E.R. and Acute Cardiac Care Unit
The E.R. and Acute Cardiac Care Unit of Centro Cardiologico Monzino, classified as a Highly Specialised (second level) Emergency Department, is the point of access to the hospital for acute cardiovascular diseases. A growing number of patients benefit from the services of our Emergency Department; 23% of patients assessed in the Department were then admitted to the hospital; in the last year about a quarter of all patients admitted to the Cardiology Centre came from the Emergency Department.
The most common disorders seen in the Department are acute myocardial infarction, unstable angina, heart failure and arrhythmias.
The Emergency Department has nine stations, all equipped with monitors for the continuous recording of vital parameters (electrocardiographic trace, oxygen saturation, invasive and non-invasive arterial pressure); of these, four are dedicated to short-term observation, four to longer observation (in any case never more than 24 hours), while the last station is located in a specific environment equipped with instruments dedicated to the management of cardiovascular emergencies (highest priority access code). The four stations for longer observation are also used for the assessment and management of chest pain (Chest Pain Unit), with the aim of confidently defining the cardiovascular nature or otherwise of the symptoms reported by the patient through a specific diagnostic protocol including continuous monitoring of vital signs, repeated electrocardiograms (ECG), serial measurements of markers of myocardial necrosis and, finally, a provocative test (stress echocardiogram or ECG).
The Acute Cardiac Care Unit comprises 25 beds in 12 rooms and is closely connected with Accident and Emergency because it exclusively admits patients from this Unit who do not require admission to the Cardiology Intensive Care Unit.
There were more than 1,100 admissions to the Unit last year.
The most frequently treated diseases are heart failure, unstable angina, non-ST segment elevated myocardial infarction, tachyarrhythmias and bradyarrhythmias. However, the main cardiovascular conditions are often accompanied by a broad range of internal medicine problems, partly related in relation to the progressive aging of the population. In some cases, after the first treatment and the initial diagnostic classification, patients who need further therapeutic procedures are transferred to specific wards (Cardiac Surgery, Invasive Cardiology).
Given the variety of disorders that must be dealt with, and their acute nature, the Department's medical and nursing staff are required to be particularly versatile and committed and to have specific and interdisciplinary training.
The research activity of the E.R. and Acute Cardiac Care Unit is aimed mainly at studying the problems related to ischaemic heart disease both through the identification of new markers of myocardial ischaemia and by conducting trials of new drugs.
The Unit participates in several international, multicentre phase II and III trials investigating the safety and efficacy of new antithrombotic drugs used in the context of acute coronary syndromes and atrial fibrillation.
The Unit’s doctors collaborate with the Institute of Cardiology of the University of Milan, allowing students of the degree course in Medicine and Surgery and those specialising in Cardiology to attend, in rotation, the Accident and Emergency and Urgent Cardiology Care Unit for the purpose of receiving specific training. The Unit also provides the logistics and tutors necessary for the preparation of the theses for both undergraduates and post-graduate junior specialists.
National and international scientific activities
The Unit’s doctors participate in various congress of the main Italian and European scientific societies. They are also involved in the management of numerous phase II and phase III international trials on the treatment of acute coronary syndromes and atrial fibrillation.