A coronary care unit (CCU) or cardiac intensive care unit (CICU) is a hospital ward specialized in the care of

patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other hea ...

s with

heart attack A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which ma ...

unstable angina Unstable angina (UA), also called crescendo angina, is a type of angina pectoris that is irregular. It is also classified as a type of acute coronary syndrome (ACS). It can be difficult to distinguish unstable angina from non-ST elevation (non-Q ...

cardiac dysrhythmia Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adult ...

and (in practice) various other cardiac conditions that require continuous monitoring and treatment.

Characteristics

The main feature of coronary care is the availability of

telemetry Telemetry is the in situ collection of measurements or other data at remote points and their automatic transmission to receiving equipment (telecommunication) for monitoring. The word is derived from the Greek roots ''tele'', "remote", an ...

or the continuous monitoring of the cardiac rhythm by electrocardiography. This allows early intervention with

medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field and ...

cardioversion Cardioversion is a medical procedure by which an abnormally fast heart rate ( tachycardia) or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs. Synchronized electrical cardioversion uses a therapeutic dose ...

or defibrillation, improving the prognosis. As

arrhythmias Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...

are relatively common in this group, patients with myocardial infarction or unstable angina are routinely admitted to the coronary care unit. For other indications, such as atrial fibrillation, a specific indication is generally necessary, while for others, such as

heart block Heart block (HB) is a disorder in the heart's rhythm due to a fault in the natural pacemaker. This is caused by an obstruction – a block – in the electrical conduction system of the heart. Sometimes a disorder can be inherited. Despite the se ...

, coronary care unit admission is standard.

Utilization

In the United States, cardiac conditions accounted for eight of the eighteen conditions and procedures with high ICU utilization (ICU utilization in more than 40% of stays) in 2011.

Local differences

In the United States, coronary care units are usually subsets of

intensive care unit 220px, Intensive care unit An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensi ...

s (ICU) dedicated to the care of critically ill cardiac patients. These units are usually present in hospitals that routinely engage in cardiothoracic surgery. Invasive monitoring such as with

pulmonary artery catheter A pulmonary artery catheter (PAC), also known as a Swan-Ganz catheter or right heart catheter, is a balloon-tipped catheter that is inserted into a pulmonary artery in a procedure known as pulmonary artery catheterization or right heart cathet ...

s is common, as are supportive modalities such as

mechanical ventilation Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move a ...

and

intra-aortic balloon pump The intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. It consists of a cylindrical polyurethane balloon that sits in the aorta ...

s (IABP). Certain hospitals, such as Johns Hopkin

maintain mixed units consisting of both acute care units for the critically ill, and intermediate care units for patients who are not critical.

Acute coronary care

Acute coronary care units (ACCUs), also called "critical coronary care units" (CCCUs), are equivalent to intensive care in the level of service provided. Patients with acute myocardial infarction, cardiogenic shock, or post-operative "open-heart" patients commonly abide here.

Subacute coronary care

Subacute coronary care units (SCCUs), also called progressive care units (PCUs), intermediate coronary care units (ICCUs), or stepdown units, provide a level of care intermediate to that of the intensive care unit and that of the general medical floor. These units typically serve patients who require cardiac telemetry, such as those with

History

Coronary care units developed in the 1960s when it became clear that close monitoring by specially trained staff,

cardiopulmonary resuscitation Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spont ...

and medical measures could reduce the mortality from complications of cardiovascular disease. The first description of a CCU was given in 1961 to the

British Thoracic Society The British Thoracic Society (BTS) was formed in 1982 by the amalgamation of the British Thoracic Association and the Thoracic Society. It is a registered charity and a company limited by guarantee. Function The society's main charitable objecti ...

Desmond Julian Desmond Gareth Julian (24 April 1926 – 26 December 2019) was a British cardiologist who pioneered the creation of coronary care units. Life He was professor of cardiology at Newcastle University (1975–86), medical director of the British Hear ...

, who founded the first CCU at the

Royal Infirmary of Edinburgh The Royal Infirmary of Edinburgh, or RIE, often (but incorrectly) known as the Edinburgh Royal Infirmary, or ERI, was established in 1729 and is the oldest voluntary hospital in Scotland. The new buildings of 1879 were claimed to be the largest v ...

in 1964. Early CCUs were also located in

Sydney Sydney ( ) is the capital city of the state of New South Wales, and the most populous city in both Australia and Oceania. Located on Australia's east coast, the metropolis surrounds Sydney Harbour and extends about towards the Blue Mountain ...

Kansas City The Kansas City metropolitan area is a bi-state metropolitan area anchored by Kansas City, Missouri. Its 14 counties straddle the border between the U.S. states of Missouri (9 counties) and Kansas (5 counties). With and a population of more ...

Toronto Toronto ( ; or ) is the capital city of the Canadian province of Ontario. With a recorded population of 2,794,356 in 2021, it is the most populous city in Canada and the fourth most populous city in North America. The city is the ancho ...

and

Philadelphia Philadelphia, often called Philly, is the largest city in the Commonwealth of Pennsylvania, the sixth-largest city in the U.S., the second-largest city in both the Northeast megalopolis and Mid-Atlantic regions after New York City. Sinc ...

. The first coronary care unit in the US was opened at Bethany Medical Center in

Kansas City, Kansas Kansas City, abbreviated as "KCK", is the third-largest city in the U.S. state of Kansas, and the county seat of Wyandotte County. It is an inner suburb of the older and more populous Kansas City, Missouri, after which it is named. As of ...

by Hughes Day, and he coined the term. Bethany Medical Center is also where the first "crash carts" were developed. Studies published in 1967 revealed that those observed in a coronary care setting had consistently better outcomes. DF Beck performed the first successful resuscitation of a physician with myocardial infarction in 1953, and pioneered the use of open-chest defibrillation. Zoll introduced external defibrillation in Boston in 1956, and Kouwenhoven and colleagues at Johns Hopkins highlighted the effectiveness of a combo of mouth-to-mouth, sternal compression, and closed chest defibrillation in restoring cardiac function in ventricular fibrillation patients. The first diagnostic angiogram was discovered by Mason Sones in 1958, due to an accidental injection of dye directly into the coronary artery rather than into the entire circulation - something that was previously believed to be fatal. These developments led to an interest in intensive care for myocardial infarction. In 1967, Thomas Killip and John Kimball published a report of 250 patients with acute MI's, who had experienced significantly better survival rates in CCUs compared to other institutions. This, along with other reports, led to an increase in coronary care units. Now catheterization units are commonplace in large cities.

References

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