Department of Medical HistoryEvolution of the management of acute myocardial infarction: a 20th century saga
Section snippets
The coronary care unit
The coronary care unit (CCU), the single most important advance in the treatment of AMI, came about as a result of four separate developments: the appreciation of the importance of arrhythmias as the principal cause of early death in AMI; the ability to monitor the ECG continuously with the cathode-ray oscilloscope, a device that had been greatly improved by the military during World War II; the development of closed-chest cardiac resuscitation;11 and the delegation of the treatment of
Prehospital care
Most deaths in patients with AMI are caused by arrhythmias and occur before the patient reaches the hospital. Therefore, efforts have been directed towards making available to patients some of the benefits of the CCU, especially the treatment of ventricular tachycardia and ventricular fibrillation before they reach hospital.15 Ambulances staffed by trained personnel and equipped with ECG monitors, drugs, and equipment for defibrillation and resuscitation have saved many lives.
Limitation of infarct size
Left ventricular
Current challenges and opportunities
Application of the various therapeutic measures outlined above—either alone or in combination—has reduced the early (1 month) mortality rate of patients admitted to hospital with AMI by about two-thirds since 1960. However, it is still prohibitively high—about 10% (around 7% in patients eligible for and receiving early reperfusion therapy)—and seems to have reached a plateau, perhaps because continued therapeutic advances have been offset by the more advanced age and increasing co-morbidities
Conclusions
At the beginning of the 20th century, AMI secondary to acute thrombotic coronary occlusion was regarded as a rare condition not compatible with survival. As this century draws to a close, AMI is recognised as one of the most common serious illnesses in industrialised nations. The lives of patients with AMI can be substantially prolonged and improved by the prompt recognition and treatment of cardiac arrhythmias and heart failure. Aspirin and β-blockers also reduce early mortality and infarct
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