigi Matturri,

MD PhD

2

METHODS:

Patients (n=23) who had suffered and died from stroke, with and withoutcomplicated 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. Afocal decrease in vascularization (CD34-positive) of the glomus (greater than50%) 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. Nostatistical differences were demonstrated in the pathological findings of thecarotid glomus when comparing complicated with noncomplicated plaques orage groups.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Milei%20J[auth]http://www.ncbi.nlm.nih.gov/pubmed/?term=Lavezzi%20AM[auth]http://www.ncbi.nlm.nih.gov/pubmed/?term=Bruni%20B[auth]http://www.ncbi.nlm.nih.gov/pubmed/?term=Grana%20DR[auth]http://www.ncbi.nlm.nih.gov/pubmed/?term=Azzato%20F[auth]http://www.ncbi.nlm.nih.gov/pubmed/?term=Matturri%20L[auth]http://www.ncbi.nlm.nih.gov/pubmed/?term=Matturri%20L[auth]http://www.ncbi.nlm.nih.gov/pubmed/?term=Azzato%20F[auth]http://www.ncbi.nlm.nih.gov/pubmed/?term=Grana%20DR[auth]http://www.ncbi.nlm.nih.gov/pubmed/?term=Bruni%20B[auth]http://www.ncbi.nlm.nih.gov/pubmed/?term=Lavezzi%20AM[auth]http://www.ncbi.nlm.nih.gov/pubmed/?term=Milei%20J[auth]


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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 akibatAgingpada

Aorta dan ArteriPenebalan fibrous yang progresifpada tunika intima

Fibrosis dan timbulnya skar padaotot atau elastic media

Bertumpuknya substansi yangkaya mukopolisakarida

Fragmentasi pada elastik lamina

Efek dari perubahan ini =kekuatandan elastisitas dinding pembuluh

darah.

Dilatasi progresif merupakan fenomenapenuaan pada aorta dan pembuluhdarah koroner.


Underwood and Cross;General and Systemic pathology 5th ed;2009


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Penyakit Jantung Koroner (1)

Penyakit jantung koroner = penyakit yangdisebabkan kegagalan arteri koroner untukmenyuplai darah ke otot jantung sehinggakebutuhan O2 tidak terpenuhi.

Penyakit jantung koroner terjadi karena adanya

penyempitan/penyumbatan di dinding arterikoroner .

Penyakit jantung koroner bisa menyebabkaniskemik miokard yang bisa menyebabkan infarkmiokard.

Penyakit multifaktorial yg dipengaruhi olehproses aging intrinsik, faktor lingkungan dangenetik.



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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-obatantertentu (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,1Elisabeth Rydwik,1,3LauraFratiglioni,1,4andChengxuan Qiu1,*

Background : Cardiovascular risk factors (CRFs) such as smoking and diabetes have

been associated with mobility limitations among older adults. We seek to examine towhat extent individual and aggregated CRFs and cardiovascular diseases (CVDs) areassociated with mobility limitation.

Methods : The study sample included 2725 participants (age 60 years, mean age 72.7years, 62% women) in the Swedish National Study on Aging and Care in theKungsholmen district of central Stockholm, Sweden, who were living either at their ownhome or in institutions. Data on demographic features, CRFs, and CVDs were collected

through interview, clinical examination, self-reported history, laboratory tests, andinpatient register. Mobility limitation was defined as walking speed


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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 pasienyang lebih muda. Nyeri dada yang khas seringkali tidakdidapatkan melainkan yang sering dikeluhkan pernafasan yangsedikit memberat, nyeri abdomen, fatigue, confusion, malaise

Gejala atipikal

penatalaksanaan yang tidak sesuai dalammedikasi, kateterisasi, dan mortalitas dan morbiditas meningkat

Worcester Heart Attack Studypasien > 75 years of age,keterlambatanpre hospital, banyak diluar Golden Hour (6 jam)untuk terapi fibrinolitik

Warning system impaireddelay dalam gejala PJK

Delay prognosis lebih jelek


Hazzards Geriatric Medicine and Gerontology, 6th ed.


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TERIMA KASIH


aging of cardiovascular system.pdf

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