Ischemic heart disease in the elderly

Abstract

I. The clinical features of acute myocardial infarction were compared in 72 patients over the age of 70 and 128 younger patients. Complications related to severity and ultimate prognosis such as congestive heart failure, cardiogenic shock, ventricular fibrillation and atrial fibrillation were more common in the elderly. Hospital mortality was 25% for the this ages 70 or over and 13% for the those under 70-a mortality ratio about 2:1. II. The extent and severity of selective coronary cineangiographic findings were analyzed in aged patients. The selective coronary cineangiographic findings were compared in 81 patients over the age 65 and 55 patients under the age 40 with more than 75% coronary narrowing of Iumen. Multiple vessel disease (LMT, two vessel and three vessel disease) for patients over the age 65 was demonstrated 64% (52/81) versus 49% (27/58) for patients under the age 40 (p<0.05). The incidence of significant LAD lesion due to atherosclerosis was 79% in the older patients and 57% in the younger patients (p<0.05). III. A morphological study on the myocardial infarction its aging changes and relation to atherosclerosis was performed in human hearts. The coronary sclerosis contains both components induced by physiological aging phenomenon and by pathological atheromatous change in the arterial wall. A total 556 semiconsecutive autopsied hearts was subjected for macroscopical study for narrowing of the coronary artery, using multiple cross sectioning method. Significant average coronary narrowing more than 5 in coronary narrowing index (CNI), was observed at the 4th decade and later of male and at the 5th decade and later of female, with 10 years delay in female to male. The CNI in cases without any risk factors for atherosclerosis, increased with linear parallelism to growing age in male showing more than 5 of CNI at the 7th decade or later, and it increased with a dome formation at the 5th to 6th decade in female with not beyond 5 of the CNI at any age group. Coronary arteries of 215 autopsied hearts with myocardial infarction were examined for sclerotic narrowing and thrombotic occlusion. The overall incidence of coronary thrombosis in the infarction was 53% and the incidence was higher in the massive necrosis (M) type infarction, to 70% in male and 63% in female. In the M type infarction, the highest incidence was recorded in the old male (84%) and in the older female (69%). The anterior infarction fairly matched thrombosis in the anterior descending, but the posterior one did not show such an intimate relation to thrombosis in the right coronary artery. The myocardial infarction in the elderly is characterized by association to advanced coronary sclerosis and low incidence of thrombus in the coronary arteries.