Cardiovascular Changes in/of Old Age *

Although the causes of aging are still unknown, the effects of decrements in anatomic structure and physiologic function have led to wrong concepts and resulting discriminatory policies against old people. Cardiovascular changes are common among the aged but are not necessarily symptomatic; they may be the result of past illnesses or signs of diminished cardiac reserve. In many cases, a cardiac abnormality detected by our modern diagnostic hardware does not in itself constitute the necessity for treatment. Illustrative cases are cited. A rise in blood pressure with advanced age often is a sign of adaptation to the increased rigidity of the arterial system. Certain heart murmurs mimicking mitral insufficiency may indicate slight papillary muscle dysfunction or a clinically insignificant degree of mitral valve prolapse. On the other hand, the changing clinical status in old age may involve a diminution of symptoms. Therefore, in geriatric medicine, the physician should be on the alert for aberrant manifestations, e.g., painless myocardial infarction or atypical pulmonary embolism. Psychologic evaluation is important. There is no cardiac disorder which is typical for the older age group, but also there is none from which older people are exempt.