The elderly are the fastest-growing segment of society, and heart disease is the single-most common cause of death in this population. In this article, age-related structural end functional changes that occur in the heart are discussed, including changes in the heart muscle, valves, conduction system and major arteries. Coronary artery disease affects half of those older than 65, resulting in acute myocardial infarction, angina pectoris, dysrhythmias, congestive heart failure and sudden death. Each of these is discussed, including altered presentation in the elderly and implications for practice derived from national and international studies

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