A coronary care unit in a general medical ward.

In all, 611 patients were admitted to the coronary care unit during the first 16 months. The diagnosis of acute myocardial infarction was confirmed in 461 (73.4%) of these patients and the results of treatment are shown. The hospital mortality was 19.1 per cent. Eighteen patients, who would have died without resuscitation, survived and left hospital. Ventricular fibrillation occurred in 41 (8.9%) patients, early resuscitation was successful in 23, and 14 left hospital. Asystole was the cause of cardiac arrest in 31 (6.7%) patients, most of whom had extensive heart muscle damage and failure. Resuscitation was unusual in these patients. Complete heart block occurred in 31 (6.7%) patients and all were electrically paced. Sixteen returned to sinus rhythm and 14 left hospital. No patients required long-term pacing after acute myocardial infarction. Ventricular tachycardia occurred in 45 (9.7%) patients and this arrhythmia carried a high mortality (46.6%). Our results appear to be comparable with those of most other units, many of which are considerably more elaborate in design and more heavily staffed. There are disadvantages to siting a coronary care unit in a general ward and, though good results can be achieved in a unit of this type, we think it desirable that separate accommodation should be found whenever possible. This has now been done at Dudley Road Hospital.