The coronary care unit at RNH Haslar is described, the management of patients outlined, and the results of treatment of 98 consecutive cases of acute myocardial infarction over a fifteen month period reported. As regards characteristics of the patients, extent and site of myocardial infarction, incidence of complications, mortality and causes of death, the results are generally comparable to those of large published series. The incidence of venous thrombosis, pulmonary embolism and supraventricular arrhythmias was perhaps higher than reported experience, and consequently some changes in management are suggested.
There is little hope in the foreseeable future of a substantial reduction in mortality from myocardial failure, complete heart block, or by preventing late sudden deaths. Effective treatment of ventricular fibrillation, and possibly its prevention, remain the cornerstones of coronary care, and undoubtedly reduce the hospital mortality of acute myocardial infarction. It is essential that a member of staff competent to defibrillate immediately is present in the unit at all times.
It is concluded that a purpose-built coronary care unit, sophisticated monitoring or alarm systems, and highly trained staff are not essential to provide effective coronary care.
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