Read e-book online Problems in Geriatric Medicine PDF

By Anthony Martin MD (auth.)

The indisputable fact that there are distinctive difficulties within the care of the aged in the neighborhood is considerable justification for writing a separate quantity at the topic. the information that there are expanding numbers of older humans in nearly each nation on the planet makes all of it the extra very important that the kinfolk general practitioner must have sympathy with and figuring out of the issues of them, due to the fact they're lilcely to make up an important a part of his worlcload and, more and more, will absorb extra of his time and effort. there's a revolutionary volume of incapacity with advancing years, and this is often fairly precise of these elderly seventy five years and over. expanding age is linked to critical impairment of listening to and imaginative and prescient, senses which more youthful humans take with no consideration. previous age sees the arriving of significant illnesses of heart age with a lot larger frequency, equivalent to ischaemic middle and cerebrovascular sickness, diabetes mellitus and osteoarthritis. There are different issues which are nearly restrained to the aged, akin to fractures of the femoral neck, Paget's illness and myeloma. We now understand that the disintegration of the con­ ducting tissue of the center is basically an age-related phenomenon. aging strategies impact each significant organ process within the physique and the impairment of physiological perfor­ mance due to those impacts the aged individual's reaction to infections, sickness and environmental adjustments in complicated ways in which are usually not obvious in more youthful people.

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Both these last two disorders cause prolapsing of the posterior cusp of the valve and consequent incompetence. Calcification of the mitral 33 Problems in geriatric medicine valve may also occur and sometimes this extends below the cusps and interferes with blood flow. Clinical features of senile mitral incompetence This is probably one of the commonest valvular lesions seen in old people and is frequently mistaken for aortic sclerosis or stenosis. The murmur is quite different from aortic murmurs and also differs from the classical rheumatic mitral incompetence, in that the murmur does not occupy the whole of systole and may, in fact, occur quite late in systole.

Atrial fibrillation may be established or paroxysmal. Sinus bradycardia of significant degree probably occurs in about 10% of the elderly and reflects disease of the sinus node. The concept of sinus node disease is important as far as the elderly are concerned and a whole section will be devoted to this topic. Incidence of arrhythmias in the over 70s Atrial fibrillation* Ventricular ectopics* « 1001h) Frequent ventricular ectopics t (> lOOIh) Multifocal ventricular ectopics t Runs of ventricular ectopicst } Ventricular tachycardia t Complete heart block t 11% 56% 12% 22% 9% 1% *Minor arrhythmias tMajor arrhythmias (Lown's criteria) (These figures are approximate values) The conducting system of the heart Many cells throughout the heart have the ability to discharge electrical impulses and this inherent discharge is known as 42 Disorders of the cardiovascular system (II) 'automaticity'.

G. 5 Significance of ectopic beats Multifocal ventricular ectopic beats (V) ing then'they are probably of no significance. However, if they are multifocal or occur in pairs or in a bigeminal rhythm they are of clinical significance, especially after a myocardial infarction and should be treated. Disopyramide, mexiletine and verapamil are usually effective in controlling these ectopics. The main importance of recognizing ectopic beats is that they may predispose to other more significant arrhythmias and may be a sign of digitalis overdosage or electrolyte disturbance.

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