Updated use of digitalis and nitrates in the elderly.

Myocardial ischemia may be produced by a wide variety of pathophysiologic scenarios. Currently, long-acting nitrates, beta blockers, and calcium blocking drugs are available to treat ischemia. Each class of therapy poses potential problems for the elderly, and therapy must be individualized. Long-acting nitrates are probably not the best choice of monotherapy since tolerance develops to their use over time. Congestive heart failure, a common sequela to myocardial infarction, is currently best treated by diuretics and vasodilating drugs. These therapies are generally well-tolerated by the elderly. Digitalis, which is not easily given to the elderly due to potential toxicity, is probably best avoided in this patient group unless needed to treat arrhythmia. Careful differential diagnosis of congestive heart failure is a critical pre-condition to starting any therapy for heart failure, particularly in the elderly patient.