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Cardiovascular ageing 

Cardiovascular ageing
Cardiovascular ageing

Shamsuddin Akhtar

and G. Alec Rooke

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date: 12 July 2020

This chapter comprehensively describes the physiological and pathophysiological changes in the cardiovascular system with ageing. The understanding of these changes is fundamental to the clinical care of all elderly patients. The causes of vascular ageing with increased wall stiffness and atherosclerosis are described, including vascular thickening, endothelial dysfunction, the inflammatory processes of atherosclerosis and arteriosclerosis, and vein remodelling. Cardiac ageing is then described in detail, including ventricular remodelling, fibrosis, excitation—contraction coupling dysfunction and valvular changes. Neuroendocrine changes, including those in the sympathetic and parasympathetic systems, as well as those affecting the renin–angiotensin system are explored. The consequences of these changes are summarized in the four stages of cardiovascular ageing. Finally, the outcomes from surgery and anaesthesia are reviewed. This includes appropriate monitoring, anaesthetic management, fluid therapy, the use of vasopressors, and the treatment of rhythm disorders.

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