[Role of district hospital in providing care for patients with acute coronary syndrome].

The role of a district hospital in providing care for patients with acute coronary syndrome is determined by epidemiologic and demographic characteristics, the quality of primary health care and the citizens' level of information. There are two organizational departments that participate in medical treatments as part of the complex of modern organized hospitals: Emergency Department and Coronary Care Unit. Emergency Department is very important for providing prompt and appropriate initial care. Coronary Care Unit provides continuous monitoring of all vital functions, invasive and noninvasive hemidynamic monitoring, 24-h medical attendance, and medical telephone connection with a tertiary center. The main task of medical treatments is the prevention of sudden death, and pain and discomfort relief with the aim of maximal shortening the time elapsed from the first symptom to definitive care. In patients with myocardial infarction and ST elevation, reperfusion therapy (fibrinolytic, primary PCI) should be started within the first two hours of the disease onset. In case of unstable angina pectoris and myocardial infarction without ST elevation, the targets are as follows: stabilization and passivization of the plaque (heparin, ASA, clopidogrel), medical treatment of underlying ischemia (beta blocker, calcium channel antagonist, nitrates) and initiation of secondary prevention (ACEI). The earliest possible assessment of possible risk of disease progression or potential death is of utmost importance to define therapeutic strategy at the very beginning of treatment. Modern medical treatment of acute coronary syndrome requires the following: 24-h accessibility of Emergency Medical Service, functional of medical telephone connection and continuous education of the entire medical staff.