Introduction

Life expectancy around the globe is increasing owing to better healthcare facilities and advancements in medicine. By 2050, the number of people over 80 is expected to triple to reach 426 million. With advancing age, all tissues and organs in the body undergo wear and tear changes that aggravate the risk of organ and systemic diseases. It is hard to differentiate the physiological changes that occur as part of the ageing process (and are inevitable) from the pathological changes that are potentially preventable. Heart disease is the 2^nd leading cause of death in Canada after cancer. It is also the leading cause of hospitalization in Canada. Research suggests that adults over 65 are much more likely to develop diseases of heart and blood vessels (collectively referred to as cardiovascular diseases) than younger adults. 

It is vital to understand what changes occur in an ageing heart to understand why heart diseases are common in the elderly.

How Does Your Heart Work?

The heart is a muscular organ that pumps oxygenated blood to all body tissues. A healthy adult heart is about the size of a clenched fist. Anatomically, the heart comprises four chambers, the upper chambers are known as an atrium, and the bottom chambers are known as ventricles. The right side of the heart collects deoxygenated blood from the body and pumps it towards the lungs for oxygenation; the oxygenated blood is then pumped from the left side of the heart to all the tissues via a network of blood vessels. The heart’s pumping activity is controlled by an intricate electrical system that coordinates the activity among the four heart chambers. 

     How Your Heart Changes with Age

Heart disease is a significant cause of disability among older adults that significantly interferes with their quality of life. With advancing age, the risk of coronary heart diseases increases significantly due to deterioration in the health of the heart and blood vessels. A common risk factor that increases the risk of heart diseases is the buildup of fatty deposits in the blood vessels that compromises the blood delivery to the heart. Another common risk factor is atherosclerosis (i.e., hardening/ stiffening of blood vessels) which obstructs the free flow of blood while also increasing the risk of developing high blood pressure. Development of plaques or stiffening of blood vessels restricts the delivery of oxygen-rich blood to the heart, ultimately causing weaker or damaged heart muscles that are more prone to injury. 

Other changes that occur as part of the ageing process include:

• Rhythm changes: Research suggests that at age 75, an average adult has only 10% cells at the SA node (the natural pacemaker of heart) compared to when they were 20, due to fibrosis and loss of muscle cells. This results in rhythm or electrical activity of the heart changes and manifests as an increase, decrease, or irregularities in the heart rate. It may be asymptomatic or may require medical or surgical intervention.  
• Thickening of valves: Valves are one-way doors between the chambers of the heart to allow the free flow of blood in one direction only. With advancing age, the valves become thicker/ stiffer (particularly mitral valve and aortic valve). A study suggested that calcification of the aortic valve is a leading cause of cardiac complication and increased risk of death.
• Muscular thickening: The heart is a muscular tissue. With aging, the left ventricular wall undergoes thickening due to loss of myocytes (heart cells) and resulting compensatory enlargement of existing myocytes. In addition, the aging process also enhances the deposition of amyloid proteins. These changes happen regardless of any changes in the blood pressure, but a history of longstanding hypertension can aggravate the rate of these changes. The resultant effect is thicker walls and smaller chamber cavity that limits the blood capacity of the heart chamber. An enlarged heart chamber also increases the risk of atrial fibrillation, which is a common rhythm abnormality in older adults.
• Systolic dysfunction: The systolic blood pressure (the top number on your blood pressure reading) increases as we age, while the cardiac output decreases. 
• Diastolic dysfunction: During diastole, the heart chambers are filled with blood. As we age, the volume and rate of diastolic filling decrease due to the stiffness of heart vessels. A study suggests that 1/3^rd to 2/3^rd of all elderly with heart failure have diastolic dysfunction. Poor diastolic function is also associated with increased mortality. 
• Low heart rate: The peak heart rate decreases as we age due to the declining capacity of the heart to pace itself because of thickening or fibrosis of heart muscle.  

What are Heart Diseases?

Heart diseases refer to the various heart disorders that compromise the overall circulatory functions, causing disability and death. Heart disease is a significant cause of disability among Canadians. The economic cost of cardiovascular diseases in Canada is $22 billion. 

Common types of heart diseases include:

• Coronary Artery Disease: This is the most common form of heart disease that involves compromised blood flow to the heart leading to heart attack
• Arrhythmia: Changes in the electrical activity of the heart that can present with very fast heart rate (tachycardia), very slow heart rate (bradycardia) or irregular heart rate (palpitations)
• Heart valve disease: The involves injury, damage, defects, or infections of heart valves
• Heart failure: Inability of the pumping activity of the heart that causes the buildup of fluid. Heart failure mainly affects older adults, and statistics suggest that only 17% of heart failure patients are under 65. 

Symptoms of Heart Disease?

Heart attack, heart failure, or coronary artery disease are different heart conditions that require other management and treatment options, but many heart conditions present with a similar clinical picture and risk factor profile. It is important to see your healthcare practitioner to identify your heart condition for proper treatment. 

1. Symptoms of Angina: 

The most common symptom of coronary artery disease is angina. Angina is a type of chest pain that occurs due to the reduced flow of blood towards the heart. Angina pain is often described as discomfort, pressure, heaviness, tightness, heartburn, and pain in the chest. You can also experience angina pain in your back, neck, shoulders, arms, or jaws which is often mistaken for indigestion. 

Some classic symptoms of coronary heart disease include:

• Nausea
• Dizziness, lightheadedness, and weakness
• Irregular or faster heartbeat; palpitation
• Shortness of breath
• Pain and pressure in the arms and shoulders

2. Symptoms of a Heart Attack: 

A heart attack occurs when a part of the heart muscle doesn’t get sufficient blood flow due to interruption or blockage; thereby compromising the oxygen availability to the heart tissue. One of the leading causes of heart attack is coronary heart disease; another cause is severe spasm or impulsive contraction/ shrinkage of the coronary artery, which blocks the blood flow towards the heart. The heart attack symptoms begin with slight discomfort and progresses to severe pain and distress with time. During an episode of a heart attack, the symptoms may last up to 30 minutes or longer, and these symptoms can’t be reduced or stopped with rest or any medication unlike angina, where the pain does subside with rest or medications like nitroglycerin spray. Some people don’t experience any symptoms (also known as silent myocardial infarction, i.e., MI.), seen primarily in diabetic people. 

Classic symptoms of a heart attack include:

• Chest pain or discomfort: usually, a heart attack begins with discomfort, pressure, pain, heaviness, or squeezing in the center or left side of the chest. It typically lasts for a few minutes or more or may come and go. The pain is often radiating to the left arm, which can differentiate it from heartburn. 
• Discomfort in other areas of the body: the discomfort or pain may also radiate to other parts of the body, including arms, back, jaw, neck, or stomach.
• Feeling weak, dizzy: feeling tired and lightheaded with cold sweats.
• Shortness of breath: feeling difficulty in breathing with or without chest discomfort.
• Irregular heartbeat
• Unexplained tiredness
• Nausea

Seek immediate medical assistance if you are experiencing these symptoms, as delaying treatment can result in more significant damage to the heart.

3. Symptoms of Arrhythmias:

Arrhythmia (also known as abnormal heart rhythm) refers to irregular heartbeat due to disturbances in the electrical signals that synchronize heartbeat. 

Major symptoms include:

• Palpitation; feeling of missed or irregular, a rapid heartbeat
• A sense of heart racing or pounding
• Weakness, dizziness, or fainting
• Feeling tired
• Panting or breathlessness
• Chest pain
• Anxiety
• Fatigue
• Sweating

4. Symptoms of Atrial Fibrillation:

Atrial fibrillation is a type of arrhythmia and is described as a rapid, irregular, and very fast heartbeat that may result in the formation of blood clots in the heart. It increases the risk of heart attack, heart failure, and other complications. 

Major symptoms include

• Rapid and irregular heartbeat
• Heart palpitation
• The reduced energy level and tiredness
• Fainting, dizziness, and overall weakness
• Feeling of pressure, squeezing, and discomfort in the chest
• Breathlessness (even in performing routine activities)

Some people experience no symptoms in atrial fibrillation.

5. Symptoms of Heart Valve Disease:

Valve disease may progress slowly in some people, and symptoms may not be very noticeable as the heart adapts and stabilizes with time. Some people with heart valve disease don’t experience any symptoms even if they require treatment.  However, the risk and harm associated with heart valve disease are significant, so it is recommended to take all the signs seriously no matter how trivial they may seem. 

• Breathlessness or difficulty in breathing with minimal exertion. In advanced cases, people experience shortness of breath while lying down in bed.
• Tiredness
• Weakness, lightheadedness, or dizziness
• A feeling of pain, pressure, suffocation, and tightness 
• Palpitation, i.e., irregular, rapid, or skipped heartbeat.

Sometimes valve disease if, left untreated, may lead to heart failure. In which case, symptoms include:

• Ankle or foot swelling
• Abdominal swelling that makes you feel bloated
• Sudden and rapid weight gain

Symptoms don’t always show the seriousness of your valve issues. Sometimes you have no symptoms of heart valve disease; however, your condition is serious, and you need prompt medical assistance. 

6. Symptoms of Heart Failure:

Classic symptoms of heart failure include:

• Breathing difficulty or shortness of breath with activity or lying flat on your back.
• Coughing with white or pink blood-tinged mucus 
• Swelling in legs, ankles, and abdomen
• Fatigue
• Weakness and dizziness
• Heart palpitation
• Nausea, vomiting, and faintness
• Chest pain

Like heart valve disease, symptoms of heart failure don’t always depict a true picture of your heart health. Sometimes you may develop severe symptoms; however, your heart condition is not that bad, and sometimes you don’t feel any symptoms, and your heart condition is worse. 

According to the Canadian Institute for Health Information, the average length of hospital stay is highest in heart failure patients – and typically lasts 9-10 days.

7. Symptoms of Congenital Heart Defects:

Congenital heart diseases are birth defects that impact the normal working of the heart and are present at birth. Congenital birth defects are common and can be diagnosed before birth, immediately after birth, during childhood or sometimes during adulthood. Sometimes, people born with congenital heart defects don’t experience any symptoms and are diagnosed incidentally during a physical exam or chest X-ray. 

The classic symptoms include:

• Tiredness in performing any task or poor exercise tolerance 
• Breathlessness
• Rapid and fast heartbeat
• Heart failure symptoms
• Valve disease symptoms
• Bluish tinge in skin and lips

8. Congenital Heart Defects in Infants and Children:

In infants and children, the significant symptoms of congenital heart defects include:

• A bluish tinge on the face, nails, and lips (also known as cyanosis)
• Rapid breathing
• Poor feeding
• Low weight gain
• Recurring lung infections
• Difficulty in performing various tasks such as running, exercising etc.,
• Developmental delays 

9. Symptoms of Heart Muscle Disease

Heart muscle disease, also known as cardiomyopathy, sometimes doesn’t show any symptoms and people live a normal life, but the symptoms worsen over time as heart functions deteriorate without any intervention in some people. 

The symptoms may present at any age and include:

• General weakness and extreme fatigue
• Pain, pressure, and discomfort in the chest especially after any activity or exercise. It can also occur after consuming meals or even at rest.
• Fainting and dizziness
• Symptoms of heart failure
• Swelling and inflammation or edema of legs, ankles, or foot
• Irregular or abnormal heartbeat or palpitations
• High blood pressure

Sometimes cardiomyopathy patients also experience arrhythmias and are at risk of sudden death.

10. Symptoms of Pericarditis:

Sharp and stabbing pain in the centre of the chest is the most common symptom of Pericarditis; however, some people may experience dull pain or a pressure-like feeling in the chest. The pain may also spread to the arms, shoulders, and back. This pain gets worse on coughing, deep breathing, or lying flat. 

Other common symptoms include:

• Slight fever
• Swelling or edema in legs and abdomen
• General weakness, tiredness, and fatigue
• Coughing
• Heart palpitation
• Breathlessness, especially when lying down

What Can You Do to Lower the Risk of Heart Disease?

Did you know that 9 in 10 Canadians have at least one risk factor for stroke or heart disease? According to the latest statistics, 189 out of 100,000 Canadians die from major heart diseases each year. Early detection and prompt management can help in improving the outcome and reduce the risk of complications. 

• Reduce your risks for the Big Four: 

Chronic diseases are health issues that last at least one year or more, impact your daily activities and require ongoing medical intervention. Data suggests that these are the four leading causes of avoidable or preventable deaths in Canada. The big four chronic diseases include cancer, diabetes, heart diseases, and lung diseases. 

Many chronic diseases are caused by common risk factors such as consuming unhealthy, processed, and oily foods cause obesity and high lipid levels, which aggravates the risk of developing heart diseases, certain types of cancers, and diabetes. Likewise, smoking increases the risk of developing heart diseases, various cancers, and chronic obstructive pulmonary disease. Research suggests that making healthy lifestyle choices can reduce your risk of developing these chronic health issues, minimize your risk of developing complications and improve your overall health and quality of life. 

The big four chronic diseases include:

• Cancer:  Cancer is caused by an uncontrollable growth of abnormal cells in the body. These abnormal cells then spread to other parts of the body and compromise the blood supply and nutrition delivery to the healthy cells, causing compromised health. 
• Cardiovascular disease: cardiovascular diseases are disorders of blood vessels and the heart. The risk factors include accumulation of fatty deposits in the arteries, development of abnormal blood clots, or stiffening of arteries due to atherosclerosis. 
• Diabetes: It is a chronic metabolic condition that occurs when your body is unable to convert the food we eat into energy. The food we consume is broken down into glucose and is released into the bloodstream. When sugar levels increase in blood, it stimulates our pancreas to release insulin which helps our body cells to efficiently utilize glucose as a form of energy. People who have diabetes are either incapable of producing enough insulin or are unable to utilize insulin due to insulin insensitivity. Diabetes also leads to other complications and health-related issues. However, by efficiently managing the blood sugar levels, you can reduce x 1x the risk of developing serious complications. Learn more about diabetes and its management options here. 
• Chronic respiratory disease: Chronic respiratory diseases affect the airways and other parts of the lungs. The most common types are asthma, chronic obstructive pulmonary disease, lung cancer, sleep apnea, and cystic fibrosis. Smoking and other poor lifestyle habits further elevate respiratory issues. 

Eight healthy choices to reduce the risk of disease:

These four chronic diseases can easily be prevented by adopting a healthy lifestyle and avoiding bad habits.

 

• Avoid smoking: Smoking is one of the significant causes of lung cancer and chronic obstructive pulmonary disease. It also aggravates the risk of heart-related issues and stroke. Smokers are more likely to develop asthma, irreversible lung damage, and heart-related issues like a heart attack or stroke than nonsmokers. 
• Be physically active: Physical activity and exercise are essential aspects of a healthy mind and body. Exercise helps maintain a healthy weight and reduce the accumulation of excess fat that aggravates the risk of developing heart diseases, diabetes, and other health-related issues. Engage yourself in a physically dynamic lifestyle that doesn’t necessarily mean exercising in a gym or structured environment. You can start small, focus on the regularity, time, and intensity of workouts. Gradually increase your level of physical activity.  Try to do moderate exercise, which you can continue easily; it can be simple like dancing; walking, climbing stairs, and stretching. Walking for 20 to 30 minutes daily or taking 1000 steps in a day is a simple, do-able goal. Combined with other physical and healthy activities it will significantly reduce the chances of developing various chronic diseases such as diabetes, heart diseases, and metabolic disorders. 
• Eat healthy food: Eating a healthy, nutritious, and well-balanced diet is important for our overall health. Nutritious and healthy food provides our body with various vitamins and minerals that are important to fight against various diseases while improving our immunity. Maintaining a well-balanced diet is also good for a healthy weight, reducing high cholesterol levels and reducing the chances of developing various health-related issues and diseases.  You should select foods high in fiber and low in fat. 2 to 3 servings of fresh fruits and vegetables daily are very important for good health. Avoid eating junk foods and processed foods as they are not nutritious and can cause weight gain. Some healthy food choices include:

• Lentils
• Fruits
• Green leafy vegetables
• Beans
• Whole grains
• Dairy
• Nuts
• Rice

• Achieve healthy weight: Obesity increases the risk of various diseases such as diabetes, heart-related issues, cholesterol levels, and some types of cancer. According to research the risk of a heart attack in overweight women is three times higher than in women with a healthy weight.  Try eating healthy and exercising daily to maintain your weight. Talk to your nutritionist to develop a healthy diet and workout plan to stay healthy and active.
• Control blood pressure: If you have a personal or family history of hypertension, monitor your blood pressure regularly to minimize the risk of complications. 
• Limit alcohol intake: Excessive alcohol consumption significantly compromises your quality of life by affecting your mood, energy levels, and overall physical and mental health. Long-term alcohol consumption is associated with liver damage, heart diseases, and even cancer. Limit your alcohol intake to live a healthy and productive life. 
• Reduce stress levels: Stress is the root cause of various diseases. It increases your blood pressure and cholesterol levels and puts you at risk of stroke or heart disease. Poorly managed stress also triggers mental disorders such as anxiety and depression. Seek help if you are unable to manage your stress with simple interventions.   
• Go for regular checkups and tests: It is very important to visit your primary care provider to assess your health condition and detect any underlying health issues – early detection and prompt treatment help in improving the overall outcome.  
• Making changes takes time and effort: There are some risk factors that we can control (such as diet or bodyweight), but some risk factors such as family history, genetic diseases, ethnicity, age, or gender are beyond our control. However, making healthy lifestyle choices helps improve the overall physical health and quality of life.  Making lifestyle changes is not easy. It takes time to quit your bad habits and adopt healthier ways of living. Set realistic goals and understand that healthier choices will reduce your risk of developing various chronic diseases and illnesses. 

Conclusion:

Ageing and age-related wear and tear are inevitable; however, certain lifestyle changes such as weight management, dietary modification, and a stress-free dynamic lifestyle can slow down the progression of tissue damage. Check out Mednow.Ca to learn how simple lifestyle modifications can help you in achieving better health. If you have an existing health condition, keep up with your medical regimen. Don’t forget to utilize our full-service online pharmacy to refill your prescription in time without any hassle. 

References:

1. https://www.nia.nih.gov/health/heart-health-and-aging 
2. https://www.canada.ca/en/public-health/services/chronic-diseases/healthy-living-prevent-disease.html 
3. https://www.healthpartners.com/blog/heart-disease-facts/ 
4. https://www.heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure/causes-of-heart-failure 
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366686/ 
6. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/heart-disease-canada.html 

This article offers general information only and is not intended as medical or other professional advice. A healthcare provider should be consulted regarding your specific situation. While the information presented is believed to be factual and current, its accuracy is not guaranteed, and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the authors as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by Mednow or its affiliates.

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