Shared decision-making for older adults with cardiovascular disease.

Shared decision-making is appropriate for clinical decisions involving multiple reasonable options, which occur frequently in the cardiovascular care of older adults. The process includes the communication of relevant factual information between the patient and the clinician, elicitation of patient preferences, and a mutual agreement on the best course of action to meet the patient's personal goals. For older adults, there are common challenges and considerations with regard to shared decision-making, some of which (eg, cognitive impairment) may be biologically linked to cardiovascular disease.

Spontaneous triple coronary artery dissection in a 78-year-old woman resolved angiographically with anticoagulation and medical management.

A 78-year-old woman who presented with chest pain, on a background of hypertension and varicose veins, was found to have a non-ST segment elevation myocardial infarction with coronary angiography demonstrating dissections of all three major arteries distally. She was treated medically, with anticoagulation and risk factor management as the primary therapies. This is the first reported case of triple spontaneous coronary artery dissection treated medically, along with angiographic follow-up demonstrating complete resolution.