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Cardiovascular Disease in the Elderly, Third Edition, Revised and Expanded FREE TO VIEW

Amanda A. Beck, MD, PhD
Chest. 2005;128(1):476. doi:10.1378/chest.128.1.476
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By Wilbert S. Aronow and Jerome L. Fleg, eds. New York, NY: Marcel Dekker, 2004; 847 pp; $199.95

This is an updated edition of the well-received review of cardiovascular disease in the geriatric population edited by Wilbert Aronow of New York Medical College and Jerome Fleg of the National Institutes of Health. It is the latest in the series Fundamental and Clinical Cardiology from Editor-in-Chief Samuel Goldhaber of Harvard and Henri Bounameaux of the University Hospital of Geneva.

The editors state that the primary goal of this third edition is to provide clinicians with a comprehensive, easy-to-read information source incorporating the latest knowledge on the epidemiology, pathophysiology, and management of cardiovascular disease in the older person. The authors note that a recurring theme throughout the new edition is that aging per se lowers the threshold for development of various cardiac, vascular, and metabolic disorders and alters their clinical manifestations

The text is organized into eight parts and 32 chapters. The initial presentation, covering the fundamental changes that occur in the cardiovascular system with aging, provides a good basis for understanding pathologic manifestations in these patients. The chapter on cardiovascular drug therapy provides an extensive list of drugs available for use in elders, taking particular note of the changes in metabolism that occur with age, recommendation for dose adjustments, as well as those medications best avoided in this age group. The chapter on hypertension offers an extensive review of clinical trials that have focused on aging patients.

As medical management of some conditions improve, those affected are living into later years. The editors have therefore added a new chapter focusing on the interaction of diabetes and cardiovascular disease in the aging diabetic. The chapter on pathophysiology presents the latest information on the biochemistry and pathologic anatomy of cardiovascular disease, while the chapter on diagnosis reviews the patterns of clinical symptoms and the standard diagnostic methods for identifying cardiovascular disorders, as well as the limitations introduced by their application to those of advanced age. Subsequent chapters include one covering angina pectoris, reviewing the current status of standard therapies plus newer pharmaceutical and mechanical options; one on therapy of acute myocardial infarction, presenting an evidence-based review of which medical management options do and which do not work for elders; two chapters devoted to surgical management and surgical indications specific to elders; and two chapters dealing with secondary prevention strategies in the elderly.

A series of chapters are devoted to the unique geriatric aspects of aortic valve disease, mitral valve disease, endocarditis, cardiomyopathies, thyroid heart disease, heart failure, and supraventricular, ventricular, and bradyarrythmias. Cerebrovascular disease is nicely reviewed and incorporates an excellent algorithm for evaluating syncope. Special issues related to anticoagulation in elders are covered in a separate chapter. Peripheral vascular disease presents a significant medical and functional issue for many elders and is well covered. A chapter devoted to the perioperative cardiovascular evaluation presents both a review of the literature in this area and practical recommendations on how to properly accomplish this for elders. The final chapter specifically addresses the difficult ethical and quality-of-life issues that are essential to comprehend when caring for the geriatric population.

Did the authors achieve their goal of being readable? Yes. Did they clearly present the vulnerability that advanced age itself presents? Yes. Did they accomplish something more, presenting the unique multifactoral issues and needs that must be addressed to care for a geriatric patient? Yes indeed!




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