Question 12

 Describe the effects of ageing on the cardiovascular system.

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College Answer

The physiological changes associated with ageing are well described in the major texts although candidates do need to assimilate this information from a number of sources. Core components of the answer templates that were frequently missed included those of; concentric hypertrophy and its effects on afterload, as well as the difference between compliance, elastance, elasticity, elastin and collagen and how ageing affects these elements. A template using broad headings such as the effects on the heart/myocardium, the vasculature, the autonomic nervous system, the conduction system and perhaps epithelial function would be a good starting point when constructing an answer to this question. The examiners noted that several candidates wrote at length about various pathologies that increase in incidence with ageing which does not adequately address the core of the question. 


  • Structural changes:
    • Myocardial:
      • LV hypertrophy
      • Interventricular septal hypetrophy
      • LVOT narrowing
      • Valvular sclerosis
      • Degeneration of sympethetic innervation
    • Vascular:
      • Dilation of aorta and large arteries
      • Thickening of arterial walls
      • Decreased windkessel effect
  • Functional changes:
    • Myocardial:
      • Increased systolic function
      • Decreased diastolic function
      • Increased atrial diastolic contribution (atrial "kick")
      • Decreased cardiac output (by 1% per year)
      • Decreased maximal heart rate
      • Increased cardiac workload (due to afterload increase)
      • Blunted baroreceptor reflexes
    • Electrophysiological:
      • SA node atrophy
      • Conductive tissue loss
      • Action potential prolongation
    • Vascular:
      • ​​​​​​​Decreased arterial compliance
      • Decreased endothelial NO-mediated vasodilatory function
      • Systolic blood pressure increases
      • Pulse pressure increases (diastolic pressure increases less than systolic)
      • Pulmonary arterial pressure increases
    • Neurohormonal:
      • ​​​​​​​Increased ANP secretion
      • Increased circulating catecholamine levels
      • Decreased  renin, angiotensin and aldosterone concentrations


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