Sometimes Less Is Best with the Elderly Heart
Prairie Doc® Perspectives - Week of February 10, 2019
By Richard P. Holm, MD
A beautiful 90-year-old woman came into the emergency room after another fall. The last year had been tough for her as she had developed diastolic heart failure. Her weakness and breathlessness were helped some by diuretics, but she was troubled by extreme variations in blood pressure, high one moment and dangerously low the next. Also, she had a calcified and somewhat tight aortic valve and was on a blood thinner for atrial fibrillation.
Heart disease in the elderly includes a wide variety of conditions. The following is a partial list:
The risk of falling was simply too high to continue my 90-year-old patient on blood thinners. I stopped them and backed off a little on the diuretic which could have been worsening her blood pressure drops and causing the falls. The age-old ethic came to mind: “First of all, do no harm.” Balancing the advantages and harms of medicines in the elderly requires careful consideration, and sometime less is best.
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