SPECIFIC HEART PROBLEMS IN ELDERLY (Old age)
ENDOCARDITIS
Infective endocarditis is more common among the elderly. More than a quarter of all cases occur in people 60 years. The prevalence has increased because the number of elderly and those with artificial valves increased nosocomial bacteremia has become more widespread, and people suffering from valvular heart disease survive longer. infective endocarditis affecting eight times as many older men, older women.
Underlying cardiac lesions that predispose elderly endocarditis usually differ from those of younger patients. Mitral annular calcification or aortic insufficiency is more prevalent with the elderly, and congenital heart defects are more common in younger subjects. increased atherosclerosis in the elderly may be a factor, because the atheromatous deposits in the valves may cause turbulence, which is endothelial damage and thrombus formation. About 30% of elderly patients with rheumatic endocarditis is damaged, about 25% of calcified valves, and about 5% of mitral valve prolapse, but about 40% are unknown or valvular lesions. Any valvular heart disease increases endocarditis.
Antibiotic prophylaxis is indicated in elderly patients with valvular heart disease, especially in patients with prosthetic heart valves or calcified, especially before procedures. The optimal treatment requires the use of microbicides drugs. For critically ill patients, empirical therapy should start immediately after obtaining blood cultures, as valvular heart disease may be limited. Initially, the choice of antibiotic is based on micro-organism is more likely in the specific clinical context. If the onset is subacute in patients who use intravenous drugs and has a native valve endocarditis, infection with streptococci or enterococci is likely. The standard treatment is empirically high doses of IV penicillin G (or ampicillin) with an aminoglycoside such as gentamicin. If the onset is acute or if the patient is using drugs intravenously, the treatment should target S. aureus.
If the first is acute or if the patient used drugs IV, treatment should be subjected to S. aureus. If the first is an acute patient does not use IV drugs and who is a native valve endocarditis, penicillinase-resistant penicillin (eg nafcillin) or a cephalosporin (eg cefazolin) is appropriate as initial therapy. If the patient is a prosthetic valve, vancomycin-resistant strains can be addressed to S. aureus and S. epidermidis. After the micro-infected have been identified, antimicrobial therapy should be amended accordingly, that the more effective, less toxic and less expensive treatment . Treatment should be continued for at least 2 weeks longer than patients with prosthetic valves.
In some patients with infective endocarditis with valve replacement. Indications for valve replacement is due to the deterioration of blood flow to valve dysfunction, fungal endocarditis, during infection despite appropriate antimicrobial therapy, repeated relapses at the end of the beginning of treatment or surgery complicated by valve endocarditis prosthetic extension extravalvular infection and recurrent emboli.
ENDOCARDITIS
Infective endocarditis is more common among the elderly. More than a quarter of all cases occur in people 60 years. The prevalence has increased because the number of elderly and those with artificial valves increased nosocomial bacteremia has become more widespread, and people suffering from valvular heart disease survive longer. infective endocarditis affecting eight times as many older men, older women.
Underlying cardiac lesions that predispose elderly endocarditis usually differ from those of younger patients. Mitral annular calcification or aortic insufficiency is more prevalent with the elderly, and congenital heart defects are more common in younger subjects. increased atherosclerosis in the elderly may be a factor, because the atheromatous deposits in the valves may cause turbulence, which is endothelial damage and thrombus formation. About 30% of elderly patients with rheumatic endocarditis is damaged, about 25% of calcified valves, and about 5% of mitral valve prolapse, but about 40% are unknown or valvular lesions. Any valvular heart disease increases endocarditis.
Antibiotic prophylaxis is indicated in elderly patients with valvular heart disease, especially in patients with prosthetic heart valves or calcified, especially before procedures. The optimal treatment requires the use of microbicides drugs. For critically ill patients, empirical therapy should start immediately after obtaining blood cultures, as valvular heart disease may be limited. Initially, the choice of antibiotic is based on micro-organism is more likely in the specific clinical context. If the onset is subacute in patients who use intravenous drugs and has a native valve endocarditis, infection with streptococci or enterococci is likely. The standard treatment is empirically high doses of IV penicillin G (or ampicillin) with an aminoglycoside such as gentamicin. If the onset is acute or if the patient is using drugs intravenously, the treatment should target S. aureus.
If the first is acute or if the patient used drugs IV, treatment should be subjected to S. aureus. If the first is an acute patient does not use IV drugs and who is a native valve endocarditis, penicillinase-resistant penicillin (eg nafcillin) or a cephalosporin (eg cefazolin) is appropriate as initial therapy. If the patient is a prosthetic valve, vancomycin-resistant strains can be addressed to S. aureus and S. epidermidis. After the micro-infected have been identified, antimicrobial therapy should be amended accordingly, that the more effective, less toxic and less expensive treatment . Treatment should be continued for at least 2 weeks longer than patients with prosthetic valves.
In some patients with infective endocarditis with valve replacement. Indications for valve replacement is due to the deterioration of blood flow to valve dysfunction, fungal endocarditis, during infection despite appropriate antimicrobial therapy, repeated relapses at the end of the beginning of treatment or surgery complicated by valve endocarditis prosthetic extension extravalvular infection and recurrent emboli.
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