Clinical Presentation of Coronary Artery Disease in the Elderly: How Does it Differ From the Younger Population?
CHD is the major cause of morbidity and mortality in the elderly in the U.S. In this age group, the clinical presentation of CHD can be quite atypical. In general, the incidence of typical precordial chest pressure/pain denoting myocardial ischemia is less common whereas dyspnea as an anginal equivalent symptom is frequent. The diagnosis of ischemic cardiac pain is frequently confused by the many comorbid conditions present in the elderly. Even when classic ischemic precordial discomfort is present it tends to be less severe and less well defined. The elderly appear to have reduced pain perception and as a result silent myocardial ischemia is more common and carries a somewhat worse prognosis in the elderly than in younger age groups. Similarly, the presenting symptoms of acute myocardial infarction in the elderly can be nonspecific. The classic crushing substernal chest pain decreases with age whereas the symptom of dyspnea gradually increases. Neurologic symptoms, weakness, and worsening heart failure are common clinical presentations of an acute infarction in elderly patients. Silent (unrecognized) myocardial infarctions are common in the elderly and carry serious prognostic implications.
Gregoratos
Gabriel
G
Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA.