CORONARY CARE

Hospital Care And The Coronary Care Unit (CCU)

Most patients suspected of having suffered an acute heart attack are admitted to a hospital's coronary care unit (CCU). The CCU is intended to be a quiet, calm, and restful area in which patients can be further evaluated and closely monitored. A specially trained nurse who works with doctors and other members of the medical team provides individualized care. Visiting hours are usually restricted.

The length of stay in the CCU varies, depending on :
• Whether or not the diagnosis of a heart attack is confirmed
• The severity of the heart attack
• The presence and severity of associated complications

A patient with a heart attack without complications spends about two to three days in a CCU before being transferred to a step-down unit. A step-down unit offers less intensive care than the CCU but still permits continuous ECG monitoring to screen for abnormal heart rhythms or other complications. The patient usually goes home five to seven days after hospital admission.

What Are The Goals Of Care In The CCU?

Care in the CCU focuses on:
• Relief of chest pain and anxiety
• Further assessment (diagnostic tests) to confirm a diagnosis
• Limiting the size of the heart attack and the area of heart muscle that dies
• Reducing the work of the heart
• Identifying, preventing, and treating complications from the heart attack

In the CCU:
• Care for the patient begun in the emergency setting continues
• Additional diagnostic tests are ordered
• Doctors determine appropriate medical-surgical intervention.
• The patient's level of activity and diet is restricted


Diet And Activity Levels

Additional precautions taken during the stay in the CCU and step-down unit, include
• Restricting the diet
For the first 24 hours, the patient is placed on a clear liquid diet to reduce the possibility of aspiration due to nausea and vomiting. A healthy food plan, including complex carbohydrates and fiber-rich foods, is later introduced. All individuals who have suffered a heart attack need to permanently adopt a healthy diet.
• Limiting activity levels
All patients are initially placed on bed rest. Patients who are stable, free of pain, and free of complications are sometimes to get out of bed to use the commode. Patients who remain free of complication often begin limited physical activities within 24 hours.

Progression Of Activity

Days 1-2
• Sitting up with feet dangling over the side of the bed
• Lifting and lowering of the arms, called range-of-motions exercises, to prevent muscle and joint stiffness and to prevent blood clots from forming in the legs

Days 3-4
• Bathing and dressing while sitting on the bed or in a chair
• Taking short walks around the hospital room
• Taking supervised walks outside the hospital room
• Showering without shampooing hair (no raising of arms above head)

Days 5-7
• Walking about 600 feet three times a day
• Shampooing hair (activities with arms over the head)
• Climbing stairs with supervision
• Undergoing an exercise tolerance test

After several days in the hospital, a patient with an uncomplicated heart attack can go home. Physical activity is then gradually increased over the next three to six weeks. Doctors may recommend the patient attend cardiac rehabilitation.

Nice to Know:
While still hospitalized, the patient may get to know members of the cardiac rehabilitation team. Cardiac rehabilitation services can involve many health care providers, including:
• Doctors, including the family doctor, a heart specialist or cardiologist, and a surgeon.
• Nurses
• Exercise specialists
• Physical and occupational therapists
• Dietitians
• Psychologists or other behavior therapists