摘要
长期的心失败和压抑的混乱有高流行和发生在老。几研究显示出消沉怎么趋于加重共存的长期的心失败和它的临床的结果并且反过来也如此，在特别老。在长期的心失败和消沉在之间的否定协同老可以被接近仅仅考虑位于两个这些条件下面的 multifaceted pathophysiological 特征，例如行为因素， neurohormonal 激活，煽动性的调停人， hypercoagulability 和脉管的损坏。不过，在这二个条件之间的 pathophysiological 连接还很好没被建立。尽管有在长期的心失败的消沉的高流行老病人和它的否定预示的价值，因为分享的症状，它特别经常是未被认出的。用可靠问询表，屏蔽心情混乱因此与长期的心失败在老病人被推荐，就算不能由心理健康职业运动员代替诊断会见。在这个背景，消沉的治疗要求包括的一条多学科的途径：心理疗法，抗抑郁剂，锻练训练和 electroconvulsive 治疗。尽管有冲突结果，有选择血清素举起禁止者的药理学治疗改进生活的质量但是不保证更好的结果。锻练训练在改进生活和预后的质量是有效的，但是同时心脏的康复服务是极大地 underutilized。
Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including： psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.
