As the number of individuals over age 65 years continues to increase, the elderly will comprise an ever-growing portion of each physician's practice. While heart disease in the elderly may be similar in many respects to that in younger patients, major age-related differences do exist with regard to etiology, pathogenesis, natural history, clinical presentation, and management. Optimal management of the older cardiac patient requires that these differences be taken into account. In prescribing a medical regimen, it is important to keep in mind that age-related decreases in renal function, hepatic perfusion, and drug metabolism may result in higher drug levels and that the elderly are also often more prone to adverse drug effects, especially central nervous system changes. One should remember that chronology is not necessarily synonymous with physiology, and much depends on the individual patient in terms of the lifestyle he/she led and that which he/she wishes to have. Advanced age may be associated with greater interventional morbidity and mortality, but age alone should not be a contraindication to aggressive medical or surgical therapy.