MANAGEMENT OF ACUTE MYOCARDIAL-INFARCTION IN THE ELDERLY

The prevalence of myocardial infarction (MI) is high among the elderly population. Many of the physiological and morphological changes attri butable to 'normal' aging predispose older adults to cardiovascular in stability, The incidence of both MIs and their associated morbidity an d mortality increase with aging. Older MI patients may therefore deriv e substantial benefit from appropriately selected therapeutic interven tion. In fact, given the high morbidity and mortality associated with MI in the elderly, aggressive therapeutic strategies may be particular ly warranted. There are a number of age-related cardiovascular changes that contribute to the increasing incidence of MI as adults age. Howe ver, age itself is not a contraindication to aggressive therapy. Commo n MI management options include invasive and pharmaceutical strategies . The relative advantages of angioplasty and thrombolytics must be con sidered. Other drugs used in the treatment of MI include beta-blockers , ACE inhibitors, nitrates, aspirin, anticoagulants, magnesium, antiar rhythmics and calcium antagonists. Significant peri-infarction complic ations, including heart failure, hypotension, arrhythmias, myocardial rupture and cardiogenic shock, often occur in older adults. Age-specif ic management strategies for these complications are reviewed.