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Congestive heart failure.

The prevalence of congestive heart failure increases as the population ages. Conventional treatment of congestive heart failure is usually applied to persons over 60 with heart failure; yet very little is known concerning the cardiovascular alterations induced by aging. Animal experiments have indicated that presbycardia as a distinctive entity does exist but that it does not, in and of itself, cause heart failure in large numbers of individuals. The main causes remain the same as those in the younger population (i.e. ischemic and hypertensive disease). Diagnosis is altered in aged individuals because symptoms and signs may not be those classically described and taught. Pharmacologic treatment is hampered by a decreased responsiveness to inotropic agents, while toxicity levels are probably not altered. Although vasodilators may theoretically promote more satisfactory results, their clinical effectiveness and potential toxicities in elderly patients have not been evaluated.