The intermediate coronary care unit. A stage in continued coronary care.

Abstract

The concept of continued and progressive coronary care rather than intermediate coronary care is proposed.At each clinical stage the patient may be at risk and his management needs tv b3 planned appropriatelyprevention of the development of coronary disease, prehospital care, acute coronary care, subacute coronary care, and late hospital stay. Meticulous continued care once the patient leaves the hospital and returns home may be neededfor a long time.Although the benefit of an intermediate coronary care unit has not yet been proved, significant patient risk continues beyond 12 days of hospital admission. High risk patient subsets are emerging requiring careful continued monitoring and the ability to undertake emergency measures as needed, and this is particularly so in patients suffering large anterior infarction, in those with infarction associated with cardiac failure, when infarction is associated with fascicular block and other types of conduction disturbances, and in patients who continue with rhythm disturbances after their admission to the hospital. Electrocardiograph leads III and Vl displayed simultaneously should be routinely monitored in patients with fascicular blocks and acute anterior infarction as a guide to instituting prophylactic transvenous pacemaking.The continuation of intensive patient care and monitoring beyond the usual 2 to 5 days in a coronary care unit allows early mobilisation ofpatients in safety, thus speeding their ultimate rehabilitation.There is, as yet, no satisfactory study documenting the need for intermediate coronary care units, but much presumptive evidence is available to indicate that this is so. A carefully controlled randomised study z uld be invaluable.'Keep your enthusiasm, but let strict verification be its constant companion'-Pasteur. Despite some contrary views (Mather et al., 1971) most agree that coronary care units (CCU) reduce the mortality of acute myocardial infarction provided that the patient survives long enough to be admitted (Meltzer, 1968;Pantridge, 1970;Hofvendahl, 1971;MacMillan and Brown, 1971). In our own CCU an analysis of more than 500 proven cases of acute myocardial infarction has shown a progressive decline of mortality in the acute phases of myocardial infarction from more than 28 per cent

Intermediate Coronary Care Units

“…Of these deaths 43% occurred after the patient had left the CCU and while he was being cared for in an immediately adjacent cardiology ward. 3 The causes of death were cardiac failure in 54% and rhythm disturbance in 40%; the remaining 6% died of a variety of causes. Other reports confirm these findings.1011…”

“…Patients having myocardial infarction associated with cardiac failure; often these patients have suffered previous myocardial infarction, or systemic hypertension was known to be present. 3. Those having myocardial infarction in association with fascicular block.…”

Efeito do tratamento crônico do metotrexato associado à nanoemulsão de LDE no remodelamento cardíaco por infarto do miocárdio em ratos Wistar

“…Este processo é parte integrante do remodelamento agudo no pós-infarto (Swynghedauw, 1999;Opie et al, 2006) Levando em consideração que a limpeza dos debrís celulares pelos neutrófilos, monócitos e macrófagos é fundamental na cicatrização do infarto, no entanto, a modulação desta resposta inflamatória é importante para prevenir excessiva degradação tecidual levando à expansão do infarto e IC (Kempf et al, 2012). Alguns estudos demonstram que a limitação do tamanho do infarto é uma importante estratégia para controlar a IC (Resnekov, 1977;Geltman, 1979). Sendo assim, os efeitos da limitação do infarto de diversos fármacos com ações anti-inflamatórias foram testados na tentativa de encontrar tratamentos eficazes para o IAM (Madias et al, 1982;Scheuer et al, 1997;Kempf et al, 2012).…”