Delirium in Elderly Cardiac Patients

Abstract

Delirium is a common complication in cardiac patients, yet it is scarcely mentioned in standard cardiology textbooks <[Braunwald, 2001]; [Fuster, 2001]>. This important syndrome is frequently the earliest and sometimes the only sign of an underlying life-threatening illness. Delirium is associated with increased mortality, longer hospital stays, functional decline, and higher rates of institutional care <[Cole and Primeau, 1993]; [Murray et al, 1993]>. It is a highly distressing experience for patients and their families <[Brietbart et al, 2002a]>, can be disruptive to other patients in the same room, and often impedes nursing care. The symptoms of delirium are remembered by over half of patients who are unfortunate enough to experience it <[Brietbart et al, 2002b]>. Delirium interferes with accurate symptom assessment (e.g. recall of chest pain), physical exam, and medical treatment. The increased sympathetic arousal that occurs in the setting of delirium can lead to adverse cardiovascular events <[Braunwald, 2001]>. This chapter aims to provide physicians who look after older patients with cardiac disease a simple and practical approach to the prevention, diagnosis, and management of this very prevalent and important condition.

...The body’s delicate; the tempest in my mind doth from my senses take all feeling else save what beats there.William Shakespeare, King Lear, Act III, Scene IV