Talk:Management of acute coronary syndrome

Reviews

• Anderson JL, Adams CD, Antman EM; et al. (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". Circulation. 116 (7): e148–304. doi:10.1161/CIRCULATIONAHA.107.181940. PMID 17679616. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Hoekstra J, Cohen M (2009). "Management of patients with unstable angina / non-ST-elevation myocardial infarction: a critical review of the 2007 ACC /AHA guidelines". Int. J. Clin. Pract. 63 (4): 642–55. doi:10.1111/j.1742-1241.2009.01998.x. PMC 2705816. PMID 19222616. {{cite journal}}: Unknown parameter |month= ignored (help)

Doc James (talk · contribs · email) 11:58, 11 October 2010 (UTC)

Suggestions for improvement

After congratulating previous editors for their work in this article, I must stress the need for its improvement; class C is unacceptable! Some suggestions and thoughts I would like to open to discussion:

1. The order of its contents is arbitrary and bewildering: Antiplatelet agents → Nitroglycerin → Beta Blockers → Heparin → Myocardial Energy Metabolism Regulator → Reperfusion. I propose analyzing reperfusion first, as it is arguably the most important part of myocardial infarction (MI) management, and then continuing with acute phase medical therapy, long term medical therapy and lifestyle changes - though I admit antiplatelet agents are another good choice as a first section, as aspirin is usually the first measure that has to be taken before the patient reaches medical facilities.

Another appealing outline of contents would contain two major sections: "emergency management", and (something in the lines of) "management during hospitalization and at discharge"NikosGouliaros (talk) 20:03, 30 September 2014 (UTC)

2. I propose removing the "Myocardial Energy Metabolism Regulator" section in mildronate altogether: it's poorly cited and the drug has no indication in MI (that is, in the acute phase of Mi or in patients with a history of MI just because they had an MI).

3. MI's management can only be written according to guidelines by major cardiological societies. However, this page being oriented to laymen, references to guidelines in the text (as opposed to citations) is usually redundant.

4. Very poor intoduction. "Time is muscle": an important principle, that is both poorly explained and cited - though I wonder if it's so central as to be included in the introductory section.

Lead section rewritten; "time is muscle" explained; details on treatments (O2, Morphine, nitrates) removed to be mentioned in the appropriate sections.NikosGouliaros (talk) 22:58, 28 September 2014 (UTC)

5. The distinction between STEMI and NSTEMI is another problem in the article. Sometimes STEMI is used almost as if equal to MI. More importantly, one needs to decide how important this distinction is for wikipedia readers and to what extent differences in management of the two need to be outlined. My opinion is that for general readers this distinction might be one too technical, however my suggestion is to mention it in the lead section, and outline the different management approaches in the sections where they apply (e.g. in "Reperfusion therapy").

The above are obviously thoughts for discussion. However, I have every intention of being bold and making the changes I think will improve the article.NikosGouliaros (talk) 16:00, 25 September 2014 (UTC)

And moving on:

6. This article also needs could also benefit from a detailed list of the goals of management of MI, including reduction of the patient's risk of death, relief of symptoms, limitation of the infarct size, and long term prevention of heart failure and other long term complications. Unfortunately I cannot currently find a citation for such a list. NikosGouliaros (talk) 09:12, 27 September 2014 (UTC)

7. The article will also benefit from a list of suggested reading, aka of selected works cited (as in some featured articles of WP:Medicine. This means that some works in the full references list will be cited in short form, with an anchor to the complete entry in the selected citations list. Any objections? (Working on it) NikosGouliaros (talk) 22:28, 29 September 2014 (UTC)

The article is moving on in my sandbox. Unfortunately many of the sections that are already ready cannot be inserted in the article, as the result would be inconsistent without other sections that aren't ready yet. NikosGouliaros (talk) 23:16, 5 October 2014 (UTC)

Requested move

The following discussion is an archived discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review. No further edits should be made to this section.

The result of the move request was: page moved. NikosGouliaros (talk) 14:24, 5 October 2014 (UTC)

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Myocardial infarction management → Management of acute coronary syndrome – In wikipedia there is occasional confusion between myocardial infarction (MI) and ST elevation MI (STEMI). For instance, the article on Acute coronary syndromes (ACS) has a link to MI at the STEMI subsection of the treatment section. More importantly, there is occasional confusion between Myocardial infarction and Acute coronary syndrome. ACS is the general term encompassing the following acute conditions: ST elevation myocardial infarction (STEMI), non ST elevation MI (NSTEMI), and unstable angina. Moreover, NSTEMI and unstable angina fall under the umbrella of non ST elevation ACS: both American Heart Association/American College of Cardiology and European Society of Cardiology guidelines refer to Non-ST elevation ACS rather than NSTEMI. This article is the only special article on the management of conditions of the ACS spectrum, and, indeed, is actually an article on management of ACS, as little distinction is made in current medical practice between management of NSTEMI and (confirmed) unstable angina. In other words: "NSTEMI" is included in myocardial infarction, and also "NSTEMI" is at many levels of medical management indistinguishable from "ACS". One cannot explain the management of myocardial infarction(s) without actually explaining the management of ACS.

Admittedly, "ACS" is even further from everyday speech than "myocardial infarction", with the latter article having been attempted to be moved to "Heart attack". However, it is as simple as that: a fully expanded article, or a featured article, talking about MI management *which I happen to be currently working on) would in reality be an article on ACS management. NikosGouliaros (talk) 15:21, 4 October 2014 (UTC)

The discussion on this proposal has already started in Talk: WikiProject Medicine, with opinions being added there.NikosGouliaros (talk) 15:25, 4 October 2014 (UTC)

References

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The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page or in a move review. No further edits should be made to this section.

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