Clinical Examination and Investigation of the Heart

Abstract

It is well established that symptoms of heart disease are often modified in the elderly. Cardiac pain, both that of angina pectoris and that of cardiac infarction, may be either greatly reduced in intensity, or overshadowed by the simultaneous development of mental confusion, presumably because of reduction in cardiac output and cerebral blood flow. The dyspnea of cardiac failure is replaced as a leading symptom by fatigue, though patients in whom this occurs appear objectively to be as breathless as those who do complain of dyspnea. This frequent relative insignificance of the major symptoms of heart disease in the elderly makes proper and detailed clinical examination and investigation the more important. There are, however, numerous problems of interpretation, both of physical signs and of the results of investigations, that are particular to the cardiology of old age. Knowledge of these problems is essential in arriving at an accurate and complete cardiological diagnosis, which is often a crucial part of the overall assessment of the elderly patient.