Coronary Heart Disease and Acute Myocardial Infarction

Abstract

Coronary heart disease (CHD) is a term that conventionally refers to atheromatous disease of the coronary arteries and the sequelae that result thereof. The focus of this chapter will concentrate on this specific entity in the elderly and its principal complication—acute myocardial infarction. CHD is not a disorder of old age. Indeed, we know that atherosclerotic lesions can be seen as early as the second and third decade. In susceptible individuals, CHD begins even earlier and can be clinically manifest as early as the first decade. This disease process, however, progresses through life so that in the elderly, very marked changes may be observed not only in the coronary arteries but also in all the other major arteries. CHD produces its most devastating consequences in the fourth, fifth, and sixth decades, and at one time it was thought that those who survived that period had escaped its life-limiting or lethal consequences. However, it is now clear that this is not the case since CHD is also a major cause of morbidity and mortality in the elderly (Figure 8-1). Important distinctions exist in CHD in the elderly, however, as will become evident in the course of this chapter, and these must be borne in mind in the management of these patients.