Shortness of breath (SOB) is a very common symptom among the elderly, mostly women, being caused by many diseases of the heart , lungs, muscle weakness, anxiety, arthritis.
Normal aging process is not a cause of that.
It is normal with advanced age to have less energy and less drive, to take longer than before in performing usual activities, to be “slower”, but it is not normal to become breathless doing them.
We see often in elderly a purposely decrease in activities to avoid SOB or chest pain, considering these symptoms ” normal for age”, and postponing medical attention. Aging causes a decrease in lung capacity to fill up during each breath and loss of height contributes to lower lung volumes; however these changes should not trigger SOB with normal, usual activities
Most of the time SOB is caused by Diastolic Heart Failure, or “The old women’s heart”
Aging causes stiffness of the heart muscle, predisposing to diastolic heart failure.
In diastolic failure, the muscle of the heart becomes thick, stiff, and cannot relax properly, allowing a minimal blood filling of the heart. A stiff balloon cannot expand to fill up with air; thus, despite normal strength of balloon’s walls, there is minimal air to be pumped out.
Because of normal muscle and contraction, diastolic heart failure has normal Ejection Fraction, or EF.
It manifest with SOB with minimal walking or incline , leg swelling, SOB while sleeping , excessive fatigue, elevated blood pressure with minimal walking
In contrast, in the more common systolic failure, the muscle is damaged and week, and despite filling up perfect, cannot pump out the blood . The EF is low. This form of heart failure is seen after heart attacks
The more common Systolic heart failure has low Ejection Fraction; weak, dilated and flabby heart.
Diastolic heart failure, more common in elderly, has normal Ejection Fraction; bulky, thick, small heart
Treatment : American Heart Association and American College of Cardiology recommend controlling:
• systolic and diastolic blood pressure
• leg swelling and lung congestion using diuretics (“water pills”)
• how fast the ventricles beat in people with atrial fibrillation (beta blockers)
