Coronary care unit
Encyclopedia
A coronary care unit is a hospital ward specialized in the care of patient
s with heart attack
s, unstable angina
, Cardiac dysrhythmia
and (in practice) various other cardiac conditions that require continuous monitoring and treatment.
or the continuous monitoring of the cardiac rhythm by electrocardiography
. This allows early intervention with medication
, cardioversion
or defibrillation
, 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
, a specific indication is generally necessary, while for others, such as heart block
, coronary care unit admission is standard.
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 catheter
s is common, as are supportive modalities such as mechanical ventilation
and intra-aortic balloon pump
s (IABP).
Certain hospitals, such as Johns Hopkins http://www.hopkinsmedicine.org/cardiology/ccu.htm, maintain mixed units consisting of both Acute care units for the critically ill, and intermediate care units for patients who are not critical.
, or post-operative "open-heart" patients commonly abide here.
.
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
, and early CCUs were located in Sydney
, Kansas City
and Philadelphia. Studies published in 1967 revealed that those observed in a coronary care setting had consistently better outcomes. The first coronary care unit was opened at Bethany Medical Center in Kansas City, Kansas
by Dr Hugh Day, and he coined the term. Bethany Medical Center is also where the first "crash carts" were developed.
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
s with heart attack
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
s, unstable angina
Unstable angina
Unstable angina is a type of angina pectoris that is irregular. It is a type of acute coronary syndrome.It can be difficult to distinguish from non–Q-wave myocardial infarction.-Definition:...
, Cardiac dysrhythmia
Cardiac dysrhythmia
Cardiac dysrhythmia is any of a large and heterogeneous group of conditions in which there is abnormal electrical activity in the heart. The heart beat may be too fast or too slow, and may be regular or irregular.Some arrhythmias are life-threatening medical emergencies that can result in cardiac...
and (in practice) various other cardiac conditions that require continuous monitoring and treatment.
Characteristics
The main feature of coronary care is the availability of telemetryTelemetry
Telemetry is a technology that allows measurements to be made at a distance, usually via radio wave transmission and reception of the information. The word is derived from Greek roots: tele = remote, and metron = measure...
or the continuous monitoring of the cardiac rhythm by electrocardiography
Electrocardiogram
Electrocardiography is a transthoracic interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body...
. This allows early intervention with medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
, cardioversion
Cardioversion
Cardioversion is a medical procedure by which an abnormally fast heart rate or cardiac arrhythmia is converted to a normal rhythm, using electricity or drugs. Synchronized electrical cardioversion uses a therapeutic dose of electric current to the heart, at a specific moment in the cardiac cycle...
or defibrillation
Defibrillation
Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...
, 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
Atrial fibrillation is the most common cardiac arrhythmia . It is a common cause of irregular heart beat, identified clinically by taking a pulse. Chaotic electrical activity in the two upper chambers of the heart result in the muscle fibrillating , instead of achieving coordinated contraction...
, a specific indication is generally necessary, while for others, such as heart block
Heart block
A heart block can be a blockage at any level of the electrical conduction system of the heart .* Blocks that occur within the sinoatrial node are described as SA nodal blocks....
, coronary care unit admission is standard.
Local differences
In the United States, coronary care units are usually subsets of intensive care unitIntensive Care Unit
thumb|220px|ICU roomAn intensive-care unit , critical-care unit , intensive-therapy unit/intensive-treatment unit is a specialized department in a hospital that provides intensive-care medicine...
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 catheter
Pulmonary artery catheter
In medicine pulmonary artery catheterization is the insertion of a catheter into a pulmonary artery. Its purpose is diagnostic; it is used to detect heart failure or sepsis, monitor therapy, and evaluate the effects of drugs...
s is common, as are supportive modalities such as mechanical ventilation
Mechanical ventilation
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
and intra-aortic balloon pump
Intra-aortic balloon pump
The Intra-aortic balloon pump ' is a mechanical device that increases myocardial oxygen perfusion while at the same time increasing cardiac output. Increasing cardiac output increases coronary blood flow and therefore myocardial oxygen delivery...
s (IABP).
Certain hospitals, such as Johns Hopkins http://www.hopkinsmedicine.org/cardiology/ccu.htm, 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 (ACCU), also called "critical coronary care units" (CCCU) is equivalent to intensive care in the level of service provided. Patients with acute myocardial infarction, cardiogenic shockCardiogenic shock
Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively....
, or post-operative "open-heart" patients commonly abide here.
Subacute coronary care
Subacute coronary care units (SCCU), also called Progressive care units (PCU), Intermediate coronary care units (ICCU), or stepdown units, and 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 anginaUnstable angina
Unstable angina is a type of angina pectoris that is irregular. It is a type of acute coronary syndrome.It can be difficult to distinguish from non–Q-wave myocardial infarction.-Definition:...
.
History
Coronary care units developed in the 1960s when it became clear that close monitoring by specially trained staff, cardiopulmonary resuscitationCardiopulmonary resuscitation
Cardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive...
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
British Thoracic Society
The British Thoracic Society was formed in 1982 by the amalgamation of the British Thoracic Association and the Thoracic Society. It is a registered charity and a company limited by guarantee.-Function:...
, and early CCUs were located in Sydney
Sydney
Sydney is the most populous city in Australia and the state capital of New South Wales. Sydney is located on Australia's south-east coast of the Tasman Sea. As of June 2010, the greater metropolitan area had an approximate population of 4.6 million people...
, Kansas City
Kansas City, Missouri
Kansas City, Missouri is the largest city in the U.S. state of Missouri and is the anchor city of the Kansas City Metropolitan Area, the second largest metropolitan area in Missouri. It encompasses in parts of Jackson, Clay, Cass, and Platte counties...
and Philadelphia. Studies published in 1967 revealed that those observed in a coronary care setting had consistently better outcomes. The first coronary care unit was opened at Bethany Medical Center in Kansas City, Kansas
Kansas City, Kansas
Kansas City is the third-largest city in the state of Kansas and is the county seat of Wyandotte County. It is a suburb of Kansas City, Missouri, and is the third largest city in the Kansas City Metropolitan Area. The city is part of a consolidated city-county government known as the "Unified...
by Dr Hugh Day, and he coined the term. Bethany Medical Center is also where the first "crash carts" were developed.