ABSTRACT
As in any body tissue or organ, changes take place in the cardiovascular system as life
progresses. Some of these changes allow easy identification of the very elderly heart when
examining autopsy cardiac specimens as unknowns. The “normal” elderly heart has
relatively small ventricular cavities and relatively large atria and great arteries. The
ascending aorta and left atrium, in comparison with the relatively small left ventricular
cavity, appear particularly large. The coronary arteries increase in both length and width;
the former, particularly in association with the decreasing size of the cardiac ventricles,
results in arterial tortuosity. (The young river is straight and the old one winding.) The
leaflets of each of the four cardiac valves thicken with age, particularly the
atrioventricular valves; these have a smaller area to occupy in the ventricles because of
the diminished size of the latter. Histological examination discloses large quantities of
lipofuscin pigment in myocardial cells; some contain mucoid deposits (mucoid
degeneration). These changes appear to affect all population groups of elderly individuals
regardless of where they reside on the earth or their level of serum lipids. An elevated
systemic arterial pressure appears to both accelerate and amplify these normal expected
cardiac changes of aging. Both the aorta and its branches and the major pulmonary
arteries and their branches enlarge with age. Because the enlargement is in both the
longitudinal and the transverse dimension, the aorta, like the coronary arteries, tends to
become tortuous. This process is further amplified as the vertebral bodies become smaller
and the height becomes somewhat shorter. The major pulmonary arteries appear to be too
short and have too low a pressure to dilate longitudinally.
