Which of the following is a true statement about heart disease in older adults?
a. Myocardial infarction (MI) has many of the same symptoms in older patients as in middle-aged persons.
b. Both excessive urination at night and de-creased urination can be signs of heart failure (HF).
c. Any exertion on the part of an older adult patient with heart disease can bring on another heart attack.
d. A person with HF is likely to have trouble breathing, except when lying down.
B
Because the heart is an ineffective pump in HF, both excessive urination at night and decreased urination can occur when older adults have an MI. Nocturia occurs in HF when the heart is una-ble to maintain adequate renal blood flow in the performance of daily activities; then, during the night when the patient's lower extremities 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.
The classic presentation of angina pectoris in older patients is often absent in what is known as a silent MI, with only mild discomfort, perhaps even limited to nausea or "heartburn" as the only symptom. Failure to engage in cardiac rehabilitation exercises is more likely to result in another MI or be an aggravation of HF than ordinary exertion. A person with HF is more likely to have difficulty breathing except when the trunk is upright (orthopnea).
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