What is the difference in cardio-vascular diseases in the elderly? - In elderly patients with acute coronary syndrome the diagnosis is frequently hampered by non-specific symptoms and these patients often seek medical help later than younger individuals. Elderly and old patients with acute coronary syndrome are still less frequently being referred to percutaneous coronary intervention (PCI) than younger patients, although statistically even octogenarians profit from PCI more than from thrombolysis or purely drug therapy. In stable coronary artery disease the focus is on consistent treatment of risk factors. Therapy of systolic heart failure in the elderly is not fundamentally different from that administered to younger individuals, and therapy is just as effective. In old age diastolic heart failure is frequent. The risk of thrombo-embolic complications in atrial fibrillation increases with age. What makes the difference in cardio-vascular diseases in the elderly? - Physiological organ aging processes and immunosenescence provide possible explanations for the frequently atypical clinical presentation of severe ailments and altered pharmacokinetics in old age. Influenza and pneumococcus vaccinations are effective in preventing cardiovascular events.