Acute Coronary Care 1987

ISBN-13: 9781461294351 / Angielski / Miękka / 2012 / 368 str.

Robert M. Califf; G. S. Wagner; Robert M. Califf

Opis

During the 25 years since acute coronary care was focused into Coronary Care Units there have been three major Phases: I. prevention of death caused by arrhythmias; II. prevention of death due to myocardial failure; and III. limitation of infarct size. In the latter two Phases, there has been infringement upon the time honored concept of a prolonged period of rest for the patient in general and the heart in particular to minimize myocardial metabolic demands. During the second Phase of coronary care, patients with myocardial failure received aggressive measures to increase cardiac work via increase in preload, decrease in afterload, and direct increase in inotropy. It was believed that true cardiogenic shock was so irreversible that it should be prevented by vigorous efforts to improve the cardiac output despite the risk of extending the area of ischemic myocardium. However, Phase II produced minimal overall reduction in mortality. In the initial part of Phase III, myocardial infarct (MI) size limitation was attempted by reducing myocardial metabolic demands via either beta adrenergic or calcium channel blocking agents. We are currently several years into the second part of Phase III of coronary care where the principle means of limiting MI size is restoration of coronary blood flow.

Spis treści

I. Coronary Care: The Pre-Hospital Phase.- 1. Automatic Detection of Ventricular Fibrillation/Defibrillation.- 2. Helicopter Transport of Patients with Acute Ischemic Syndromes.- 3. Medico-legal Principles of Emergency and Intensive Medical Care.- II. Coronary Care: The Post-Admission Phase.- 4. Effects of Lidocaine on Ventricular Fibrillation, Asystole, and Early Death in Patients with Suspected Acute Myocardial Infarction.- 5. Intravenous Beta Blocker Therapy for Acute Myocardial Infarction.- 6. The Role of Tissue Plasminogen Activator in Myocardial Infarction.- 7. The Use of Confidence Profiles to Assess Tissue-type Plasminogen Activator.- III. Coronary Care: The Coronary Care Unit Phase.- 8. Preparation of the Nurse for Coronary Care in the 80’s.- 9. ST Segment Changes During Early Myocardial Infarction.- 10. A New Method for Electrocardiographic Monitoring.- 11. Computerized Quantitative Electrocardiography: Potential Roles in Evaluating the Cardiac Patient.- 12. External Transthoracic Pacing in Patients with Acute Myocardial Infarction.- 13. Use of the Intra-aortic Balloon Pump in Unstable Angina.- 14. Criteria for Transfer from the Coronary Care Unit.- 15. Prognosis, Treatment and Special Concerns of Older Patients Following Acute Myocardial Infarction.- IV. Coronary Care: The Pre-Discharge Phase.- 16. Risk Stratification Post Myocardial Infarction.- 17. Left Ventricular Volume Changes Following Acute Myocardial Infarction.- 18. Use of the Echocardiogram for Identifying Infarct Expansion.- 19. Ventricular Arrhythmias after Acute Myocardial Infarction: Consideration of Arrhythmia Frequency, Complexity and Variability in Assessing Risk of Sudden Cardiac Death.- 20. The Role of the Signal Averaged Electrocardiogram in Predicting Post Infarction Ventricular Tachycardia and Sudden Death.- 21. The Role of Electrophysiologic Testing in the Post-myocardial Infarction Patients.- V. Coronary Care: The Convalescent Phase.- 22. The Use of Exercise Cross-sectional Echocardiography and Exercise Doppler Echocardiography for the Assessment of Coronary Disease.- 23. The Management of Q-wave versus Non-Q-wave Infarction.- 24. Current Status of Calcium Channel Blockers After Myocardial Infarction.