PubMed · 244523
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L C Colvin, D L Bertram. 1978. CCUitis.. https://pubmed.ncbi.nlm.nih.gov/244523/
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OBJECTIVE: To examine the immediate and long-term clinical and prognostic significance of primary ventricular tachycardia, defined as tachycardia of ventricular origin occurring within 48 hours of acute myocardial infarction in patients without hemodynamic compromise (Killip class I). DESIGN: Prospective cohort study. SETTING: Intensive coronary care units in eight regional, referral, and university hospitals. PATIENTS: A total of 162 patients with primary ventricular tachycardia, both sustained and nonsustained (study group), and 2578 counterparts without ventricular tachycardia (reference group). MEASUREMENTS: In-hospital rates of atrial fibrillation, atrioventricular block, congestive heart failure, cardiogenic shock, and cardiac arrest. In-hospital and 1-year follow-up rates of sudden death, nonsudden cardiac death, and noncardiac death. RESULTS: The study and reference groups had similar mortality (in-hospital, 6.8% and 9.6%, P greater than 0.2 and at 1 year after discharge, 3.7% and 5.4%, P greater than 0.2, respectively) and in-hospital complication rates (atrioventricular block, 13.0% and 9.7%, P greater than 0.2; cardiogenic shock, 3.7% and 3.0%, P greater than 0.2; cardiac arrest, 1.8% and 4.4%, P greater than 0.2, respectively). Patients with sustained ventricular tachycardia (28 patients) compared with those with nonsustained ventricular tachycardia (134 patients) had higher rates of polymorphic tachycardia (50% compared with 6%, P = 0.001), in-hospital total cardiac mortality (21% compared with 4%, P = 0.003) and sudden-death mortality (14% compared with 2%, P = 0.001); they also showed a trend toward a higher in-hospital mortality than the reference group (21.4% compared with 9.6%, P = 0.15) but had no increased mortality 1 year after discharge (4.6% compared with 5.4%, P greater than 0.2). CONCLUSIONS: As a group, patients with primary ventricular tachycardia do not differ from counterparts without primary ventricular tachycardia in their in-hospital clinical course and 1-year prognosis. Primary sustained ventricular tachycardia is often polymorphic and carries worse in-hospital prognosis than nonsustained tachycardia. However, it does not predict recurrent ventricular tachycardia or increased sudden-death rates during the next year.
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The purpose in this article is to give an overview of the role of a coronary care nurse. No attempt is made to give a detailed account of any particular aspect of care but rather to inspire coronary care nurses to think about their practice and what can be achieved. In the 1960s Coronary Care Units (CCUs) were shown to reduce mortality from fatal arrhythmias and nursing care was based around observation and emergency treatment. The focus of coronary care is now moving towards infarct size reduction and the prevention of infarction in patients with unstable angina. Nurses are adapting their role accordingly--the skill, knowledge and judgement required to recognise reversible ischaemic episodes in the early pre- or post-infarctional period is paramount. It is equally and vitally important that nurses are able to recognise and assess the psychological and rehabilitation needs of patients. These aspects of care can be met ideally by using a system based on primary nursing and focusing on the patients' individual needs. Nursing practice should be research-based, and under constant review with positive change encouraged.