Coronary Care Unit
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A coronary care unit (CCU) or cardiac intensive care unit (CICU) is a hospital ward specialized in the care of
patient A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The patient is most often Disease, ill or Major trauma, injured and in need of therapy, treatment by a physician, nurse, op ...
s with
heart attack A myocardial infarction (MI), commonly known as a heart attack, occurs when Ischemia, blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction (tissue death) to the heart muscle. The most common symptom ...
s,
unstable angina In dynamical systems instability means that some of the outputs or internal states increase with time, without bounds. Not all systems that are not stable are unstable; systems can also be marginally stable or exhibit limit cycle behavior ...
, cardiac dysrhythmia and (in practice) various other cardiac conditions that require continuous monitoring and treatment.


Characteristics

The main feature of coronary care is the availability of
telemetry Telemetry is the in situ collection of measurements or other data at remote points and their automatic transmission to receiving equipment (telecommunication) for monitoring. The word is derived from the Greek roots ''tele'', 'far off', an ...
or the continuous monitoring of the cardiac rhythm by
electrocardiography Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity through repeated cardiac cycles. It is an electrogram of the heart which is a graph of voltage versus time of t ...
. This allows early intervention with
medication Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmaco ...
,
cardioversion Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs. Synchronized electrical cardioversion uses a therapeutic dose of ...
or
defibrillation Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). Defibrillation delivers a dose of electric current (often called a ''count ...
, improving the prognosis. As arrhythmias are relatively common in this group, patients with myocardial infarction or unstable angina are routinely admitted to the coronary care unit. For other indications, such as
atrial fibrillation Atrial fibrillation (AF, AFib or A-fib) is an Heart arrhythmia, abnormal heart rhythm (arrhythmia) characterized by fibrillation, rapid and irregular beating of the Atrium (heart), atrial chambers of the heart. It often begins as short periods ...
, a specific indication is generally necessary, while for others, such as heart block, coronary care unit admission is standard.


Utilization

In the United States, cardiac conditions accounted for eight of the eighteen conditions and procedures with high ICU utilization (ICU utilization in more than 40% of stays) in 2011.


Local differences

In the United States, coronary care units are usually subsets of
intensive care unit An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive care medicine. An inten ...
s (ICU) dedicated to the care of critically ill cardiac patients. These units are usually present in hospitals that routinely engage in cardiothoracic surgery. Invasive monitoring such as with pulmonary artery catheters is common, as are supportive modalities such as
mechanical ventilation Mechanical ventilation or assisted ventilation is the Medicine, medical term for using a ventilator, ventilator machine to fully or partially provide artificial ventilation. Mechanical ventilation helps move air into and out of the lungs, wit ...
and intra-aortic balloon pumps (IABP). Certain hospitals, such as Johns Hopkin

maintain mixed units consisting of both acute care units for the critically ill, and intermediate care units for patients who are not critical.


Acute coronary care

Acute coronary care units (ACCUs), also called "critical coronary care units" (CCCUs), are equivalent to intensive care in the level of service provided. Patients with acute myocardial infarction,
cardiogenic shock Cardiogenic shock is a medical emergency resulting from inadequate blood flow to the body's organs due to the dysfunction of the heart. Signs of inadequate blood flow include low urine production (<30 mL/hour), cool arms and legs, and decreased ...
, or post-operative "open-heart" patients commonly abide here.


Subacute coronary care

Subacute coronary care units (SCCUs), also called progressive care units (PCUs), intermediate coronary care units (ICCUs), or stepdown units, provide a level of care intermediate to that of the intensive care unit and that of the general medical floor. These units typically serve patients who require cardiac telemetry, such as those with
unstable angina In dynamical systems instability means that some of the outputs or internal states increase with time, without bounds. Not all systems that are not stable are unstable; systems can also be marginally stable or exhibit limit cycle behavior ...
.


History

Coronary care units developed in the 1960s when it became clear that close monitoring by specially trained staff,
cardiopulmonary resuscitation Cardiopulmonary resuscitation (CPR) is an emergency procedure used during Cardiac arrest, cardiac or Respiratory arrest, respiratory arrest that involves chest compressions, often combined with artificial ventilation, to preserve brain function ...
and medical measures could reduce the mortality from complications of cardiovascular disease. The first description of a CCU was given in 1961 to the British Thoracic Society by Desmond Julian, who founded the first CCU at the Royal Infirmary of Edinburgh in 1964. Early CCUs were also located in
Sydney Sydney is the capital city of the States and territories of Australia, state of New South Wales and the List of cities in Australia by population, most populous city in Australia. Located on Australia's east coast, the metropolis surrounds Syd ...
,
Kansas City The Kansas City metropolitan area is a bi-state metropolitan area anchored by Kansas City, Missouri. Its 14 counties straddle the border between the U.S. states of Missouri (9 counties) and Kansas (5 counties). With and a population of more t ...
,
Toronto Toronto ( , locally pronounced or ) is the List of the largest municipalities in Canada by population, most populous city in Canada. It is the capital city of the Provinces and territories of Canada, Canadian province of Ontario. With a p ...
and
Philadelphia Philadelphia ( ), colloquially referred to as Philly, is the List of municipalities in Pennsylvania, most populous city in the U.S. state of Pennsylvania and the List of United States cities by population, sixth-most populous city in the Unit ...
. The first coronary care unit in the US was opened at Bethany Medical Center in
Kansas City, Kansas Kansas City (commonly known as KCK) is the third-most populous city in the U.S. state of Kansas and the county seat of Wyandotte County. It is an inner suburb of the older and more populous Kansas City, Missouri, after which it is named. As ...
by Hughes Day, and he coined the term. Bethany Medical Center is also where the first "crash carts" were developed. Studies published in 1967 revealed that those observed in a coronary care setting had consistently better outcomes. DF Beck performed the first successful resuscitation of a physician with myocardial infarction in 1953, and pioneered the use of open-chest defibrillation. Zoll introduced external defibrillation in Boston in 1956, and Kouwenhoven and colleagues at Johns Hopkins highlighted the effectiveness of a combo of mouth-to-mouth, sternal compression, and closed chest defibrillation in restoring cardiac function in ventricular fibrillation patients. The first diagnostic angiogram was discovered by Mason Sones in 1958, due to an accidental injection of dye directly into the coronary artery rather than into the entire circulation - something that was previously believed to be fatal. These developments led to an interest in intensive care for myocardial infarction. In 1967, Thomas Killip and John Kimball published a report of 250 patients with acute MI's, who had experienced significantly better survival rates in CCUs compared to other institutions. This, along with other reports, led to an increase in coronary care units. Now catheterization units are commonplace in large cities.


References

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