Coronary Heart Disease and Acute Myocardial Infarction

  • Francis G. Dunn
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 31)


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.


Coronary Heart Disease Acute Myocardial Infarction Acute Myocardial Infarction Mitral Regurgitation Myocardial Oxygen Consumption 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Medalia LS and White PD. Disease of the aged: Analysis of pathological observations in 1,251 autopsy protocols in old persons. JAMA 149: 1433–1437, 1952.CrossRefGoogle Scholar
  2. 2.
    Kennedy RD, Andrews GR, and Caird FI. Ischaemic heart disease in the elderly. Br Heart J 39 (10): 1121–1127, 1977.PubMedCrossRefGoogle Scholar
  3. 3.
    Gordon T, Castelli WP, Hjortland MC, Kannel WB, and Dawber TR. Predicting coronary heart disease in middle-aged and older persons. The Framington study. JAMA 238(6):497499, 1977.Google Scholar
  4. 4.
    McKeown F. Pathology of the Aged. London: Butterworths, 1965, pp 16–39.Google Scholar
  5. 5.
    Sarnoff SJ, Braunwald E, Welch GH Jr, Case RB, Stainsby WN, and Macruz R. Hemodynamic determinants of oxygen consumption of the heart with special reference to the tension-time index. Am J Physiol 192: 148–156, 1958.PubMedGoogle Scholar
  6. 6.
    Malcolm ID, Sniderman A, and Morin JE. Successful coronary artery bypass surgery in an 80year-old man with Prinzmetal’s angina. Can Med Assoc J 119 (7): 749–750, 1978.PubMedGoogle Scholar
  7. 7.
    Campbell AE, Caird FI, and Jackson TFM. Prevalence of abnormalities of electrocardiogram in old people. Br Heart J 36: 1005–1011, 1974.PubMedCrossRefGoogle Scholar
  8. 8.
    Pepine CJ and Conti RC. Calcium blockers in coronary heart disease. Part 1, Modern Concepts of Cardiovascular Disease 50: 61–66, 1981.PubMedGoogle Scholar
  9. 9.
    Pepine CJ and Conti RC. Calcium blockers in coronary heart disease. Part II. Modern Concepts of Cardiovascular Disease 50: 67–72, 1981.PubMedGoogle Scholar
  10. 10.
    Dargie HJ, Lynch PG, Krikler DM, Harris L, and Krikler S. Nifedipine and propranolol: A beneficial drug interaction. Am J Med 71: 676–682, 1981.PubMedCrossRefGoogle Scholar
  11. 11.
    Report of the unstable angina pectoris study group. Unstable angina pectoris national cooperative study group to compare medical and surgical therapy. Part II. American J Cardiol 42: 839–848, 1978.CrossRefGoogle Scholar
  12. 12.
    Crawford T, Decter CD, and Teare RD. Coronary artery pathology in sudden death from myocardial ischemia: A comparison by age group. Lancet 1: 181–185, 1961.PubMedCrossRefGoogle Scholar
  13. 13.
    Rodstein M. Heart disease in the aged. In Rossman I (ed), Clinical Geriatrics. Philadelphia: Harper & Row, 1979, pp 181–203.Google Scholar
  14. 14.
    Pathy MS. Clinical presentation of myocardial infarction in the elderly. Br Heart J 29: 190, 1967.PubMedCrossRefGoogle Scholar
  15. 15.
    Thould AL. Coronary heart diseases in the aged. Br Med J 2: 1089, 1965.PubMedCrossRefGoogle Scholar
  16. 16.
    Rodstein M. The characteristics of nonfatal myocardial infarction in the aged. Arch Intern Med 98: 84, 1956.CrossRefGoogle Scholar
  17. 17.
    Williams BO, Bess TB, Semple T, and McGuinnes JB. The elderly in a coronary unit. Br Med J 2 (6033): 451–453, 1976.PubMedCrossRefGoogle Scholar
  18. 18.
    Zeman FD and Rodstein M. Cardiac rupture complicating myocardial infarction in the aged. Arch Intern Med 105: 431, 1960.PubMedCrossRefGoogle Scholar
  19. 19.
    Abrams DL et al. Ventricular aneurysm. A reappraisal based on a study of sixty-five consecutive autopsied cases. Circulation 27: 164, 1963.PubMedCrossRefGoogle Scholar
  20. 20.
    Sampson JJ and Hutchinson JC. Heart failure in myocardial infarction. Prog Cardiovasc Dis 10: 1, 1967.PubMedCrossRefGoogle Scholar
  21. 21.
    Bjorck G. The biology of myocardial infarction. Circulation 37: 1071, 1968.CrossRefGoogle Scholar
  22. 22.
    Bjorck G, Sievens J, and Blamquist J. Studies in myocardial infarction in Malmo 1935–1954. Part III. Acta Med Scand 162: 81–97, 1958.CrossRefGoogle Scholar
  23. 23.
    Kannel WB and Gordon T. Evaluation of cardiovascular risk factors in the elderly. The Framingham study. Bull NY Acad Med 54: 573–591, 1978.Google Scholar
  24. 24.
    Norwegian Multicenter Study Group. Timolol-induced reduction in mortality and re-infarction in patients surviving acute myocardial infarction. N Engl J Med 304: 801–807, 1981.CrossRefGoogle Scholar
  25. 25.
    B-blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction. JAMA 247: 1707–1714, 1982.CrossRefGoogle Scholar
  26. 26.
    Hjalmarson A, Herlitz J, Malek I, et al. Effect on mortality of metoprolol in acute myocardial infarction. Lancet 2: 823–827, 1981.PubMedCrossRefGoogle Scholar
  27. 27.
    Wilhelmsson C, Vedin JA, Wilhelmsen L, Tibblin G, and Werko L. Reduction in mortality after myocardial infarction by treatment with alprenolol. Preliminary results. Lancet 2: 1157 1160, 1974.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1984

Authors and Affiliations

  • Francis G. Dunn

There are no affiliations available

Personalised recommendations