The proportion of the population aged 80 to 100years and beyond looks set to increase considerably over the coming decades, which will pose a major public health problem. The specificity of geriatric cardiology as compared to general adult cardiology resides in the fact that every medical intervention requires ethical reflection: to do or not to do? How should we do it and how far should we go? Geriatric cardiology differs not so much in terms of the actual medical and technical application, but rather in the decisions to use, or on the contrary, forego such interventions. In addition to solid knowledge built on evidence-based medicine, geriatric cardiology requires that the physician exercise a spirit of synthesis that might justify deviation from medical guidelines where necessary.