Acute Coronary Care

When a patient develops symptoms suggestive of and infarction, this section is emphasized. There acute coronary insufficiency, the health care sys- are brief sections on prediction and prevention of tem is presented with a challenging diagnostic ischemic events, methods of diagnosing and siz- and management problem. During the past 20 ing infarcts, and methods of monitoring the pa- years, hospitals have been developing coronary tient with myocardial ischemia. A major focus of care units as the specialized inhospital facilities for the text is on "coronary care. " As indicated above, such patients. For the past 15 years, many com- during the past 20 years five distinct phases of munities have employed paramedical personnel coronary care have evolved: (a) prehospital, (b) to extend the principles of "coronary care" to the postadmission, (c) coronary care unit, (d) predis- site of the patient who develops the problem. charge, and (e) convalescent. Cardiac rehabilitation programs have also been The section on pathophysiology begins with a established to facilitate the return to function of chapter by Greenfield and Rembert discussing patients who have had acute coronary insuffi- the factors that determine the transmural distri- ciency. More recently, aggressive medical and bution of blood flow. Reimer then shows the surgical techniques have been developed to either relationship between coronary blood flow and prevent or limit the extent of myocardial necrosis both reversible and irreversible damage to the that develops due to acute coronary insufficiency. myocardium.