Cardiologia in geriatria

With an exponential growth in the number of older adults, understanding the common disorders of the elderly patient requiring cardiac care is becoming increasingly important. Incorporating recent advances in the field, Tresch and Aronow's Cardiovascular Disease in the Elderly 6th Edition has been completely revised and updated to provide cardiologists, primary care physicians, geriatricians and other clinicians caring for the elderly a comprehensive and accessible overview of the epidemiology, pathophysiology and treatment of cardiovascular disorders in older patients.

Heart failure is predominantly a disease of the elderly; aging of the population is contributing to an epidemic of heart failure. The epidemiology, pathophysiology, prognosis, clinical manifestations, diagnostic assessment, etiology, and role of echocardiography in the diagnostic assessment and etiology of heart failure are discussed. The treatment of heart failure in the elderly through the use of diuretics, inotropic drugs, neurohormonal antagonists, antiarrhythmic drugs, angioplasty, surgical therapy, cardiac resynchoronization therapy, exercise therapy, and use of implantable cardioverter-defibrillators are presented. All of the authors who have contributed to this book are nationally and internationally recognized experts in cardiovascular disease in the elderly who are dedicated to improving care for older persons with cardiovascular disease. Their many years of personal experience enable them to summarize and synthesize their respective topics with unique insights that are highly beneficial to the reader.

CARLO CONTI You are today confronting sensitive questions on the subject of "Cardiac surgery and heart diseases in old age" and I congratulate you on this. It is a brave and important step to discuss this multifaceted question which demands an answer and an explanation from many perspectives: From a medical perspective, there is the question of the medical feasibility and durability of treatment. From an economic angle we ask ourselves whether we can pay for everything that is medically feasible. From the patient's perspective there is the legitimate de- sire and the justified need not to leave anything untried that might serve to sustain or improve the quality of life. The ethical perspective: is what is feasible really desirable? Should everything be done simply because it can be done? Is it ethically acceptable to set an age limit on an opera- tion that in all probability will produce an improvement in the quality of life? And if so, where does this limit lie? Below it surgery is "worthwhile" but above it is not? No- one in all seriousness and with a clean conscience will want to draw this line randomly or arbitrarily. That ap- pears to us - quite rightly - morally unacceptable. The doctors' perspective: they are obliged by the Hippo- cratic oath in principle to carry out all the treatments that are indicated and comply with the rules of the art of med- ICIne.