Admissions to hospital of patients aged 75 or over with symptoms suggestive of acute myocardial infarction have increased markedly since 1982. Patients over 75 present to hospital as soon after the onset of symptoms as do younger patients; they require more treatment with diuretics and digoxin than do younger patients and their fatality rate is higher. Despite this, the chance of patients over 75, especially women, being admitted to a Coronary Care Unit, and so being treated with a thrombolytic and being monitored closely for the complications of acute infarction are much less than those for patients under 75. If we are confident that we can influence the outcome of and reduce fatality from acute myocardial infarction, we should be prepared to offer elderly patients the same opportunities for treatment that we currently afford to younger patients.