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At the beginning of the 1960's myocardial infarction patients were admitted to the general hospital wards, given morphia and oxygen and often found dead by the morning. It was decided that we knew very little of what was happening to these patients and decided to set up an intensive care unit where not only the electrical activity of the heart could be continuously monitored on magnetic tape but also the haemodynamic changes by means of cardiac catheterisation during the 24 hours. Apart from arrhythmias we felt it important to be able to determine the size of the infarct and the effect, if any, of drug and other interventions. For some years I had been using vectrocardiography to determine infarct size but was not happy with the results so turned to the use of surface maps by taking a number of electrocardiograms over the surface of the chest and reconstructing maps which had some bearing on the size and extent of the infarcted area. At about this time beta-blockers were introduced and this method seemed as though it might be useful to see their effect in acute myocardial infarction. The surface maps clearly showed the changes associated with the administration of practolol. Unfortunately, in two cases the patients developed untoward arrhythmias and we were hesitant in using beta-blockers under these circumstances. Practolol also had to be abandoned due to its side effects on the eyes. This was the first intensive coronary care unit designed for the intensive study of electrical, haemodynamic, respiratory and renal changes in patients following an acute coronary disease with all the data being recorded on magnetic tape. The unit at Hammersmith Hospital was supported by the Medical Research Council and attracted many overseas research workers with resultant new research work in the field of myocardial infarction over a period of years.
J. P. Shillingford (Sat,) studied this question.