Diagnostic and therapeutic procedures in the ageing heart require a holistic approach considering polypathology and polypharmacology of the diseased organism. Adaptation to stress is inadequate due to a delayed and reduced reaction of the sympathetic nervous system. Vagal disturbances are discussed as well. Coronary heart disease and its complications, bradyarrhythmias and premature atrial and ventricular contractions and congestive heart failure dominate the clinical picture of the elderly patient. These clinical entities represent the main causes for death at higher age. Pharmacotherapy has to be adjusted according to differences in absorption, pharmacokinetics and pharmacodynamics, drug interferences and an age specific spectrum of side effects.
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