To describe the macroscopic characteristics of chronic Chagas heart disease in autopsied elderly.The elderly studied were 60 or older. Twenty of them had chronic Chagas heart disease (CHD) and positive serology for the disease, and 14 had no heart disease (WHD) nor morphological changes suggestive of it and were serologically negative for Chagas disease.The CHD elderly had cardiac weight greater than the WHD (385 +/- 141.1 vs 306.8 +/- 62.1g, respectively; p > 0.05), in addition to significantly higher heart weight-to-body weight ratio (0.71% [0.5-1.42%] vs 0.59% [0.47-0.91%] p < 0.05). When compared, the CHD elderly presented lower fibrous thickening and/or atherosclerosis in the ascending aorta, mitral and tricuspid valves, and left and right coronaries than the WHD elderly. In the aortic and mitral valves, the lesions were significantly less severe (p < 0.05). Left ventricular apical lesion was observed in 45% of the CHD elderly, and intracardiac thrombosis in the left ventricle was found in 10% of them.Fibrous thickening and/or atherosclerosis were found to be less severe in the valves and arteries of the CHD elderly. Moreover, heart weight and intracardiac thrombosis frequency were lower than those detailed in the literature for non-elderly individuals.