By Elliott M. Antman M.D., F.A.C.C, John D. Rutherford M.B., F.R.A.C.P., F.A.C.C (auth.)

Attention to lowering the foremost danger components modern coronary care includes a linked to the advance of arterio­ multitude of measures: efforts to avoid the sclerosis has been frequent and looks to acute occasion; thrombolytic treatment to abort have decreased the prevalence of coronary artery infarction; pharmacological measures to hold up ailment. however, acute myocardial and decrease ischemic telephone dying; tracking of infarction and similar ischemic syndromes the hemodynamic outcomes of myocardial signify the commonest reasons of demise as infarction; therapy of acute pump failure; use good as one of many primary purposes for of recent electric units in addition to a wide hospitalization within the industrialized global. In variety of new medicines to avoid and deal with gentle of this, care of the sufferer with acute cardiac arrhythmias; and at last, id coronary sickness continues to be an enormous scientific ahead of sanatorium discharge of sufferers who're at problem. excessive threat for recurrent infarction or unexpected The method of dealing with sufferers with dying and the alternative of the ideal acute myocardial infarction may be stated to have administration process. advanced via 3 significant levels. For the This high-quality booklet offers entire first half-century after Herrick's landmark descriptions of those quite a few facets of paper describing this was once released in modern coronary care. it truly is actual, 1912, administration consisted essentially of thorough, and simply readable.

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From Goldman L, et al: A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain. ) segment elevations or Q waves into a highprobability terminal subgroup (figure 2-27). The computer protocol then classified the other patients using the presence or absence of new ischemic ST-segment or T -wave changes and seven other clinical factors. The breakdown of patients in each of the 14 terminal branches of the decision tree is documented in table 2-6. Integration of such a model with physicians' judgment may identify patients at low risk who do not need to be cared for in CCUs and may prevent the failure to admit patients who do require this specialized attention .

Q waves (or increased prominence of existing Q waves) ST-segment elevations, and T-wave inversions. As noted earlier in the initial phase of myocardial infarction ECG changes may be within normal limits or nonspecific, and serial tracings taken every 8 to 12 hours should be examined. When obtained at the time the patient presents to a doctor or the emergency room, the ECG should be a means of confirming the clinical impression and should not supersede it. If the patient is suspected clinically of having sustained a myocardial infarction, particularly based on the history, then he should be treated accordingly, even if the ECG tracing is completely normal.

3. 0 -.... 5 0 6 36 54 Months FIGURE 2-3. Survival of patients randomized to medical and surgical therapy in the National Cooperative Study of Unstable Angina Pectoris designed to compare surgical and medical therapy. The open circles represent all medical patients and the closed triangles represent all surgical patients. The survival curves for patients assigned to surgical and medical therapy did not differ statistically. The one-year survival rate was 93% for the medical and 92% for the surgical group, at two years the respective estimated survival rates were 91 % and 90%.

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