Atypical presentations of cardiovascular disorders in the elderly.

Despite the high prevalence of cardiac disease in the elderly, specific cardiac disorders are often missed or misdiagnosed in this age group. Not uncommonly, the clinical manifestations are significantly different from those in the younger patient with the same disorder. The classical findings of aortic valve stenosis may not be present and the disorder is frequently misdiagnosed as mitral valvular incompetence. Mitral valve prolapse, usually considered a benign disorder in the young and middle-aged, may present with heart failure in the elderly, and mitral valve surgery may be necessary. Instead of angina pectoris, dyspnea may be the first manifestation of coronary artery disease in the elderly. Acute myocardial infarction may be silent or present in an atypical manner with abdominal distress, acute signs of cerebral insufficiency, or dyspnea.