Alya Putri Khairani |

130110110220 | B2

ICCU / CICU

A Coronary Care Unit (CCU) or Cardiac Intensive Care Unit (CICU) is a hospital ward specialized in the care
of patients with Heart Attacks, Unstable Angina, Cardiac Dysrhythmia and (in practice) various other cardiac
conditions that require continuous monitoring and treatment. Coronary care units, initially established in the 1960s
as separate units for the early detection and treatment of Arrhythmias complicating Acute Myocardial Infarction,
currently provide the setting for the monitoring and treatment of a wide variety of critical cardiovascular disease
states
The main feature of coronary care is the availability or the continuous monitoring of the cardiac rhythm
by Electrocardiography. This allows early intervention with medication, cardioversion or defibrillation, improving
the prognosis. As Arrhythmias 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, coronary care unit admission is standard.
DIAGNOSIS AND TREATMENT
The ICU team uses a wide range of diagnostic, monitoring and treatment techniques to help care for patients. They
will monitor:
Temperature, Blood Pressure, Heart Rate, Respiratory Rate, Oxygen in the blood, Level of Na + K+, Urine output, and
GCS
There are likely to be lots of machines around the patient. This is all equipment used to help them function,
including:
Cardiovascular support, to measure the heart's output
An external cardiac support device, to help the heart beat properly
Respiratory ventilator, to help the patient breathe
Kidney machine, to provide the kidney function when the organs aren't working properly
Doctors and nurses will also give the patient drugs or medication to improve their condition. This could include:
Medication to support the heart's function
Manipulation of the lungs to improving breathing
Giving antibiotics and additional fluid
The administration of drugs to improve their general condition
Providing adequate nutrition, often through a feeding tube
Infection control, which may include moving the patient to a secure side room
Pain control, including giving sedatives or painkillers

Cardiac ICU also works closely with other specialties in the hospital to provide everyday care to the patients,
ensuring comfort, privacy and dignity. This includes:

Physiotherapy to help increase the patient's mobility, breathing capability or muscle development

Dietitians who work to ensure each patient is properly nourished

Attending to the psychological aspect of a patient's hospital journey, by linking them with the hospital
chaplaincy team or putting them in touch with support groups

Pharmacy staff who attend regular ward rounds to ensure that medication is safe and appropriate for each
patient

Microbiology staff who deal with infection control

Based on a journal, system of care in the third world, especially in Jakarta shows that CICU in Indonesia should be
developed in a better way. Improvement in the system of care of AMI is one of the major efforts to decrease the
mortality among ACS patients. The JAC registry data showed that Jakarta should build its own AMI system of care,
especially for STEMI patients. This is because most STEMI patients (59%) did not receive reperfusion therapy and
almost 80% of the patients presented very late (>12 h). It was shown that the patients not receiving reperfusion
therapy had an almost two and a half fold increase of in-hospital mortality compared with patients who did receive
reperfusion therapy

Alya Putri Khairani |

130110110220 | B2

References:
http://www.uhs.nhs.uk/OurServices/Bloodandcirculation/CardiacIntensiveCareUnitCICU/Diagnosisandtreatment.aspx
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370084/

Treatment for Supraventricular Tachycardia

In many cases, symptoms of supraventricular tachycardia (SVT) stop quickly and no treatment is
needed. However, treatment is available to stop an episode of SVT and prevent future episodes if necessary

1. Vagal Maneuver
Vagal maneuvres are techniques designed to stimulate the Vagus Nerve. Stimulating this nerve can help
reduce the speed of the electrical impulses in your heart and stop episodes of Supraventricular Tachycardia.
However, these techniques work in less than 1 in 3 cases.

Valsalva Maneuver
There is no standard way to perform this maneuver, but it often involves holding the nose, closing mouth
and trying to exhale hard while straining as if you were on the toilet. If you are in hospital, you may be
asked to blow hard into a tube instead. It can also tried by dipping face into a bowl of cold water, as
this can have a similar effect

Carotid Sinus Massage

This involves massaging the Carotid Sinus in an attempt to stimulate the Vagus Nerve. However, this
should only be carried out by a health professional and should not be attempted at home

2. Medication

Adenosine
This medication blocks the abnormal electrical impulses in the heart. Side effects of adenosine are
relatively common, but usually short-lived. After an injection you may experience nausea (feeling
sick), dizziness, chest tightness or shortness of breath

Verapamil

3. Cardioversion
If a prolonged episode of Supraventricular Tachycardia doesn't respond to Vagal Maneuver or medication, or if
these treatments are unsuitable, a treatment called cardioversion may be used. Cardioversion is a relatively
simple procedure that uses Defibrillator to apply an electrical current to the chest. This shocks the heart back
into a normal rhythm. Cardioversion is a very effective procedure and serious complications are uncommon.

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However, your chest muscles may feel sore afterwards and areas of skin where the electrical shocks were
applied may be red and irritated for a few days
There are also some treatments that reduce your chances of having further SVT episodes

1. Self-help
Some Supraventricular Tachycardia episodes are triggered by things like tiredness, drinking lots of alcohol or
caffeine, or smoking lots of cigarettes. Cutting down on the amount of caffeine or alcohol, stopping or limiting
cigarettes you smoke, and making sure to get enough rest can help reduce the chances of having further
episodes
2. Medication
Medication can be prescribed to prevent further episodes of SVT by slowing down the electrical impulses in to
the heart. These medications are taken as a daily tablet and include Digoxin, Verapamil and -blockers.
Common side effects of these medications can include dizziness, diarrhea and blurred vision. Tiredness can
occur with -blockers and men may experience problems getting erections. Less common side effects include
difficulty getting to sleep (insomnia) and depression
3. Catheter Ablation
This prevents further episodes of SVT by destroying the tiny parts of the heart causing the problems in the
heart's electrical system. This is a safe and highly effective treatment. During the procedure, catheter is
inserted into a vein in your upper leg or groin, before being guided to your heart. When the wire reaches the
heart, it records the electrical activity to pinpoint the precise location of the problem. When the problem area is
found, high-frequency radiowaves are transmitted to the catheter tip to destroy it, producing a small scar. Local
anesthetic will be given. The procedure normally lasts about an hour and a half. Catheter Ablation is very
effective at preventing future episodes of SVT, but like all operations it carries a risk of complications. These
include bruising and bleeding where the catheter was inserted. Typically any bruising will be small, but even if
the bruise is large it will require no treatment and will disappear within two weeks. There is also a small risk
(less than 1 in 100) of the heart's normal electrical system being damaged (Heart Block). If this happens,
patient may need a permanent Pacemaker to control the heart rhythm

Valsalva maneuver

References:
http://www.nhs.uk/Conditions/Supraventricular-tachycardia/Pages/Treatment.aspx

Alya Putri Khairani |

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A forceful attempt at expiration when the airway is closed at some point; especially : a conscious effort made
while holding the nostrils closed and keeping the mouth shut especially for the purpose of testing the patency of
the Eustachian tubes, adjusting middle ear pressure, or aborting Supraventricular Tachycardia Merriam-Webster
When a person forcefully expires against a closed Glottis, changes occur in Intrathoracic Pressure that dramatically
affect venous return, cardiac output, arterial pressure, and heart rate. Initially during a Valsalva, Intrathoracic
(intrapleural) Pressure becomes very positive due to compression of the thoracic organs by the contracting rib
cage. This increased external pressure on the heart and thoracic blood vessels compresses the vessels and cardiac
chambers by decreasing the Transmural Pressure across their walls. Venous compression, and the accompanying
large increase in right atrial pressure, impedes venous return into the thorax. This reduced venous return, and
along with compression of the cardiac chambers, reduces cardiac filling and preload despite a large increase in
intrachamber pressures.
Reduced filling and preload leads to a fall in cardiac output by the Frank-Starling mechanism. At the same time,
compression of the Thoracic Aorta transiently increases aortic pressure (phase I); however, aortic pressure begins
to fall (phase II) after a few seconds because cardiac output falls. Changes in heart rate are reciprocal to the
changes in aortic pressure due to the operation of the baroreceptor reflex. During phase I, heart rate decreases
because aortic pressure is elevated; during phase II, heart rate increases as the aortic pressure falls
When the person starts to breathe normally again, Aortic pressure briefly decreases as the external compression
on the Aorta is removed, and heart rate briefly increases reflexively (phase III). This is followed by an increase in
Aortic pressure (and reflex decrease in heart rate) as the cardiac output suddenly increases in response to a rapid
increase in cardiac filling (phase IV). Aortic pressure also rises above normal because of a
baroreceptor, sympathetic-mediated increase insystemic vascular resistance that occurred during the Valsava

References:
http://www.cvphysiology.com/Hemodynamics/H014.htm