Aging changes in the heart and blood vessels

How circulation works

The right side of the heart sends blood to the lungs for oxygen and removal of carbon dioxide. The left side pumps oxygen-rich blood through the aorta and branching arteries. In tiny capillaries, tissues receive oxygen and nutrients and release waste; veins then return blood to the heart.

Changes in the heart

The heart's electrical pacemaker loses some cells, and conducting pathways can develop fibrous tissue or fat deposits. A healthy resting pulse often stays broadly similar, but the heart may respond less strongly during exertion. An older person's ECG can differ from a younger person's without every difference indicating disease; persistent rhythm disturbances still need evaluation.

The heart wall, particularly around the left ventricle, may thicken. A slightly larger heart does not necessarily hold more blood, because thick walls can reduce the chamber's space and slow filling. Heart muscle cells also change and may accumulate lipofuscin pigment. Valves can thicken and stiffen, sometimes producing a murmur; examination determines whether valve disease is present.

Blood vessels and blood

The aorta and other arteries may become thicker and less flexible, increasing pressure and the heart's workload. Capillary walls can thicken and exchange substances more slowly. Blood-pressure sensors called baroreceptors become less responsive. On standing, pressure may therefore fall enough to cause dizziness, especially with dehydration or certain medicines.

Total body water and circulating blood volume can decrease. Red blood cell production may respond more slowly to blood loss or illness. Some immune-cell functions become less effective, affecting resistance to infection. Anemia is not simply normal aging: nutrition, bleeding, chronic illness, and medicines are among its possible causes.

Reduced reserve and related conditions

At rest, circulation can still meet the body's needs. Illness, infection, injury, physical exertion, emotional stress, some medicines, and stimulants such as caffeine create additional demands. Less reserve can make these situations harder to tolerate. Several conditions become more relevant with age and require their own diagnosis.

• Atherosclerotic plaques can narrow arteries, contributing to coronary disease, angina, or heart attack.
• Arrhythmias, including atrial fibrillation, and heart failure can affect circulation.
• Valve disease includes aortic stenosis, a narrowing of the valve leading into the aorta.
• Clots, deep vein thrombosis, thrombophlebitis, varicose veins, and peripheral arterial disease can cause vascular problems; leg pain when walking may be a sign.
• Aneurysms are weakened, widened arterial areas that may rupture. Interrupted brain circulation can cause a transient ischemic attack or stroke.

Protecting cardiovascular health

Controlling blood pressure, cholesterol, diabetes, excess weight, and smoking helps address risks that can be changed. Regular activity suited to your abilities supports function, weight management, glucose control, and stress management. Ask for guidance before starting an unfamiliar exercise program, especially if you have symptoms or a known condition.

• Choose a heart-healthy eating pattern with less saturated fat and appropriate portions; avoid smoking.
• Review blood pressure at least yearly, or more often when your clinician advises.
• If cholesterol is normal, a five-year interval may be appropriate, but diabetes, cardiovascular or kidney disease, and other risks may require closer follow-up.
• Men aged 65–75 who have ever smoked should discuss ultrasound screening for an abdominal aortic aneurysm.

When to seek medical help

Report new breathlessness, swollen legs, persistent palpitations, faintness on standing, or reduced exercise tolerance. Blood-pressure medicines may need adjustment if they cause dizziness or falls, but do not change them yourself. A murmur, anemia, or leg pain needs assessment rather than an assumption that age is the explanation.

• Possible heart attack symptoms include chest pressure, upper-body discomfort, breathlessness, cold sweats, nausea, or sudden dizziness. Call emergency services even if symptoms are mild or uncertain.
• Sudden facial droop, one-sided weakness, speech difficulty, vision loss, or major balance disturbance requires emergency help, even if it passes.
• Sudden severe chest, back, or abdominal pain, collapse, or severe breathing difficulty requires urgent assistance.
• Do not drive yourself when a heart attack or stroke is suspected.