Which is a true statement about heart disease in older adults?
a. Myocardial infarction has many of the same symptoms in older patients as in middle-aged persons.
b. Both excessive urination at night and decreased urination can be signs of heart failure.
c. Any exertion on the part of an older adult patient with heart disease can bring on another heart attack.
d. A person with heart failure is likely to have trouble breathing, except when lying down.
B
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A Incorrect. In older patients the classic presentation of angina pectoris is often absent in what is known as a silent myocardial infarction (MI), with only mild discomfort, perhaps even limited to nausea or "heartburn."
B Correct. Because the heart is an ineffective pump in heart failure (HF), both of these can occur when older adults have an MI. Nocturia occurs in heart failure when the heart is unable to maintain adequate renal blood flow in the perfor-mance of daily activities; then, during the night when the patient's lower ex-tremities are elevated for sleep, the heart is able to perfuse the kidneys with the assistance of increased venous return owing to the elevated extremities. Inade-quate urine production is due to inadequate perfusion from an ineffective pump.
C Incorrect. Failure to engage in cardiac rehabilitation exercise is more likely to result in another MI or aggravation of HF than ordinary exertion.
D Incorrect. A person with HF is more likely to have difficulty breathing except when the trunk is upright (orthopnea).
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