Coronary Care
Unit
These units are routinely equipped with a system that permits
continuous monitoring of the cardiac rhythm of each patient and hemodynamic monitoring
in selected patients.
Defibrillators,
respirators, noninvasive Tran thoracic pacemakers, and facilities for introducing
pacing catheters and flow directed balloon tipped catheters are also usually available.
Equally important is the organization of a highly trained team of nurses
who can recognize arrhymias, adjust the dosage of antiarrhythmic, vasoactive and
anticoagulant drugs, and perform cardiac resuscitation, including electroshock
when necessary.
Patients should be admitted to a coronary care unit
early in their illness when It is expected care provided. The availability of
electrocardiograpic monitoring and trained personnel outside the coronary care
unit had made it possible to admit lower risk patients (those not hemodynamically
compromised and without active arrhymias) o “intermediate care units”.
The duration of stay in the coronary care units is dictated by the on
going need for intensive care. IF STEMI has been ruled out with in 8 to 12 h and
symptoms are controlled with oral therapy.
Patients may be transferred
out of the coronary care units. Also patients who have a confirmed STEMI but who
are considered to be at low risk may be safely transferred out of the coronary
care unit with in 24h .
Activity
Factors
that increased the work of the heart during the initial hours of infarction may
increase the size of the infarct . There fore patients with STEMI should be kept
at bed rest for the first 12h.
However in the absences of complications,
patients should be encouraged, under supervision , to resume an upright posture
by dangling their feet over the side of the be3d and sitting in a chair with in
the first 24 h.
This practice is psychologically beneficial and usually
result in a reduction in the pulmonary capillary wedge pressure. In the absence
of hypotension and other complications, by the second or third day.
Patients
typically are ambulating in their room with increasing duration and frequency
and they may shower or stand at the sink to bathe. By day 3 after infraction,
patients should be increasing their ambulation progressively to a goal of 185m
a least times a s day.
Diet
Because
of the risk of emesis and aspiration soon after MI. patients should receive either
nothing or only clear liquids by mouth for the first 4 to 12h.
The typical
coronary care unit diet should provide <300 mg/d. Complex carbohydrates should,
make up 50 to 55 % of total calories.
Portions should not be unusually
large, and the menu should be enriched with food that are high in potassium, magnesium
, and fiber but low in sodium. Diabetes mellitus and hypertriglyceridemai are
managed by restriction of concentrated sweets in the diet.
Antithrombotic
Agent
The
use of antiplatelet and antithrombin therapy during the initial phase of STEMI
is based on extensive laboratory and clinical evidence that thrombosis plays an
important role in the pathogeisis of this conditions.
The primary goal
of treatment with antiplatelet and antithrombin agents is to establish and maintain
patency tendency to thrombosis and thus the like wood of mural thrombus formation
or deep venous thrombosis, either of which could result in pulmonary embolization
Beta
Andrenoceptor Blockers.
The
benefit of the beta-blockers in patients with STEMI can be divided in to those
that occur immediately when the drug is given for secondary prevention after an
infarction.
Acute intravenous beta blockade improves the myocardial
oxygen supply demand relationship, decreases pain, reduce infarct size, and decreases
the incidence of serious ventricular arrhythmias.
An overview of the
data from 27000 patients enrolled in nine randomized trials in the prethrombolysis,
era indicates that intravenous.
Fllowed by oral beta blocked is associated
with a 15% relative reduction, in mortality nonfatal reinfarction, and nonfatal
cardiac arrest. In patients who undergo fibrinolyisis soon after the onset of
chest pain, no incremental reduction and reinfarction are reduced.
