Diseases of the elderly
In old age, the following diseases are more common.
Hypertension - is a stable increase in blood pressure above 140/90 mm Hg.Art.The development of hypertension leading role played by genetic factors and environmental factors.External risk factors include: age over 55 years for men, over the age of 65 years for women, smoking, increased cholesterol levels above 6.5 mmol / l, adverse family history of cardiovascular disease, microalbuminuria (with concomitant diabetes), sensitivity to the disorderglucose, obesity, high fibrinogen, inactive lifestyle, high ethnic, socio-economic, geographic risk.
In old age, hypertension occurs more frequently as a result of atherosclerotic lesions of blood vessels (most commonly affects the aorta, coronary arteries, cerebral arteries).
Allocate atherosclerotic hypertension - a hypertension in elderly patients, in which mostly increases systolic blood pressure and diastolic blood remains at a normal level, which leads to a large difference between systolic and diast
The classification of hypertension emit 111 degree high blood pressure.
I degree: blood pressure numbers 140-159 / 90 to 99 mm Hg.Art.
II degree: blood pressure numbers 160-179 / 100- 109 mm Hg.Art.
III degree: blood pressure numbers above 180 / 110mm Hg.Art.
With increase in blood pressure of patients with disturbed headache, dizziness, may be noise in the ears, flashing "flies" in front of his eyes.However, it should be noted that the severe headache accompanied by dizziness, nausea, tinnitus, observed in a significant increase in blood pressure numbers and can be a manifestation of a hypertensive crisis.Also, patients may disturb frequent palpitations (usually sinus tachycardia), Diverse pain in the heart.
in elderly hypertensive patients with atherosclerotic objective symptoms, such as headache, dizziness, can not be detected.Basically complaints come at a significant increase in blood pressure numbers.
Often patients are elderly do not experience unpleasant symptoms in a significant increase in blood pressure numbers, patients can feel good about themselves and blood pressure of 200 and 110 mm Hg.Art.Diagnosis of hypertension in such patients is often made with a random identification of high blood pressure (when the medical examination, hospitalization with other disease).Many of them believe that the absence of discomfort at high pressures suggests benign course of the disease.This belief is fundamentally wrong.Such latent (hidden) for hypertension leads to the fact that people are not experiencing painful, painful symptoms, has no motivation examined and treated, as a result of antihypertensive therapy in such patients are starting to be delayed or not done at all.Now it is proved that the risk of vascular events (myocardial infarction, acute stroke, thromboembolism) in these patients is much higher than that of people with normal blood pressure numbers.
Features of measuring blood pressure in elderly patients: the elderly can be expressed by a thickening of the wall of the brachial artery in connection with the development of atherosclerosis in it.It is therefore necessary to establish a cuff pressure higher level of compression sclerosed artery.As a result, there is falsely elevated blood pressure numbers, the so-called psevdogipertenziya.
psevdogipertenzii phenomenon detected reception Osler, for that blood pressure is measured at the brachial artery palpatory and auscultatory method.If the difference in this case more than 15 mm Hg.Art., then psevdogipertenzii phenomenon confirmed.The true blood pressure in these patients can only be measured by invasive.
also in elderly people may experience orthostatic hypotension, so the blood pressure have to be measured in the supine position.
Hypertension requires constant treatment, regular intake of medicines.Patients with hypertension in the first place shows the active motor mode, a balanced diet, compliance with work and rest, control of body weight, avoiding alcohol, smoking.Consumption of salt per day is not more than 4-6 g
in the treatment of hypertension using various groups of drugs, mostly ACE inhibitors (captopril, enalapril, prestarium, lozinopril), diuretics (hydrochlorothiazide, furosemide, indapamide), beta-blockers (atenolol, propranolol, egilok, Concor), diuretics (furosemide, hydrochlorothiazide, indapamide), sedatives (valerian, passifit, afobazol).Often, a combination of these groups of drugs.Arterial hypertension in elderly patients is prolonged, but benign than hypertension at a young age.
Angina is one of the most common forms of ischemic heart disease.The main feature is the typical pain of angina - is pressing, constricting chest pain that occurs when small physical exercise (walking at 200-1000 m, depending on the functional class), docked at rest or sublingual nitroglycerin in 3-5 minutes.This pain may radiate to left shoulder blade, shoulder, jaw.Such coronary pain occurs when insufficient flow of oxygen to the heart muscle when the need for it is increased (for example, during physical exertion, emotional overvoltage).The attack of angina may also occur when walking in cold windy weather or drinking cold drink.Typically, the patient knows that, when a load occurs angina: how far he can go on a floor up.Such patients should always carry nitratsoderzhaschie drugs.
should be remembered as the so-called unstable angina, in which the attack of chest pain can dramatically change your character: decrease the distance that a patient can pass without pain, stop working before the effective nitroglycerin or have to increase the dose in order to stop the pain.The most dangerous, when the pains begin to appear during the night.Unstable angina is always regarded as a preceding infarction condition, and a patient requires immediate hospitalization.When expressed pain syndrome, the patient must be given nitroglycerin under the tongue, it is not necessary to give the patient several tablets or giving them continuously: 1-2 should be given a tablet, wait for 10-15 minutes, then another, to wait again 10 to 15 minutes, and so on.d.Large doses of nitroglycerin can be given only by controlling blood pressure - it should not be reduced.
angina for a long, inadequate treatment or lack of it may subsequently lead to the development of heart failure, myocardial infarction.
should know that not all the pain in the heart may be anginal origin.Most elderly patients the prevalence of pain on the left of the sternum, bearing constant, aching in nature, aggravated by certain movements.When probing along the ribs or spine can reveal painful points.Such pains are typical for osteochondrosis, intercostal neuralgia, myositis.Sometimes they are aggravated against the background of colds.Such pains are well treated by NSAIDs (such as diclofenac, ibuprofen).Sometimes the chest pain occur after a hearty meal after poevshy went to bed.Such pain can occur as a result of abdominal distention (Remgelta syndrome) and associated diaphragm tension.Also in the elderly it is quite common diaphragmatic hernia when expanding hiatal and horizontal portion of the stomach moves into the chest cavity.There are pains that are held in a vertical position.Sick of the pain can sleep half-sitting.
Women in menopause, along with typical symptoms such as feeling hot flushes to the face, a feeling of pins and needles on the extremities, feeling of anxiety, unmotivated bouts of shivering, may also occur Diverse pain in the heart.Usually, they are not related to physical activity, but on the contrary, tend to occur at rest, can be confusing for quite a long time, the clock does not run.Remove these pains usually help valokordin, Corvalol, valerian, while nitroglycerin to them has no effect.
angina Treatment generally involves taking a group of drugs such as nitrates.For nitrates include nitroglycerin, nitrosorbid, Erin.Taking these drugs can cause a severe headache, to reduce this unpleasant side effect of nitrates taken in conjunction with validol.Also used for the treatment of drugs that reduce cholesterol - statins (which include Vasilip, atorvastatin), drugs that reduce blood viscosity, - anticoagulants (aspirin, tromboass, cardiomagnil).
Heart failure - a pathological condition caused by weakness of the contractile activity of the heart and the failure to provide adequate circulation.Heart failure - this is usually a secondary condition, complicating the primary heart failure, blood vessels or other organs.The causes of heart failure are the following diseases: coronary heart disease, malformations of the heart, hypertension, myocarditis, degenerative changes infarction, cardiomyopathy, diffuse lung disease.
the initial stages of heart failure, the heart's ability to impaired relaxation occurs diastolic dysfunction, left ventricular chamber is filled with blood is less, which reduces the volume of blood ejected ventricle.However, to cope alone heart, blood volume compensates needs.During the exercise, when the heart rate increases, the total emission of blood is reduced, and the body begins anoxia, and the patient has weakness, shortness of breath with any exertion.Heart failure is characterized by a decrease in the patient's tolerability to the usual exercise.
There are acute and chronic heart failure.
acute left ventricular failure develops in the load on the left ventricle (this may result in hypertension, aortic defects, myocardial infarction) and in the presence of a provoking factor, such as physical and emotional stress, infection.
Clinically, acute left ventricular failure manifested in the form of cardiac asthma or pulmonary edema.
Cardiac asthma develops acutely manifested increasing shortness of breath, feeling short of breath, choking.In addition to these symptoms may appear cough with expectoration of sputum first light, then it may appear in the blood veins.Auscultation of the lungs auscultated hard breathing, in the lower parts - wet finely wheezing.The patient is sitting up in bed with your pants down feet - this situation facilitates the patient's condition as a result of unloading maloyu circulation.In the absence of treatment and progression of the disease may develop pulmonary edema.
pulmonary edema can develop not only in left ventricular failure, but also in pneumonia, the appearance of foreign bodies in the bronchi, a sharp decrease in atmospheric pressure.Pulmonary edema - an acute condition that requires emergency treatment, since symptoms are developing so rapidly that an unfavorable outcome can occur quite quickly.Suddenly, often at night, against the background of angina attacks in patients there is a sharp shortness of breath (up to suffocation), there is a dry cough, which is quickly replaced with a wet branch frothy bloody sputum.The patient takes a forced semi-sitting or sitting position, legs down, resting his hands on the bed, a chair, breathing support muscles involved.There comes a general excitement, a sense of fear of death.The skin becomes cyanotic.In the light of all the fields auscultated wet variegated wheezing, respiratory rate increases to 40-45 breaths per minute.
flow pulmonary edema is always difficult, the prognosis is very serious.Even with positive results in the treatment of relapse is always possible condition.
in the treatment of acute left ventricular failure is used sublingual nitroglycerin tablets 10 mg every 10 minutes, mandatory control of blood pressure, intravenous narcotic analgesics (1-2 ml of 1% morphine), intravenous diuretics (2,0-8,0 ml of 1% solution of furosemide), cardiac glycosides intravenous, administration is preferable strofantina Korglikon or in small doses (0.25-0.5 ml of 0.05% solution), combining them with drugs potassium and magnesium for improvedmetabolism in the myocardium.
Chronic heart failure develops slowly, often it causes are hypertension, coronary artery disease, aortic defects.
Clinic chronic heart failure has three stages.
When I stage is dominated by the common symptoms: weakness, fatigue, increase in shortness of breath, quickened heart rate during physical activity.At times, you may receive akrotsianoz.Dimensions of the liver does not change.All these phenomena are alone after the cessation of exercise.
In stage II symptoms begin to occur even at less exertion: increased dyspnea, tachycardia increases, there may be a dry cough.There are local symptoms (akrotsianoz), lower limb swelling are observed, which do not pass in the morning, after the swelling may increase (up to the development of hydrops - the presence of fluid in the cavities of all: ascites, hydrothorax, hydropericardium).The liver increases in size, becomes dense.In the lungs auscultated wet finely wheezing.When the state of decompensation, patients are forced position: sit in bed with your pants down.
In stage III (final, dystrophic) against total pronounced congestive failure develop severe irreversible changes in the internal organs in violation of their function and decompensation.Develop renal, hepatic insufficiency.
Drug-free treatment is to limit physical activity, correction of water-electrolyte metabolism.Needed bed rest and the restriction of fluid intake and salt.Consideration should be given daily diuresis, the patient should keep a diary account of the number of drunk and allocated liquid.In determining the amount of fluid you drink per day, it is necessary to consider in all the patients received the products.
When medication is necessary:
• treat the underlying disease that led to heart failure (etiological treatment);
• strengthen reduced left ventricular function (cardiac glycosides);
• reduce the increased blood volume (diuretics, vasodilators);
• eliminate or reduce peripheral edema and congestion in the viscera (diuretics);
• lower blood pressure (ACE inhibitors);
• lower heart rate (beta-blockers, cardiac glycosides, verapamil);
• improve the metabolic processes in the myocardium, enhancing its contractility (drugs potassium, magnesium, Riboxinum).
Among all rhythm disorders, especially common in the elderly, there are atrial fibrillation and complete blockade of the cardiac conduction system.These two arrhythmias are dangerous and can lead to serious complications, which in turn can lead to death.