Heart attacks are the single largest killer of older adults. More than one-half of all adults hospitalized for an acute heart attack are 65 or older and they account for 80% of all deaths from heart attacks. Those age 70 and older with an heart attacks have a death rate that is twice that of those who are younger with an heart attacks The Framingham Study found that 45 percent of heart attacks are silent or unrecognized and this percentage increases with age among males (Kannel & Abbott, NEJM, 1984).

The symptoms of a heart attack depend on the location, site and amount of damage to the heart. As with ischemia, the symptoms of an acute heart attacks may be different in the elderly than in younger people. The typical symptoms of an heart attacks are listed in the table below. Although complaints of chest pain are the most common symptom reported by middle-aged people, less than 30% of older adults report chest pain in the early stages of an heart attacks. Older people having a heart attack are more likely to complain of shortness of breath or to have vague symptoms such as confusion, abdominal pain or generalized weakness.

Anyone with suspected symptoms of a heart attack should seek medical attention immediately. Most deaths occur within the first 24 hours after a heart attack unless they are treated in a hospital setting. In addition early treatment with clot dissolving drugs can help prevent heart damage as well as other complications of heart attack. Even with early treatment, about one in three older adults (ages 70 to 99 years) hospitalized for a heart attack will die.

Symptoms of a Heart Attack

• Chest pain or pressure
• Nausea or vomiting
• Sweating
• Dizziness
• Weakness
• Shortness of Breath
• Heart Palpitations
• Indigestion
  
  

Treatment of heart attacks

The great majority of acute heart attacks are caused by a blood clot which occludes the blood supply to the heart. Inital treatment for a heart attack focuses initially on addressing the symptoms (e.g., medication for chest pain), treating the arrythmias, reducing oxygen demand on the heart (e.g. oxygen therapy, bedrest), and initiating (when appropriate) thrombolytic therapy. Thrombolytic agents (i.e. streptokinase, tissue plasminogen activator (tPA)) can be infused intravenously. They prevent or reduce damage to the heart muscle by dissolving the clot occluding the vessel and thereby restoring circulation to the heart.

Once the patient is stable other treatments may include:

• Percutaneous Transluminal Coronary Angioplasty (PTCA) : PTCA (balloon angioplasty) is a procedure that is similar to coronary angiographyc except that the catheter has a tiny balloon at its tip. The specially designed balloon-tipped catherter is inserted into the heart and positioned at the stenotic (narrowed) coronary vessel. It is then inflated to dilate the artery or compress the plaque in the vessel which improves the blood flow. Sometimes a stent, a metal coil, is permanently implanted to keep the artery open. The procedure is done while the patient is awake and can take 1 to 2 hours.
  
  
• Coronary Artery Bypass Graft (CABG or "cabbage") : CABG is a surgical procedure in which a blood vessel, usually from the leg or chest, is grafted onto the blocked artery, bypassing the obstructed coronary artery. Often more than one artery is blocked so several grafts may be necessary to restore circulation to the compromised areas of the heart. The CABG is performed on individuals with severe chest pain which is not responsive to medical treatment or amenable to PTCA. It is usually successful in relieving some of the symptoms of heart disease (e.g., chest pain) and diminishes the likelihood of (another) heart attack.