Das Herz im Alter
Abstract
Zusammenfassung. Das Wissen um kardiovaskuläre Veränderungen im Alter und deren therapeutische Optionen ist wichtig. Es kann zur Hypertrophie des linken Ventrikels, zur diastolischen Dysfunktion, Herzklappenveränderungen und pulmonaler Hypertonie kommen. Im Alter entwickeln Patienten häufig eine arterielle Hypertonie. Bei über 100-Jährigen sind valvuläre Veränderungen häufig (Aortenstenose und Mitralinsuffizienz). Das Risiko einer koronaren Herzkrankheit beträgt 35 % für Männer und 24 % für Frauen. Im Alter sind Sinusknotendysfunktion und Vorhofflimmern gehäuft. 25 % aller Schlaganfälle sind kardiale Embolien bei Vorhofflimmern. Kardiale Interventionen bei Betagten werden zunehmend häufiger durchgeführt und beinhalten koronare kathetertechnische Revaskularisationen oder Klappeneingriffe (perkutaner Aortenklappenersatz oder MitraClip). Die optimale Therapie im Alter beinhaltet neben kardiovaskulären Interventionen auch Medikamente und eine Lebensstilmodifikation und dient vor allem der Verbesserung der Lebensqualität.
Abstract. Knowledge of cardiovascular changes in old age and their therapeutic options is important. Old age can lead to hypertrophy of the left ventricle, diastolic dysfunction, heart valve changes and pulmonary hypertension. Patients often develop arterial hypertension. Valvular changes are common in people over 100 years of age (aortic stenosis and mitral insufficiency). The risk of coronary heart disease is 35 % for men and 24 % for women. In old age, sinus node dysfunction and atrial fibrillation are common. 25 % of all strokes are cardiac embolisms in atrial fibrillation. Cardiac interventions in the elderly are increasingly frequent and include coronary catheter revascularization or valve interventions (percutaneous aortic valve replacement or MitraClip). Optimal therapy in old age includes not only cardiovascular interventions also include drugs and a lifestyle modification and mainly serves to improve the quality of life.
Résumé. La connaissance des changements cardiovasculaires en vieil âge et leurs options thérapeutiques est importante. L’âge peut conduire à une hypertrophie du ventricule gauche, la dysfonction diastolique, des changements des valves cardiaques et à l’hypertension pulmonaire. Les patients âgés développent souvent une hypertension artérielle. A l’âge de plus de 100 ans les changements valvulaires les plus fréquents sont la sténose aortique et la régurgitation mitrale. Le risque de maladie coronarienne est de 35 % pour les hommes et de 24 % pour les femmes. Un dysfonctionnement du nœud sinusal et la fibrillation auriculaire deviennent aussi fréquents. 25 % de tous les accidents vasculaires cérébraux sont dus à une embolie d’origine cardiaque dans la fibrillation auriculaire. Les interventions cardiaques chez les personnes âgées sont effectuées plus fréque et comprennent une revascularisation coronaire ou un remplacement de la valve aortique par voie percutanée ou l’insertion d’un dispositif MitraClip. La thérapie optimale chez la personne âgée comprend non seulement les interventions cardiovasculaires mais aussi les médicaments et une modification du style de vie pour améliorer la qualité de vie.
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