1: Which of the following is NOT considered a "normal" age-related change in the cardiovascular system?

a) Increased risk of developing hyperlipidemia

b) Widening of the pulse pressure

c) Congestive heart failure due to diastolic dysfunction

d) Greater contribution of "atrial kick (systole)" to cardiac output

e) Tendency to develop isolated systolic hypertension

2: Which of the following is TRUE concerning chronic atrial fibrillation (AF) or its management in the elderly?

a) There is clearly excessive risk of bleeding complications with antithrombotic therapy for stroke prophylaxis in AF patients with unstable gait and a tendency to fall.

b) The older AF patient is more likely to experience congestive heart failure due to diastolic dysfunction than younger AF patients related to age-associate myocardial stiffening.

c) There is data to suggest cardioversion is less likely to return the heart to normal sinus rhythm in the shortterm in aged AF patients than in younger AF patients, hence cardioversion appears to be of dubious value in the elderly.

d) Risk of stroke from AF is independent of age.

e) Prevalence of AF rises from middle to old age, then drops again in advanced old age.

3: Which of the following is FALSE concerning coronary heart disease (CHD) or its management in the elderly?

a) CHD is the #1 cause of death in older persons.

b) Typical presenting symptoms of acute coronary syndromes, like retrosternal chest pain, become less frequent with advancing age.

c) Atypical presenting symptoms of acute coronary syndromes, like delirium (acute confusional state), are more common in advanced age than in younger CHD patients.

d) Beta-blockers and thrombolysis appear less effective in older patients with acute myocardial infarction vs. their younger counterparts, hence are appropriately used less frequently in the elderly.

e) Elderly CHD patients are more likely to suffer complications like heart block or congestive heart failure post-myocardial infarction than younger post-MI patients.

4: Consideration should be given to the following aspects of diagnosis or management of congestive heart failure (CHF) in the elderly, EXCEPT:

a) Strict sodium restriction is crucial to implement in managing the elderly CHF patient.

b) The prevalence of CHF due to diastolic dysfunction increases with advancing age.

c) CHF can be misdiagnosed as comorbid disease (e.g. COPD exacerbation) or mistakenly attributed to "normal aging."

d) There is evidence to support a multidisciplinary approach to the management of CHF in the elderly to reduce readmission rates for CHF.

e) Elderly CHF patients are at increased risk of developing orthostatic hypotension due to age-related changes in peripheral vasculature and/or medications, particularly when even mildly hyponatremic.

5: Which of the following statements is TRUE?

a) The NCEP strongly recommends lipid-lowering therapy for secondary prevention in the elderly, but recommends against the same for primary prevention.

b) Hyperlipidemia is protective with respect to mortality in healthy older persons.

c) Since the "oldest old" are the fastest growing segment of the population and the sufferers of the greatest burden of disease, they are regularly and explicitly included in clinical trials.

d) Age-related changes in renal and hepatic function have little clinical impact on drug metabolism.

e) A person’s "functional" or "physiologic" age is proving to be more important than his/her chronological age in attaining optimal outcomes with disease treatments.

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