292.2 🩺 國考版

292.2.1 高頻考點

292.2.1.1 Aging CV Physiology

  • ↑ Arterial stiffness (ISH, ↑ PWV)
  • LV hypertrophy + diastolic dysfunction
  • ↓ Baroreflex → orthostasis
  • ↓ β-response → blunted HR
  • Myocardial fibrosis, ATTR amyloid

292.2.1.2 Common CV Issues

  • HTN (ISH)
  • HFpEF (with ATTR-CM)
  • AF
  • AS
  • CAD (atypical, silent MI)
  • Stroke

292.2.1.3 Key Trials in Elderly

  • SPRINT-Senior: < 120 better in ≥ 75 yo
  • STEP: Chinese elderly, < 130
  • EARLY-TAVR: asymptomatic severe AS
  • HF-ACTION (HFrEF), REHAB-HF (HFpEF): cardiac rehab benefits
  • ELDERCARE-AF: edoxaban 15 mg low-dose in fragile elderly

292.2.1.4 Frailty Tools

  • Clinical Frailty Scale (CFS) 1-9
  • Edmonton Frail Scale
  • Fried Frailty Phenotype (5 criteria)
  • Gait speed (< 0.8 m/s)
  • Edmonton Frail Scale, Katz ADL

292.2.1.5 Beers Criteria (Highlights)

  • Avoid: 1st-gen antihistamines, TCAs, BZDs, antipsychotics for delirium, NSAIDs long-term, PPIs > 8 wk
  • Use with caution: digoxin, antiarrhythmics, aspirin > 70 yo for primary prevention

292.2.1.6 STOPP/START

  • STOPP: medications that should usually be stopped
  • START: medications that should be started
  • Geriatric-specific deprescribing

292.2.2 易混淆比范

Disease Typical Adult Elderly Pattern Pearl
HTN Diastolic > Systolic ISH (S↑, D↓) Arterial stiffening
HF HFrEF HFpEF (ATTR) Tafamidis if ATTR
AS Bicuspid in young Calcific degenerative TAVR all risk
MI Typical chest pain Dyspnea, fatigue, silent Atypical presentation
Syncope Vasovagal Orthostatic, AS, AV block Multifactorial

292.2.3 Special Topics

292.2.3.1 ATTR-CM in Elderly HFpEF

  • 13-25% of HFpEF > 80
  • Wild-type ATTR most common in elderly
  • Bone tracer scan (PYP) for screening
  • Tafamidis (ATTR-ACT) ↓ mortality + hospitalization

292.2.3.2 Senile Aortic Sclerosis

  • Calcification without significant gradient
  • Different from severe AS
  • ↑ Cardiovascular risk marker (CV-equivalent)

292.2.3.3 Conduction Disease in Elderly

  • Sinus node dysfunction (sick sinus syndrome)
  • AV block (degenerative — Lenegre, Lev)
  • Permanent pacer common indication