Pathology of the heart with and without cardiac failure in the aged.

According to the Registrar General's Review for 1962 (General Register Office, 1964) half the deaths from diseases of the circulatory system occur in patients over 75 years of age yet little is known of the pathology of the heart in the elderly. Recent clinical reviews (Caird, 1963; Lancet, 1963) emphasize the importance of this subject, but though information on the general morbid anatomy of old age is accumulating (Howell, 1963), little detailed work on cardiovascular pathology is at present available. Cardiovascular disease accounts for over 40 per cent of deaths over 75 years, and with the increasing life span of the population, the problem of heart disease in the elderly is one of growing importance. At the same time the quantity of pathological material available for study is also increasing. The routine necropsies in this hospital over a 22-month period have included 370 patients over 75 years of age, and this communication describes the results of detailed studies of their hearts. Findings in patients with cardiac failure are compared with those in patients with clinically normal cardiovascular systems, and the part played by the various abnormalities, and by multiple pathology, in the pathogenesis of cardiac failure in the elderly is discussed.