HEART PROBLEMS IN ELDERLY - LEV'S DISEASE , CAROTID SINUS HYPERSENSITIVITY , ATRIAL FIBRILLATION

SPECIFIC HEART PROBLEMS IN THE ELDERLY . 

LEV'S DISEASE IN ELDERLY .

Lev disease, or illness Lenegre Lev, is a branch block with normal heart and normal coronary arteries due to fibrosis or calcification in the heart conduction system. It affects the membranous septum, the apex of the diaphragm and, often, mitral valve disease and aortic rings.1 Lev is most commonly seen in older people, and is often described as the conduct of senile degeneration système .

Disruption of His - Purkinje conduction fibrosis and calcification is more frequent in the former given that Lev disease.It with Stokes - Adams attacks and must be treated after a pacemaker inserted. Age is not an indication for the cons-rate, even when the most advanced equipment used physiologically. Pacemakers should be prescribed at similar criteria in young and old.

CAROTID SINUS HYPERSENSITIVITY ..
Carotid sinus hypersensitivity (CSH) is an overreaction to stimulation of carotid sinus baroreceptors. This results in dizziness or fainting transient cerebral perfusion decreased. While the role of baroreceptors generally decreases with age, some people feel a carotid baroreflex sensitivity. For these people, even a slight stimulation of the neck results in a marked bradycardia and a fall in blood pressure. CSH affects mainly older men. It is a powerful contributing factor and a potentially treatable cause of unexplained falls and episodes of neurocardiogenic syncope in the elderly people.However, CSH is often overlooked in the differential diagnosis of syncope. CSH, orthostatic hypotension, vasovagal syncope are common conditions that may coexist in patients with syncope and falls.

Carotid sinus reflex plays a central role in the homeostasis of blood pressure. Changes in transmural pressure baroreceptors and stretch out the heart, carotid sinus, aortic and other large vessels. afferent impulses to provide the carotid sinus, glossopharyngeal, vagus nerve and nucleus tractus solitarius and para median is the nucleus of the brainstem. efferent limbs through the vagus and sympathetic nerves in the heart and blood vessels, control of heart rate and vasomotor tone.

Management of carotid sinus hypersensitivity (CSH) is based on the frequency, severity and consequences of the symptoms of each patient. Most patients can be treated with education, lifestyle changes, waiting, and routine monitoring. One of the few people who have recurrent disabling symptoms and may need the following ways: it is used to treat recurrent pharmacotherapy, symptomatic conditions. However, none of the agents was found to create long-term efficacy of large randomized controlled trial. Permanent pacemaker implantation in general, an effective treatment for cardioinhibitory CSH and mixed forms of CSH. maintaining the volume can be monitored in the form of CSH vasodilator prevention of syncopal episodes, maintaining an adequate number of stations. Individuals without a second heart would be to increase salt intake and drink more fluids containing electrolytes.

Surgical and radiological denervation denervation of the carotid sinus nerve were the techniques used previously, but have been largely abandoned due to high rate of complications. Surgery is an option for a patient with a neck tumor is compressing the carotid sinus. 

Although a variety of pharmacological agents were used empirically to treat recurrent CSH, symptomatic, no agent has been unequivocally shown to provide effective long-term large-scale randomized controlled trials. Some observers have been successfully used serotonin reuptake inhibitors sertraline and fluoxetine in patients who have not responded to stimulation room.

ATRIAL FIBRILLATION IN ELDERLY .

Atrial fibrillation (AF) is the most frequently diagnosed arrhythmia, affecting 2.3 million people in the United States. Its circulation increases with age, and up to 9% of persons aged 80 years is affected.1 Atrial fibrillation is characterized by a lack of coordinated atrial activity and the loss of organized atrial slowdown could lead to a multitude of clinical scenarios, including decompensated heart failure (CHF), embolic stroke (CVA), ischemia, dizziness / weakness, and even in asymptomatic patients with tachycardia.

Management of atrial fibrillation includes many methods: pharmacological treatment to keep patients in sinus rhythm and control of speed, DC electric catheter ablation and anticoagulation to prevent thromboembolic disease.

Atrial fibrillation (AF) resulted in codeshare different waveforms within the Atria, which bombard the atrioventricular (AV) node, commonly leading to tachycardia, which is irregularly irregular. The speed with which atrial fibrillation causing ventricular contraction depend on the state of the AV node refractory. It is the loss of atrial contraction and its effect on ventricular filling, also called ventricular calcium loss. Moreover, this contraction can lead to loss of blood stagnation atrium and can contribute to the formation of thrombi. Patients may be at risk of embolization when atrial fibrillation converted to sinus rhythm organized atrial contraction may now lead to loosening or fragmentation of atrial thrombus in the systemic circulation.

The autonomic nervous system may play a role in triggering atrial fibrillation. Increased sympathetic innervation in patients with atrial fibrillation may be responsible for the conversion of atrial fibrillation substrate and can lead to development of persistent atrial fibrillation. More recently, lung tissue and the vein left atrium pulmonary vein (LA) junction has been shown to play an important role in activating and maintaining atrial reentrant atrial activity. It is an atrial muscle that extends into the thoracic veins, and this tissue is innervated vagal. These anatomical findings are important in a technique that pulmonary vein isolation for atrial fibrillation ablation catheter.

Risk factors for atrial fibrillation (AF) are age, male gender, hypertension longstanding valvular heart disease, left ventricular hypertrophy, coronary heart disease (with or without depression of left ventricular function), diabetes, smoking, and any form of carditis. Take care of hemodynamically unstable patients are guided by ACLS protocols, including the direct current (DC) DC. Symptomatic patients may benefit from intravenous (IV) agents control rates, or calcium channel blockers or beta-blockers.

In most cases, the patient is stable, but they have a high ventricular response and need drugs that control the speed, with a target heart rate during the 80th This target heart rate recommended was challenged in the study RACE II examined cons of HR 110 less than 80 years. The gentle arm was no difference in the control arm Strict composite endpoint of death from heart failure, CHF, stroke, systemic bleeding, and fatal arrhythmia events.

If there is another clinical condition to drive the tachycardia, such as fever, infection or dehydration, then efforts to control the temperature and the restoration of aid normovolemic control tachycardia. Consideration of anticoagulation based on patient risk factors may also begin the emergency.