Manifestations
The manifestations of heart failure in the elderly often are
masked by other disease conditions. Nocturia is an early symptom
but may be caused by other conditions such as prostatic
hypertrophy. Dyspnea on exertion may result from lung disease,
lack of exercise, and deconditioning. Lower extremity
edema commonly is caused by venous insufficiency.
Among the acute manifestations of heart failure in the elderly
are increasing lethargy and confusion, probably the result
of impaired cerebral perfusion. Activity intolerance is common.
Instead of dyspnea, the prominent sign may be restlessness.
Impaired perfusion of the gastrointestinal tract is a common
cause of anorexia and profound loss of lean body mass.
Loss of lean body mass may be masked by edema.The elderly also maintain a precarious balance between the
managed symptom state and acute symptom exacerbation.
During the managed symptom state, they are relatively symptom
free while adhering to their treatment regimen. Acute
symptom exacerbation, often requiring emergency medical
treatment, can be precipitated by seemingly minor conditions
such as poor compliance with sodium restriction, infection,
or stress. Failure promptly to seek medical care is a common
cause of progressive acceleration of symptoms.