LAUSR

Introduction In Western countries, ischemic heart disease is the leading cause of death, and stable angina is its frequent manifestation, representing the onset symptom in 50% of the patients. When stable angina is present, the risk of adverse cardiovascular events doubles, and increases with age. It is estimated that in the United States of America 7 million patients are affected with stable angina, and the prevalence increases in the elderly reaching almost 10% in patients over 85 years. The diagnosis of angina could be challenging in the elderly because of their comorbidities, functional limitations and the often atypical presentation of the symptoms. Accordingly, oldest patients with a clinical suspect of stable angina require an integrated diagnostic assessment starting with a careful clinical history and accurate physical exam, and extending to personalized laboratory and instrumental tests chosen considering the individual patient’s clinical and functional status. The clinical history, for instance, should be collected not only from the patient, but also from the family members or the direct caregiver. An accurate history is critical in the diagnostic process, for the frequent lack of typical symptoms leads to a delayed or even a missed diagnosis. The typical effort-induced pain, with rapid regression with rest, is often absent in the elderly, presenting rather, and more so with advancing age, atypical symptoms or angina equivalents such as dyspnea, jaws pain, nausea and epigastric pain. Furthermore, the diagnosis could be delayed by comorbidities limiting patient’s functional capacity such as neurologic (previous stroke, Parkinson’s disease) or osteoarticular conditions (osteoarthritis), which may contribute to hide effort-induced symptoms. The missed or delayed diagnosis increases the risk of adverse cardiovascular events, with higher incidence of acute coronary syndrome, heart failure or sudden death.