Survival after acute myocardial infarction is decreased in elderly patients as compared with the overall adult population. Although several cardiac and noncardiac causes could contribute to the increased mortality rate, little is known regarding the relative susceptibility of aging myocardium to injury during ischemia and reperfusion. We hypothesized that the elderly heart is intrinsically more susceptible to damage than the adult heart. The recovery of isolated, buffer-perfused rat hearts from elderly animals (Fischer 344 rats, 24 months of age) was compared with that of adult hearts (6 months of age) obtained from the same strain. Hearts underwent 25 minutes of ischemia followed by 30 minutes of reperfusion. Hemodynamic recovery was decreased in elderly (n = 5) as compared with adult (n = 5) hearts, including developed pressure (% of preischemic baseline: elderly 31% +/- 4% vs adult 57% +/- 4%, p < 0.01). Elderly hearts also sustained greater tissue damage, with a markedly increased release of creatine kinase (elderly 2950 +/- 500 U vs adult 860 +/- 345 U, p < 0.01) during the 30-minute reperfusion period. The release of total protein and lactate dehydrogenase, other markers of myocyte injury, was also increased. Thus the elderly rat heart is more susceptible than the adult rat heart to ischemia-reperfusion injury. Greater injury during ischemia and reperfusion in an experimental model of aged myocardium raises the possibility of a more rapid progression of ischemic damage in elderly patients suffering acute myocardial infarction.