www.elitecme.com | 2019 | HEART HEALTH 11 |  GERIATRICS As a nurse on a telemetry unit, I often “traced” a drop of blood through the heart for my patients. In a simplistic explanation, this is how a drop of blood travels through the heart: 1. Oxygen-poor blood (oxygen that has already served its purpose and is returning from its work in the body) travels from a large vessel into the right atrium. 2. The oxygen-poor blood travels into the right ventricle. 3. The oxygen-poor blood travels into another large vessel into the lungs, where it becomes oxygenated, ready to become circulated throughout the body. 4. The oxygen-rich blood is pumped back into the left ventricle. 5. The oxygen-rich blood travels into the right atrium, where it trav- els through a large vessel into the body and is circulated for use. Eventually, it will make its way back to the heart to become oxy- genated again. Throughout this process, the capillaries also remove carbon dioxide, which is a waste product, from the blood. In addition to being a strong muscle, the heart also has an electrical system. This electrical system ensures that the heart beats in perfect time – the upper and lower chambers should be coordinated so that we feel (and hear on a stethoscope) that familiar lub-dup. THE AGING HEART An aging heart naturally changes, even with excellent habits. Heart rhythm changes may occur. The electrical system that controls the heartbeat may have some changes. For example, the pathways of this system may develop fat deposits or fibrous tissue. The sinoatrial (SA) node, which is the pacemaker, may lose cells. These changes can cause: • A reduced heart rate. • Electrocardiogram (ECG) changes. For example, slight changes on the ECG may occur that are not necessarily dangerous. • Arrhythmias, such as atrial fibrillation, may also be caused by heart disease. • Heart murmurs. Heart murmurs can also be related to thickening and stiffening of the heart valves. Blood vessel changes may occur. Examples include: • Orthostatic hypotension becomes more common. This is because the baroreceptors, which monitor blood pressure and help to maintain blood pressure with position changes, become less sen- sitive with age. • The walls of the capillaries begin to thicken; this causes a reduction in the ability to exchange nutrients and wastes. • The aorta becomes thick, which contributes to hypertension. This means that the heart must work harder. As the heart works harder, it becomes hypertrophic, meaning that it becomes more muscular. The quality of the blood itself may change. Examples include: Blood volume decreases because total body water decreases with age. Anemia becomes more prevalent with aging. This is because red blood cell production becomes impaired with illness and stress. The culmination of these changes can contribute to age-related heart conditions, such as angina, heart arrhythmias, anemia, arteriosclerosis, heart failure, coronary artery disease, hypertension, aortic stenosis, and stroke. PREVENTION OF HEART DISEASE There are modifiable risk factors, though. For example, being a couch potato may feel good after a tough day at work, but it isn’t doing you any favors if you do it every night. Nor is eating that bag of potato chips! Try getting more exercise. The general guidelines are 150 minutes of activity each week. Ask your medical provider what is right for you. And if you are the couch potato that I discussed above, you don’t have to go from binging on Stranger Things to trying to run a marathon – shoot for taking a short walk for 10 to 15 minutes – then increase how long you’re walking. Don’t like walking? Try yoga. Or swimming. Ride a bike. Take a dance class. Enlist a friend’s help and find a class that you both enjoy. Follow a healthy diet. Cardiologists recommend that those at risk for heart disease (which is most people who are aging!) should limit added sugars, saturated fats – and especially trans fats. Increasing fibrous foods, such as fruits, vegetables, and whole grains is a great idea. Need help? Enlist help from a registered dietitian (RD). Lose weight if you need to. Keeping calorie intake balanced with exer- cise is optimal for weight loss – and losing weight is great for your heart. Manage stress. Stress takes its toll on all systems of the body. Learning how to manage stress can improve emotional as well as physical health. And finally… Quit smoking. Smoking damages the arteries of the heart, increases the chances of cancer and stroke, as well as many other harm- ful comorbidities. Smoking is also the leading cause of preventable deaths. n Krystina is a 30-something RN, BSN, CDE who has worked in a vari- ety of nursing disciplines, from telemetry to allergy/immunotherapy to most recently, diabetes education. She is also a writer and has enjoyed expanding her writing career over the past several years. She balances her careers as a nurse and a writer with being a wife and a mother. She has a four year old son who is an inquisitive, energetic little guy who is up for anything. She also enjoys reading, traveling, cooking, baking, and yoga (both practicing and teaching). RESOURCES MedlinePlus. Aging changes in the heart and blood vessels. Retrieved from https://medlineplus.gov/ency/article/004006.htm National Institute on Aging. Heart health and aging. Retrieved from https://www.nia.nih.gov/health/heart-health-and-aging