Die systolische Herzinsuffizienz des Älteren

Zusammenfassung

Mit zunehmendem Lebensalter kommt es sowohl im Herzen als auch im Gefäßsystem zu strukturellen Veränderungen, die die Entwicklung einer Herzinsuffizienz im Alter begünstigen. Eine vermehrte Steifheit der Arterienwand führt dabei zu einer Zunahme des systolischen arteriellen Drucks und der Pulswellengeschwindigkeit. Die resultierende Nachlasterhöhung des Herzens trägt zur Myokardhypertrophie und zur neuroendokrinen Aktivierung im Alter bei. Auf molekularer Ebene finden sich im alternden Herzen Veränderungen, die auch bei manifester Herzinsuffizienz nachgewiesen werden können. Dies gilt insbesondere für das sympathische Nervensystem. Die Therapie einer systolischen Herzinsuffizienz bei älteren Patienten unterscheidet sich nicht von der jüngerer Patienten. Sämtliche Substanzen, die bei jungen Menschen mit chronischer Herzinsuffizienz die Prognose verbessern, sind auch im hohen Alter indiziert. Dies gilt für ACE-Hemmer bzw. Angiotensin-Rezeptorantagonisten ebenso wie für Betablocker und Aldosteronantagonisten. Komorbiditäten sowie eine veränderte Pharmakokinetik und Pharmakodynamik erfordern jedoch oftmals eine langsamere Therapieeinleitung, eine individuelle Dosisanpassung sowie eine engmaschigere Überwachung älterer Patienten

Summary

Aging is associated with changes in cardiac and vascular structure, promoting the development of heart failure. An increase in vascular stiffness leads to an increase of systolic arterial pressure and pulse wave velocity. This augments the afterload of the heart, which contributes to cardiac hypertrophy and neuroendocrine activation in the elderly. On the molecular level the age-associated changes in the sympathetic nervous system are similar to alterations that can be found in congestive heart failure. Therapy of systolic heart failure does not differ between the elderly and younger patients. All drugs which have shown to improve the prognosis of younger patients are indicated in the elderly as well. This holds true for ACE-inhibitors or angiotensin receptor antagonists, betablockers and aldosterone antagonists. However, comorbidities as well as changes in the pharmacokinetics and pharmacodynamics might require a cautious initiation of the therapy, an individual adjustment of the dosage and a thoroughly monitoring of the elderly patients.

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