The Silver Tsunami Quiz: CVD in the Elderly

Adam H. Skolnick, MD


March 10, 2017

The auscultatory gap is common in older adults and occurs when Korotkoff sounds are soft or absent transiently as the cuff pressure is lowered. If one does not palpate the radial pulse to determine the maximal blood pressure, the cuff may be inflated to a point below the true maximum, thus leading to a false conclusion that the pressure is normal.

The cardiologist may have only inflated the cuff to 170 mm Hg, which may have been in the middle of the period of diminished heart sounds. Thus, when she deflated the cuff, she heard the restored systolic pulsation (following the auscultatory gap) as opposed to the true systolic maximum. The mechanism is incompletely understood but is related to arterial stiffness with decreased reflection of sound waves.[2]

Oral Anticoagulation

Polypharmacy and drug/drug interactions are of particular concern in older adults, making the novel oral anticoagulants (NOACs) for the management of nonvalvular atrial fibrillation potentially attractive in this population.


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