Echocardiographic and therapeutic approach to heart failure in the elderly

In most elderly patients, cardiac failure is associated with multiple cardiac pathologies, and the most common underlying abnormality is ventricular systolic dysfunction with reduced ejection fraction. In patients without cardiac enlargement, diastolic dysfunction may be predominant and left ventricular ejection fraction may be normal. Echocardiography is particularly suitable to evaluate changes in cardiovascular function that accompany age either as changes in disease patterns or as changes resulting simply from aging. The effects of digitalis on systolic and diastolic dysfunction are briefly reviewed, as well as the effects of diuretics, angiotensin-converting-enzyme inhibitors, and anticoagulant drugs.