Ischaemic Heart Disease in people over 65

Ageing – general comments

There are various effects of ageing in the cardiovascular system, which include:

1. A slightly enlarged heart, which does not pump as efficiently during exercise.

2. Stiffer arteries

3. Isolated systolic hypertension (where the blood pressure rises when the heart contracts).

Heart disease and the Elderly

The prevalence of risk factors for heart disease increases with increasing age, and coronary artery disease is clinically evident in 20% of those over 80 years.

However, the symptoms of ischaemic heart disease in the elderly may present differently, (breathlessness rather than chest pain, or “silent angina” in diabetics).

Elderly people may modify their lifestyle to avoid the onset of angina, may be used to having chest pains for a long period of time, (and not seeking help), and may present later with a heart attack, than younger people.

In the elderly, co-existing conditions such as anaemia and thyroid disease, heart failure and arrhythmias are common and may worsen angina.

In the elderly, angina may be caused by another condition (aortic stenosis – a tight aortic valve), and this should be considered as a cause, and ruled out, when angina is investigated.

Preventative measures and lifestyle changes with the aim of lowering risk factors are just as important in the elderly, but medication should be introduced gradually, and in lower doses because of the risk of adverse side effects and drug interactions.

Angioplasty and CABG can and should be used as treatment measures, but the risks of mortality, and side effects from the procedures are increased, and the benefits have to be weighed against the risks, in elderly people.

Diffuse disease may be present, and not amenable to procedures.