PRE-HOSPITAL MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION

A significant reduction in mortality from acute coronary heart disease can be expected only if patients are identified and treated earlier in the course of their acute illness. Unfortunately, the earliest signs and symptoms of this disease are subtle, and no good mechanism exists by which the stricken patient can be distinguished from one with less dangerous and noncardiac symptoms. It is suggested that an outpatient study unit, designed to triage for early signs and symptoms of acute coronary heart disease, may be an effective approach to this problem. Using specialized personnel, telemetric monitoring and, particularly, provocative tests of myocardial ischemia and electrical instability of the heart, it is anticipated that much could be learned in a prospective study of the early manifestations of acute coronary heart disease. Such a unit would also provide a means for field study of the use of antiarrhythmic agents, including the self-administration of parenteral medication (for example, atropine) by selected patients with known coronary heart disease. © 1969.