Pathophysiologic aspects of the development of cognitive disorders in chronic heart failure in elderly patients

The present literature review presents current views on pathophysiologic aspects of the formation and progression of cognitive disorders in chronic heart failure in elderly patients. Advanced age itself is an important predictor of the development of cardiovascular, neurodegenerative and other diseases. Involutive changes of cardiovascular system are known to potentiate the development of chronic heart failure. Heart failure in older people usually develops gradually. Formation of the cognitive deficit in heart disease is associated with chronic cerebral ischemia as well as a cascade of neurochemical processes occurring in the brain, eventually forming a vicious circle. Often the symptoms of cerebral ischemia due to reduced stroke volume occur much earlier than congestion signs in other organs and systems. Chronic cerebral ischemia that occurs due to violation of cerebral hemodynamics, is associated with both extracerebral and intracerebral causes, which in turn contributes to the development of chronic brain hypoxia and aggravation of cognitive dysfunction. Thus, the features of the development and course of disease in people of older age groups indicate that in geriatric practice existing diagnostic schemes are not always applicable. When observing patients of elderly and senile age with chronic heart failure, during the assessment of their condition and running diagnostic tests, special attention should be payed to the earliest detection of cognitive dysfunction signs in order to correct the patient's treatment and improve quality of life

Progressive multifaceted approach to the management of geriatric patients with cardiac arrhythmias

Aim. To develop a progressive multifaceted approach to the management of geriatric patients with cardiac arrhythmias.Material and methods. The study was carried out in 2 stages. The study sample consisted of 262 elderly and senile people (mean age, 69,5±1,1 years). There 145 elderly (mean age, 68,4±1,2 years) and 117 senile patients (mean age 74,4±1,3 years). We analyzed medications used for six months in geriatric patients with arrhytmias and senile asthenia (SA) and without it. The combined strategy of management of geriatric patients with arrhytmias and SA was tested.Results. SA is most common in geriatric patients who are taking drugs such as class I a, b, c antiarrhythmics, class V antiarrhythmics (cardiac glycosides), diuretics (torasemide, furosemide), and statins. This indicates the need to avoid polypharmacy and to adjust the treatment of geriatric patients with cardiac arrhythmias in accordance with Beers criteria. Presented study revealed that in patients with SA, the total antioxidant activity is reduced, which indicates the need to restore antioxidant defence to such patients. A combined strategy has been developed for the management of geriatric patients with cardiac arrhytmias and SA.Conclusion. The combined strategy of managing older patients with arrhytmias and SA helped to improve the geriatric status, prevent SA, and increase antioxidant defence. A significant improvement in the quality of life was noted, in particular, in relation to the mental and psychological well-being