This article is provided by Doctor.Global.
Due to an increase in the life expectancy of patients, aortic stenosis is now the most frequent form of valvular heart disease. The present paper focuses on aortic stenosis in elderly and senile patients as a peculiar clinical entity with great diagnostic and therapeutic problems. Therefore, given the continuous scientific developments in cardiac surgery, especially TAVR, comorbidity and the elderly are still challenging problems.
Epidemiology of Aortic Valve Changes
The epidemiology underlying aortic valve changes is an area of active research because, until recently, little was known about the natural history of these changes.
The most common changes in the valvular equipment of the heart in elderly patients regarding the pathology of aortic valves can be considered as degenerative alterations. Such alterations are seen in over 25% of patients at least 65 years old. About 70 percent of these patients have mild-to-moderate thickening of the valves’ shades and normal function, which is referred to as aortic sclerosis. However, 2-5% of these patients progress to have significant AS leading to obstruction of blood flow from the left ventricle chamber.
AF risk factors and role as a risk factor for ischemic stroke, anticoagulation management in AF, and mechanisms of valvular AS.
Potential sources of degenerative aortic valve stenosis are as follows: they are similar to the clinical risk factors for coronary atherosclerosis. Age, male gender, smoking, high LDL and cholesterol, hypertension, and metabolic syndrome are risk factors in the development and worsening of AS. Patients with AS are mostly elderly, and they often have other concomitant coronary or peripheral vascular diseases. The disease is more fulminant in elderly patients because of the long-standing, progressive alteration of the aortic valve. Therefore moderate fibrous-calcific changes observed in the valve leaflets can at some time pose a relatively severe obstruction to blood flow. The mechanical stress by blood pressure and endothelial dysfunction also contribute to the destructive process of the valve. Stiffening of the valve leaflets over time reduces the area of the valve, pressure rises in the L ventricle hence hypertrophy with ultimate failure.
Comorbidity in Elderly Patients
Old patients have to be treated for aortic stenosis together with their comorbidities, which are important in their surgical prognosis. Marked pulmonary diseases like pulmonary hypertension or COPD hamper the identification of symptoms and deciding whether they stem from the cardiovascular system or pulmonary diseases themselves. It is known that making an AVR- may not benefit the clinical condition in cases like these. They reported that fifty-sixty percent of the patients in the study require an AVR to show postoperative pulmonary dysfunction and more than thirty percent of them require oxygen. Morbidity and mortality rates increase in this surgery in patients with severe pulmonary pathology. Moreover, comorbid diabetic nephropathy, liver disease, and anemia increase the mortality risk in the patient who underwent aortic valve replacement.
Diagnostic difficulties involved in elderly patients
The diagnosis of AS in elderly and senile patients should be made based on anamnesis and examination. There are three principal points when the valve has to be replaced, these are the presence of stable angina, syncope, and symptoms of heart failure including orthopnea, edema, and paroxysmal nocturnal dyspnoea in the patient. Some of these symptoms may also be barely noticeable in elderly patients because patients are not very mobile or do not complain of active symptoms. It is pertinent to involve the relatives or caregivers to monitor changes in activity, appetite, and overall condition. Exercise testing will be able to point out asymptomatic patients, while gait tests will tell if aortic stenosis is producing disturbances. Despite no functional limitation, echo may demonstrate severe AS, and thus patients should be followed in a specialist’s practice.
Understanding if symptoms are due to aortic stenosis is the fundamental way of managing patients with the disorder. They can predict the severity of AS and cardiovascular workload and prognosis by physical examination. auscultatory findings of split S2 and an intense and crescendo-decrescendo systolic murmur suggest of aortic valve stenosis and left ventricular hypertrophy. The physical examination indicates that echocardiography is necessary if there is the presence of aortic stenosis.
Management of Aortic Stenosis in the Elderly and Senile Patients
In the present case, treating aortic stenosis in patients, especially elderly patients, requires the clinician to take into account important physiological and medical issues that relate to elderly individuals. The condition whereby the aortic valve opening is small can cause severe complications of the ailment such as heart failure, reduced physical function, and a high mortality rate. These challenges must be considered by the treatment approach for the best results. The approach to aortic stenosis treatment in elderly in this demographic must consider the unique physiological and medical challenges posed by older age.
Conclusion
The elderly and senile patients are vulnerable and the management of their surgical needs especially after valve replacement needs special attention. These patients have increased bleeding risk, renal issues, new or worsened heart rhythm problems or blockages, and decreased cognitive function. Congestive heart failure patients with severe aortic stenosis and apparent manifestations have lower preoperative exercise tolerance capacity and severe malnutrition, therefore belonging to high-risk postoperative patients. It has been found that hospitalization impacts functional status negatively and postoperative delirium impacts cognitive status. Rehabilitation and activation after valve transplantation are critical to enhance the patient’s well-being. He or she or the medical team responsible for the patient must regularly follow up on the ward and monitor the capacity for postoperative complications and or changes in the overall health status.
