Clinical Manifestations and Diagnosis of Coronary Artery Disease

Abstract

Coronary atherosclerosis is very common in the elderly population with autopsy studies demonstrating the prevalence to be at least 70% in persons over the age of 70. These autopsy findings may be coincidental, with the disease clinically silent throughout the person's life, although 20% to 30% of persons over age 65 years will demonstrate clinical manifestations of coronary heart disease (CHD). In most elderly persons, the disease will have manifested itself much earlier in their lives, however, in others the disease will be entirely silent until the person reaches his or her 70s or 80s. Unfortunately, even though CHD is prevalent in elderly persons, the disease is often not diagnosed or misdiagnosed in this age group. Failure to correctly diagnose the disease in the elderly may be due to the difference in the clinical manifestation in this age group compared with younger patients. Such differences may reflect a difference in the disease process between older and younger patients or it may be related to the superimposition of normal aging changes, plus the presence of concomitant diseases, which may mask the usual clinical manifestations.