Specialized syncope evaluation.

The concept of specialized cardiovascular care is not new. Nearly 4 decades ago, Killip and Kimball1 reported the results of their study of the treatment of 250 patients with myocardial infarction in a coronary care unit. With continuous ECG monitoring at a centralized nursing station, defibrillators at each bedside, and nurses authorized to deliver precordial shocks if physicians did not respond fast enough, the mortality rate was reduced from 26% to 7%.1 A classification scheme for heart failure severity was developed, and the authors ultimately concluded that the coronary care unit was critical to the timely recognition and treatment of potentially lethal arrhythmias.