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.

Journal Article↗

PubMed1981

Echocardiographic analysis of a malfunctioning Davila-Sierra mitral valve.

Although the Davila-Sierra mitral valve prosthesis was removed from the market nearly a decade ago, a number of patients still have this valve in place. We recently studied the echocardiographic features of a malfunctioning Davila-Sierra mitral valve prosthesis. Abnormalities that suggested improper functioning of the prosthesis included a markedly delayed poppet opening and an early diastolic hump believed to represent motion of the mitral annulus. Previously described echocardiographic indications of dys-function were not observed in our patient. We report the first known echocardiographic evaluation of a Davila-Sierra prosthesis.

Journal Article↗

PubMedDate not supplied

Infective endocarditis in the elderly: diagnosis and management.

Infective endocarditis is seen with increasing frequency in older patients. This increase is due to the general aging of the population, improved survival of patients with congenital and valvular heart disease, and the increasing use of catheters and other prosthetic devices with resulting higher incidence of nosocomial endocarditis. In older patients, infective endocarditis frequently develops in the absence of underlying structural heart disease; atheromatous deposits and mitral annular calcification are two important risk factors in this population. Infective organisms in older patients are frequently enterococci and other gastrointestinal tract bacteria. A marked febrile response is uncommon whereas central nervous system symptoms are more common in older patients. Transesophageal echocardiography can be performed safely and is a major diagnostic tool with sensitivity of more than 90% in detecting vegetations as small as 2-5 mm. Appropriately drawn blood cultures provide bacteriologic diagnosis in 80%-99% of patients. Prolonged antibiotic therapy may be required in many instances depending on the infective organism. Early surgical therapy is advisable for patients who develop heart failure as a result of severe acute aortic valvular regurgitation. Valve replacement surgery can be performed with acceptable mortality and morbidity even in very elderly patients.

Aged↗

PubMedDate not supplied

Guidelines of the Cardiogeriatrics Department of the Brazilian Cardiology Society: commentary by Editorial Board Members of The American Journal of Geriatric Cardiology.

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Arrhythmias, Cardiac↗