Preventive Management of Myocardial Infarction Mortality Reduction Outside Coronary Care Unit

Based on experience gained In coronary care units, a routine of management for the prevention, as opposed to the treatment, of progression and complications of myocardial infarction should reduce mortality among patients in both coronary care units and general wards. Forty-four patients, with 46 infarcts of less than 48 hours' duration, were treated in the general wards of community and private hospitals, without the use of electrical monitoring or specially trained nursing staff, and without resident medical staff. All patients were referred to the writer by medical practitioners because of the apparent clinical severity of Infarction. The sample group was assessed and classified according to accepted prognostic factors, and was found comparable to patients treated in coronary care units. All patients were given oxygen by face mask for at least 24 hours, frusemide Intravenously, papaveretum for pain, both heparin In 5% dextrose solution by Infusion and promethazine by mouth for three days, and phenindione by mouth thereafter; they were sat out of bed if possible on the third day. Sinus bradycardia, atrio-ventricular block and extrasystoles associated with bradycardia were treated with atropine given intravenously; all other extrasystoles were treated with lignocaine given intravenously for three days. Among the 44 patients with 46 infarcts thus treated, there were two hospital deaths (4%); one was due to cardiogenic shock, the other occurred on the thirteenth day. Cardiac arrest, except for one induced on carotid sinus pressure, did not occur during the period in hospital. The mortality rate is substantially less than the general mortality rate of 36%, and the coronary Care unit mortality rate of 14% to 30%. It is concluded that the regime deserves wider application.