Diagnosis of coronary heart disease in older adults

The prevalence and incidence of coronary heart disease (CHD) increase dramatically with age in both men and women. Myocardial ischemia in older adults is often manifest as dyspnea with or without chest pain. Older adults with acute myocardial infarction may demonstrate a wide variety of symptoms, including chest pain, dyspnea, neurologic symptoms, and gastrointestinal symptoms, and are less likely to show diagnostic Q waves or ST-segment elevation than younger patients. A sizeable percentage may have unrecognized infarction. Multiple diagnostic techniques are useful in detecting CHD in older adults, including resting and ambulatory ECG, exercise testing, and cardiac imaging. Stress testing using dipyridamole, adenosine, and dobutamine in combination with nuclear or echocardiographic imaging is especially useful for CHD diagnosis in older individuals unable to perform meaningful exercise. Both coronary computed tomographic angiography and cardiac magnetic resonance imaging are also useful for diagnosis of CHD without requiring exercise. Invasive coronary angiography can be performed with relatively low complication rates in clinically stable older adults.