Coronary heart disease in the aged.

Abstract

ConclusionThe Heller valve provides a simple, cheap, reliable, and accurate method of giving intravenous fluids to newborn infants. Its use reduces the time spent by the medical and nursing staff in supervising intravenous drips in neonates ; and it can readily be adapted for other purposes.Minor complications occur, as with any form of intravenous infusion in infants, but their incidence is not high, and is probably much lower than that associated with earlier techniques. In a series of 500 valve-infusions only two major complications were found which might be attributed to this method.The valve costs 6s. 9d., which is little more than the cost of a single disposable drip set, and it may be used more than fifty times before leak-back occurs. SummaryA method of administering intravenous fluids to infants is described and assessed in the light of experience of over 1,200 infusions. The advantages over more conventional methods are discussed and the possibilities of the adaptation of the system for other purposes are indicated. J7., 1965, 2, 1089-1093 William Heberden (1802) stated that he had seen nearly 100 people with angina pectoris, and all but four were males near or past the fiftieth year of age. We are now uncomfortably aware of the frequency with which the male members of western populations, especially the relatively young, die of coronary heart disease. The death rate from diseases of the heart is said to have changed very little in the years 1850 to 1920, but from 1924 onwards the death rate rapidly increased until about 1952, when it showed signs of levelling off (Campbell, 1963a). This apparent and alarming increase may well be due to the possibility that those who would have died from the infectious diseases now survive longer to die from coronary heart disease, as so lucidly argued by Campbell (1963b). It is doubtful, judging by post-mortem reports, that there has been any absolute increase in the incidence or severity of atheroma over the years 1908-49 ; the reverse is true if anything (Morris, 1951). There is some evidence that in the elderly the disease is different in its clinical presentation (Dreyfuss, 1959), and it is a comparative rarity to make the diagnosis of a coronary thrombosis in the age group 60-80 years (Howard and Gresham, 1961). Many of the coronary thromboses in the elderly are "silent" (Rodstein, 1956), and the distribution of the atherosclerotic lesions is different (Wright, 1960).We were impressed by the rarity with which we saw the clinical entity of acute coronary heart disease in those admitted to an acute geriatric department serving a sizable area of North Central London. In those in whom the diagnosis was made the clinical severity of the episode was marked and the outlook grave. In this paper we present our findings in a three-year retrospective study.* University College Hospital, London. Now at St. Bartholomew's Hospital, London. MethodsThe case records of all admissions to this 88-bed department over a three-year period were examined, and only those patients who...

Ischemic and Hypertensive Heart Disease in the Aged: Prognostic and Therapeutic Factors†

“…Biorck (18) reported a mortality of 47 percent in patients of the 70-79 age group and 64 percent among the 80+ age group. Thould (19) In more recent series based on patients admitted to a coronary care unit (CCU), Kincaid and Botti (21) found the mortality among those over the age of 80 to be only 25 percent, a rate similar to the 27 percent among 105 CCU patients of the 71-93 age group reported by Chaturvedi et al (22). None died in the hospital from primary arrhythmia, though terminal arrhythmias were often observed in patients with shock or severe heart failure; 42 percent died within 24 hours of onset (22).…”

“…Biorck (18) reported a mortality of 47 percent in patients of the 70–79 age group and 64 percent among the 80+ age group. Thould (19) noted a mortality rate of 79 percent among the aged, and Norris et al (20) a rate of 43 percent among 212 patients over 70 years old.…”

Management of Chronic Non‐Rheumatic Pain in the Elderly*

“…Pain perception and recognition may be greatly altered in the aged. Up to 50 percent of acute myocardial infarctions occur without pain (2, 3) in older patients. The intensity of pain is often much less.…”

Problems and Progress in Geriatrics*

“…Pulmonary embolism is more common in the elderly; previously often underdiagnosed, it is now so often over‐diagnosed that pneumonia may be missed. The manifold manifestations of myocardial infarction and the lack of them in the aged are notorious (7). Myocardial infarction must always be considered in connection with the de novo onset of gastrointestinal symptoms.…”