Talk:Myocardial infarction/Archive 1

message: Can anyone take a closer look to ouabain. strange claims there without valid references. Jeff
Excuse me, but at the end of the ouabain site there is a link to an article, which has 264 references !!! Many with direct links to pubmed and additional informations (location of the university). Where do you find this service anywhere else ? The most of the clinical references are unfortunately only published in german language, but there are also studies published in english and partly at pubmed. Regarding the pathogenesis of myocardial infarction there is a host of references from pubmed. My book about ouabain has 1380 references and a preface from Prof. Dr. med. Hans Schaefer / Heidelberg, who was a leading physiologist for several decades and international renowned. Why is there this sharp opposition against a medication that has surpassing positive effects in myocardial infarction and angina pectoris ? For more text see below. I will add more information on the ouabain site when I´ll find the time...
regarding the topics "oral absortion" and "ouabain as a newfound hormone" please see the discussion of the ouabain site. I have worked on  the topic ouabain meticulously for several years. Every little detail is  supported by references.
--RJ Petry 23:23, 4 September 2005 (UTC)

message: I have noticed that this article contains no list of symptoms or reasons for immediate action in cases of heart attack. I understand that pain radiating into the left arm is not universal, but I also understand that some other common symptoms are not either. While WP is not intended to be a medical (or emergency treatment) resource, at least something along this line should be here. Many readers will, now that WP has become the astonishing resource that it is, refer to it for some information when they think there might be a problem. Wording should, of course, contain the necessary disclaimers and warnings so as to diffuse the possibility of WP being sued for 'malpractice', but nevertheless something like this is needed here. 
I invite the medical folk who contribute to WP to add something responsible along these lines. 
Thanks.
:The most relevant symptoms are all there. There is no need for a disclaimer - the Wikipedia:General disclaimer specifically disclaims medical information. You don't need to be a doctor to edit this article! JFW | T@lk 07:20, 1 September 2005 (UTC)
replies: text: Added symptoms section. --WS 15:23, 5 September 2005 (UTC)
thread_title:  Please help --  a request 

message: Okay, this time only a brief response (not having time and not willing to be impertinent) and only to the topic of the sequence ot the sub-topics. I have clicked on every "see also" links", none of them has all three sub-topics. Only "Dresslers Disease": 1) see also, 2) references. At "Bypass" I found 1) references 2) see also 3) external links. So the statement: "all Wikipedia articles follow this sequence" is much more invalid as the results of the ouabain studies (...smile...).
I think, at least the references have to had their place before "see also". 
Regarrding the other points I will add a notice later...
--RJ Petry 08:03, 6 September 2005 (UTC)
replies: text: I've fixed the article at Coronary artery bypass surgery - I think that's the one you mentioned. Thanks for pointing it out. Note that at one time, Wikipedia did not have standards about this, but to ensure that articles have some consistency, this policy was eventually chosen by consensus. There are still many articles that have not been modified to match this new standard, but they will be eventually. Mindmatrix 17:21, 6 September 2005 (UTC)
thread_title:  Briefer responses 

message: First reference links to a report on HIV/AIDS, not on heart attacks, and only goes up to page 96 (reference cites 120-4). Would fix, but I have no idea how.  —Preceding unsigned comment added by 118.138.209.138 (talk) 03:52, 11 May 2008 (UTC)
thread_title:  First reference is incorrect 

message: Has anyone given thought to merging the "first aid" and "treatment" sections? We could divide it up into immediate care and hospital care, or something like that. Thanks! Scope2776 21:09, 5 March 2007 (UTC)
thread_title:  Merge First Aid and Treatment 

message: What's up with the categories at the bottom of the page? I belive this article has plenty of sources, and I tried to remove the tags but could not find the code. Scope2776 09:46, 5 March 2007 (UTC)
thread_title:  Categories 

message: Think this is good enough? TheKillerAngel 21:19, 12 July 2006 (UTC)
replies: text: This article still lacks a lot of relevant information - epidemiological trends, modification of risk factors etc. It is relatively poor on references, given that MI is one of the most heavily researched subjects in modern medical science. JFW | T@lk 22:43, 26 July 2006 (UTC)

text: Needs more info on drug overdoses from cocaine and Methamphetamine & Amphetamines, especially motality rates among young & healthy kids. Raquel Baranow (talk) 05:00, 18 March 2009 (UTC)

text: The actual evidence for personality types is deeply rubbish. A type C (depressed/dependable) was recently given much more prominence. It's science that has long been discredited. Same with stress and peptic ulcer (unless we're talking a stress ulcer, seen in intensive care). JFW | T@lk 22:58, 27 July 2006 (UTC)
thread_title:  FA status: Needs More Info On  . . . 

message: Gene Braunwald sums up some important paradigms in MI research in a 1993 editorial here. JFW | T@lk 22:43, 26 July 2006 (UTC)
thread_title:  History 

message: The cite below just got reverted.  Noting the complaints about the lack on numbers on the project page, this cite gives some valuable and reassuring nummbers about bleeding during antiplatelet drug prophylaxis as well as the relative cost of aspirin verses more expensive treatment.   All-in-all,  a very interesting matter,  since so many persons are on antiplatelet treatment.    IMHO it would get lost over on aspirin.  Perhaps it could be set up as a separate page, but that seems an unecessary complication.
*"Choice of Antiplatelet drug: A recent review  states: "....low-dose aspirin increases the risk of major bleeding 2-fold compared with placebo. However, the annual incidence of major bleeding due to low-dose aspirin is modest—only 1.3 patients per thousand higher than what is observed with placebo treatment. Treatment of approximately 800 patients with low-dose aspirin annually for cardiovascular prophylaxis will result in only 1 additional major bleeding episode." Further, "...the cost to prevent one major GI bleeding episode from aspirin in 1 year by substituting clopidogrel therapy would be $1,216,180..." 
::I removed that, and the reason is that (1) it is germane to all indications for aspirin, hence belongs on aspirin or antiplatelet drug, (2) leaving it here would overload the article - imagine if we listed the side-effects of ACEi, β-blockers, potassium-sparing diuretics? In a major disease like MI I'd prefer references either to official guidelines (which are based on systematic reviews) or to studies that have looked specifically at MI. JFW | T@lk 07:11, 4 September 2006 (UTC)
thread_title:  Choice of antiplatelet drug 

message: I just redirected the entry on Pericarditus here. If someone wants expand that article, please feel free to, I just didn't consider the one-line article ("This is a type of condition in which the sac arond the heart becomes inflamed. It is usually associated with a acute-heart attack, but it really isnt.") encyclopedic enough to keep. ~ trialsanderrors 18:04, 21 September 2006 (UTC)
replies: text: Erm, I think it's a mis-spelling of Pericarditis and needs deleting. --John24601 18:11, 21 September 2006 (UTC)
replies: text: Thanks, I simply changed the redirect. No need to delete if it's a possible misspelling. ~ trialsanderrors 18:14, 21 September 2006 (UTC)
thread_title:  [[Pericarditus]] 

message: I received an email about what to do if you have a heart attack and help is not immediately available. Basicaly it says that you should take a deep breath and (strongly) cough out the air, every 2 seconds. Does that really help or is this a hoax ?
xerces8, --213.253.102.145 08:20, 7 November 2006 (UTC)
replies: text: Umm... Kinda a hoax, based on a rare occurrence.  If your heart were to stop completely you will pass out in about five seconds.  If you were to know exactly when your heart stopped (for instance, if you were on a telemetry monitor that someone was watching), they could prompt you to cough to presumably create some cardiac output while waiting for your heart to restart.  This is only really useful in a controlled setting in which someone was with you while you are on telemetry in a hospital or doctor's office.  Particularly useful if there is a prolonged pause after the administration of adenosine or in a cardiac cath lab or EP lab when asystole or ventricular fibrillation is induced. Ksheka 16:56, 25 November 2006 (UTC)
thread_title:  Self help in case of attack ? 

message: The following provide a counterpoint to the reference I added:
*
*
Fvasconcellos 20:39, 26 November 2006 (UTC)
thread_title:  Omega-3 and VF 

message: Why the lead says that AMI is equal with MI ? — Indon (reply) — 11:01, 27 November 2006 (UTC)
replies: text: Because chronic myocardial infarction exists, but is very rare, I guess.--Steven Fruitsmaak (Reply) 13:02, 27 November 2006 (UTC)

text: Correction: AMI is what is generally considered under MI; look at the ICD-10 classification and you will see how AMI and chronic ischemic heart disease are organised.--Steven Fruitsmaak (Reply) 16:24, 27 November 2006 (UTC)

text: When you talk about myocardial infarction, it must have been acute at some point.  There is no such thing as a "chronic" myocardial infarction (implying progressive death of myocardium over weeks to months due to an occlusion of a coronary artery).  "Acute" just means recent in this setting.  If someone has a history of an acute myocardial infarction in the past, we just say they have a history of an MI.  Ventricular remodeling after a myocardial infarction with subsequent cell death is a totally different animal. Ksheka 15:23, 28 November 2006 (UTC)
thread_title:  AMI vs MI 

message: I removed the following bit from the article:
There is no evidence that LDL cholesterol reduction alone predicts the decrease in cardiovascular risk,Hayward RA, Hofer TP, Vijan S. "Narrative review: lack of evidence for recommended low-density lipoprotein treatment targets: a solvable problem." Ann Intern Med 2006;145(7):520-30.  and emerging evidence suggests multiple beneficial effects of statins after a MI, for example via a decrease in C-reactive protein levels.Ray KK, Cannon CP. "The potential relevance of the multiple lipid-independent (pleiotropic) effects of statins in the management of acute coronary syndromes." J Am Coll Cardiol 2005;46(8):1425-33. 
There is definitely something wrong about it (it's just not true), and it actually contradicts the previous line in the article.  The bit about C-reactive protein is actually backwards.  C-reactive protein (CRP) is a marker of inflammation.  I don't believe there is any study that decreasing the CRP level itself (via plasmapheresis) is of benefit.  Rather, decreasing inflammation is of benefit, and the decrease in inflammation is seen as a decrease in CRP levels.  (This should be addressed in an article on coronary artery disease, and not in this article.) Ksheka 16:28, 29 November 2006 (UTC)
replies: text: The first reference about () is a review article which doesn't really make much sense, since it is contradicted by a number of mega-trials (4S for instance). Ksheka 16:35, 29 November 2006 (UTC)
replies: text: Of course statins are beneficial in MI, but the question is wether this is via LDL-c alone: there seems to be some research about other effects ("pleiotropic") too. Also, I saw some studies who just treated MI patients with statins and it reduced cardiovascular risk, without looking at the patients reduce in LDL: would you not say then, that it can be beneficial to all patients, even those with LDL, say, <130? The first reference, in my eyes, doesn't contradict 4S: the question is wether people with normal LDL-c could benefit from statins, no?--Steven Fruitsmaak (Reply) 16:47, 29 November 2006 (UTC)
replies: text: Okay.  This should be made more clear, then.  Maybe mentioning that the effects of statins may be more than their LDL lowering effects and that general consensus is that statins have plaque stabilization and other pleiotropic effects that may prevent myocardial infarction. Ksheka 16:52, 29 November 2006 (UTC)
replies: text: Okay.  I put in a different sentence in the article.  I'll reference it later if no one beats me to it. :-) Ksheka 17:01, 29 November 2006 (UTC)
thread_title:  Statins 

message: While looking for references for the first aid section, I found a site (http://heart-disease.health-cares.net/survive-heart-attack.php) that apparently copied content from this article, so I reported it on Wikipedia:Mirrors_and_forks/Ghi#Health-cares.net. The original structure seems to have been introduced in this rewrite from JFW.--Steven Fruitsmaak (Reply) 21:00, 3 December 2006 (UTC)
thread_title:  Copyright issues 

message: According to this website, people should call 911 prior to looking for an ASA.  Probably correct, but could use some real pubmed references. :-)
:You should not delay calling 9-1-1 to take an aspirin. Studies have shown that people sometimes delay seeking help if they take an aspirin (or other medicine). Emergency department personnel will give people experiencing a heart attack an aspirin as soon as they arrive. So, the best thing to do is to call 9-1-1 immediately and let the professionals give the aspirin.
Ksheka 00:26, 5 December 2006 (UTC)
replies: text: Okay.  I looked this up in the guidelines.  It seems to be based on a single study, and the guidelines don't have an opinion on whether ASA should be administered before calling EMS. Ksheka 03:20, 5 December 2006 (UTC)
thread_title:  Delay caused by ASA? 

message: The article is coming along nicely.  There is only one problem:  A lot of what we write, and the references we use, make it sound like things are certain.  This is probably the way we should do it for this sort of article.  Is there a benefit in giving other opinions on matters?  As an example, I have a bunch of references I will (hopefully) add today to show that PCI is better than thrombolytics for treatment of an STEMI.  However, this is the consensus opinion that has developed after a long series of studies have looked at the matter.  And some of the studies (which I will likely not reference) showed that there was no benefit of PCI over thrombolytics.
Again, I think we are doing this the correct way, but was wondering if this will be a sticking point if we aim for feature article status in the future.
Ksheka 14:23, 5 December 2006 (UTC)
replies: text: I think there's no need for such nuances; we should inform about the highest forms of consensus, and disclose uncertainties were debate exists: if meta-analyses have shown that there is a general trend, that overrules the negative findings of some studies. As long as we are being objective, no-one can accuse us of favouring certain views, even if we do not mention things in the extreme detail.--Steven Fruitsmaak (Reply) 17:03, 5 December 2006 (UTC)
thread_title:  A one-sided affair? 

message: The following line is under immediate care: "When symptoms of myocardial infarction occur, people wait on average 3 hours, instead of calling for help immediately."  This should probably be reworded, since it sounds like we are advocating waiting around for 3 hours before calling for help.  Maybe add a line about community teaching to call 9-1-1 immediately, the whole "time is myocardium" thing and progressive permanent myocardial damage prior to being evaluated? Ksheka 17:58, 13 December 2006 (UTC)
replies: text: I was under the impression a heart attack was a pretty rapid thing, could somebody even live 3 hours whilst "having" one?, let alone operate a phone at the end of that time  —Preceding unsigned comment added by 86.154.37.35 (talk) 01:22, 26 July 2008 (UTC)
thread_title:  Immediate care 

message: Am I being dense, or is the caption in :Image:Myocardial infarct emmolition phase histopathology.jpg confusing, i.e. "7 days of duration"? Does it mean 7 days post-onset, or an MI that went on for 7 days? :) Fvasconcellos 01:23, 14 December 2006 (UTC)
replies: text: Changed it to post-infarction.  Sounds better. Ksheka 01:28, 14 December 2006 (UTC)
replies: text: Thanks. Fvasconcellos 01:30, 14 December 2006 (UTC)
thread_title:  Image in Histopathology section 

message: The article says the risk factors for atherosclerosis may be risk factors for coronary artery disease. This is like saying the risk factors for losing all of your money may be the risk factors for bankruptcy. Coronary artery disease is caused by atherosclerosis. MoodyGroove 16:11, 23 December 2006 (UTC)
thread_title:  Epidemiology and Risk Factors 

message: The citation needed to show that fibrinolytic therapy is contraindicated for Non-ST Segment Elevation MI is _Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 1994;343:311-22_. Unfortunately, I do not yet possess the skills to insert this in the article. MoodyGroove 16:44, 23 December 2006 (UTC)
thread_title:  Reperfusion 

message: The citations needed for the first paragraph are _Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet 1996; 348:771-75._ Figure 4. on page 773 should be of particular interest, which is essentially a graph of the data from the FTT Collaborative Group (see previous citation under reperfusion) showing mortality against treatment delay. No reason you can't use that citation as well as it was a meta-analysis of all major thrombolytic trials and looked at over 60,000 patients. MoodyGroove 17:39, 23 December 2006 (UTC)
replies: text: Added to article. MoodyGroove 15:22, 26 December 2006 (UTC)
thread_title:  Thrombolytic Therapy 

message: Under risk factors, the article states, "Moreover, some drugs for MI might also reduce CRP levels." This could be more clear, in my opinion. I didn't edit it because I wasn't sure what the previous author was trying to say. "Drugs for MI" is very ambiguous. Are we talking about drugs used to prevent MI? MoodyGroove 21:45, 23 December 2006 (UTC)
replies: text: It refers to the pleiotropic effects of statins.--Steven Fruitsmaak (Reply) 17:37, 24 December 2006 (UTC)
thread_title:  C Reactive Protein (CRP) 

message: ::Would creating a navigation box help direct readers through the maze of related terms for pathology, symproms, diagnoses? As a outline (yes description need be summarised right down):
 Atherosclortic cardiac disorder outline
 (Conditions may have more than one cause) 
 Pathology in arteries
  Atheroma - lump of inflammatory cells, lipids and connective tissue within artery walls
  Atherosclerosis - atheroma, underlying cholesterol crystals and calcification
  * Coronary heart disease (aka coronary artery disease) - disease (atherosclorisis or other) occuring in the heart
  * Ischaemic heart disease - reduced blood supply to the heart muscle.
 Symptoms
  Angina pectoris - chest pain due to ischemia
  Acute coronary syndrome - clinical impression from history and examination, that pain may originate from the heart.
 Clinical events
  Myocardial infarction (aka heart attack) - interruption to blood supply to part of heart.
  Cardiac Arrest -  abrupt stop of normal circulation due to failure of the heart
David Ruben  Talk  03:27, 24 December 2006 (UTC)
thread_title:  Navigation Box 

message: The intro says it's a disease, but is it not a clinical event? I admit it's kinda weird to call it a disease, but the term disease, although not clearly defined, is in my view a pathophysiological state with a known cause. There is no way of proving that it is or is not a disease, since the term "disease" is ill defined. But it's a convenient way to keep the intro simple.--Steven Fruitsmaak (Reply) 13:57, 25 December 2006 (UTC)
thread_title:  MI = disease? 

message: I've drawn a sketch to illustrate this paragraph... On Commons there is another version in German, probably better, which I've asked the author to translate. Please comment here so I can make improvements on this preliminary version, or remove if it contains big mistakes...--Steven Fruitsmaak (Reply) 15:23, 25 December 2006 (UTC)
replies: text: I think it looks great! MoodyGroove 16:36, 25 December 2006 (UTC)

text: Excellent! Ksheka 20:27, 25 December 2006 (UTC)
replies: text: The alternative from the German version.--Steven Fruitsmaak (Reply) 12:43, 26 December 2006 (UTC)
replies: text: I think the one you have posted to the main article is great. It's simple and accurate. It also shows that STEMI does not always develop Q waves. Conversely, it shows that NSTEMI sometimes does develop Q waves. The alternate example is confusing. It also seems to suggest that typical angina is a prerequisite for ACS. I like the original! MoodyGroove 14:46, 26 December 2006 (UTC)
thread_title:  Classification image 

message: Here is the reference: Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle branch block. N Engl J Med 1996;334:481-7. MoodyGroove 15:28, 25 December 2006 (UTC)
replies: text: Added to article. MoodyGroove 15:22, 26 December 2006 (UTC)
thread_title:  Sgarbossa's Criteria 

message: I've added somewhat to this section, but I mostly found info on risk stratification... Could anyone provide prognostic information after specific therapeutic interventions, e.g. after reperfusion, CABG, ... ?--Steven Fruitsmaak (Reply) 23:18, 27 December 2006 (UTC)
thread_title:  Prognosis section rewrite 

message: I recognized this scanned image from another website. It came from here: http://www.emedu.org/ecg/images/wide_3a.jpg. Do we know for a fact that the image isn't copyrighted? MoodyGroove 13:09, 28 December 2006 (UTC)
replies: text: I've certainly got good EKGs of VT.  I'll scan one in in the next couple of days.  I should probably replace (overwrite) the image that is already in wikipedia, right? Ksheka 13:14, 28 December 2006 (UTC)
replies: text: Seems that way to me, Ksheka! But then I haven't been around very long! :) MoodyGroove 14:58, 28 December 2006 (UTC)

text: I don't think it's actually really necessary to have a VT image in this article...--Steven Fruitsmaak (Reply) 17:57, 28 December 2006 (UTC)
replies: text: Not sure myself if it is necessary.  The more pictures, the better however. ;-)  Anyway, I uploaded a new image so we are okay for now.  When I find one in color I will overwrite the black-and-white one. (My teaching EKGs are all photocopies.) Ksheka 02:53, 29 December 2006 (UTC)
replies: text: Too much of a good thing can be bad too, however.--Steven Fruitsmaak (Reply) 17:26, 29 December 2006 (UTC)
thread_title:  Ventricular Tachycardia 

message: I totally rewrote this section. I may need some help formatting the references. I'm guessing that some of you may not appreciate the hyperlink to the ACC's D2B Initiative (only because I don't see any other hyperlinks throughout the article) but it's the cutting edge of what's happening, and I think it deserves an explanation. Can anyone provide some guidance on this? Steven? Ksheka? MoodyGroove 03:18, 6 January 2007 (UTC)
replies: text: I solved the issue by creating a new article for door to balloon and placing the external link to the ACC's D2B page there. MoodyGroove 15:03, 6 January 2007 (UTC)
thread_title:  Emergency Services 

message: "Loss of consciousness and even sudden death can occur in myocardial infarctions and are poor prognostic indicators."
I had a double take reading that line. Yes, loss of consciousness is probably a bad prognostic indicators, but saying that death is a poor prognostic indicator seems a little silly. "Oh, you've died. That doesn't mean you're having a heart..." -72.77.65.81 08:29, 17 March 2007 (UTC)
replies: text: Hmmm...  Not sure about that. (Someone please correct me if I am wrong, I may be a little out of my field on this one) The problem is, sudden cardiac death is a medical term that includes an arrhythmic cause for the heart to stop pumping (generally ventricular fibrillation).  There are a number of sudden cardiac death survivers that make it to the hospital.  If they develop anoxic brain damage, they likely won't make it out alive.  The ones that were resuscitated right away and don't have any brain damage will generally do better so long as a defibrillator is implanted prior to discharge from the hospital. Ksheka 11:17, 18 March 2007 (UTC)
thread_title:  Prognostic indicators 

message: This article title should be named Heart attack per popular name standards. ~ UBeR 19:31, 27 April 2007 (UTC)
replies: text: I'm aware that there has been some discussion on this before, which I think just kinda fizzled out without reaching any agreement - perhaps now is the time to open it up again. I have to say I'm firmly on the side of pages on medical topics using the proper medical name as a title (so Myocardial Infarction stays), with redirects from lay terms such as heart attack. I think it's particularly relevant in this case because lay people take "heart attack" to mean both myocardial infarction and cardiac arrest, and on some occasions I've come across people who've meant cerebrovascular accident (stroke). There are probably other definitions too (for example, I'm sure there must be someone somewhere who considers angina to be a "mini heart attack", although I've never heard the term used myself). All of these things are completely seperate medical entities requiring their own page: by all means have redirects, disambiguation pages etc.,  but the actual articles dealing with each topic need to be on the right page, albeit perhaps with common lay terms feature prominently within them. I realise that's a bit waffly, but I hope I've made some sense! It would be useful to get the opinion of others. --John24601 21:00, 27 April 2007 (UTC)
thread_title:  Name of the article 

message: I can tell I'm no expert relative to some of you folks, but is there perhaps a place here (under 'diagnosis,' perhaps?) for predictive  instruments like the ACI-TIPI?  since there's already a section on the ECGs, and one on risk factors, it seems that at least a link might be in order.  and they do make huge differences in quality of care, door to balloon time, etc.
Vivisel 13:51, 29 May 2007 (UTC)
thread_title:  predictive instruments? 

message: A good thing we never mentioned DIGAMI on this page. The general feeling seems to be that DIGAMI II undid all the work done in DIGAMI I, and now "glucose-insulin-potassium" (GIK), which is a related attempt to interfere with the glucose metabolism in STEMI. In this study, hyperglycaemia, hyperkalaemia and fluid overload were not necessarily corrected, and the authors suggest that further studies may need to incorporate this. JFW | T@lk 14:48, 2 December 2007 (UTC)
thread_title:  GIK is dead 

message: I briefly browsed over Pathophysiology and the contents section and it is not inclusive nor consistent with new research that suggests that only 15% of heart attacks are caused by the type of clot described.  The other 85% is caused by a buildup of a fatty deposit in the arteries in much the same way, except, instead of growing large enough to block blood flow enough to kill part of the heart muscle, it grows just large enough to be burst open by rapidly moving blood (especially as in a person not accustomed to physical exertion, or having obesity or cholesterol deposits), cholesterol, free radicals (smoking), etc  (the exact cause is unknown) and a blood clot forms on the surface of the plaque.  I saw this in ABC health (or was it discovery health) and will try to get citation information.  You can already see that new research is appearing as the PRIMARY cause on the third result on Google http://www.medicinenet.com/heart_attack/article.htm#tocc , so I suggest anyone interested in taking the time to edit it with information from new research.  (Actually, I looked over the templates and could not find "needs to be updated".)  Nobodymk2 01:15, 4 December 2007 (UTC)
replies: text: What you describe (blood clot forming on the surface of the plaque) is exactly what the pathophysiology section describes (disruption of an atherosclerotic plaque in an epicardial coronary artery, which leads to a clotting cascade, sometimes resulting in total occlusion of the artery). Plaque rupture is the clinical event believed to be responsible for the vast majority of acute coronary syndromes. That's not controversial, and the article is up to date in this respect. If you are aware of new research, then please cite the peer reviewed literature. I just attended AHA Scientific Sessions 2007 in Orlando and saw nothing to suggest that the theory of plaque rupture is in quesiton. MoodyGroove 01:25, 4 December 2007 (UTC)
thread_title:  Should include more recent research 

message: I'm surprised that this article seems to have WP:MEDMOS backwards. The last thing readers need to know about is epidemiology. Is there any compelling reason why we need to deviate from the WP:MED article structure in this particular instance? JFW | T@lk 22:58, 5 January 2008 (UTC)
thread_title:  MEDMOS 

message: I was surprised to see that in the introduction, it is stated that "Approximately one third of all myocardial infarctions are silent, without chest pain or other symptoms." However, further down the page, under the symptoms section, it is stated "Approximately one fourth of all myocardial infarctions are silent, without chest pain or other symptoms."
The reference that the second statement links to isn't particularly helpful; it just says "More than one in four myocardial infarctions that occurred over 30 years in the Framingham Study were detected only because of routine biennial electrocardiographic examinations. Of these, almost half were completely silent."
So what does that mean? Almost half of more than one in four? 1/8th of all myocardial infarctions are silent? Not quite sure where the 1/3 and the 1/4 figures stated in the article come from. Nitroshockwave (talk) 16:46, 16 January 2008 (UTC)
thread_title:  Silent Myocardial Infarctions discrepancy 

message: previous MI? Please have a cardiologist access.  Tkjazzer (talk) 05:07, 31 January 2008 (UTC)
thread_title:  risk factor missing? 

message: This article is too long. Some of the sections are of appropriate length and have a  link. We need to cut the oversize sections down to size and put the whole contents of each into a separate article. See Wikipedia:Article size#Very long articles. Heroeswithmetaphors (talk) 09:54, 16 June 2008 (UTC)
replies: text: I'm not sure if I agree. Which measures of length are you using? Much of the 186 K is due to the almost 200 references, which is only a drop in the ocean of literature actually available on heart attacks. Which sections should be split off? JFW | T@lk 11:21, 16 June 2008 (UTC)
replies: text: Number of words of prose is the best measure there is. This article has over 10,000 words of prose, which, by any measure for a non-core topic, is a bit on the long size. WP:SIZE says that anything in the range of 6,000 to 10,000 is probably getting too long and really needs to either be an exceptionally important topic (think world wars or core topic categories such as chemsitry) or have damn good writing, esp if the subject is technical. Thus a bit of summarizing and spinning off may be in order. --mav (talk) 05:09, 28 September 2008 (UTC)

text: As the risk factors are similar to those of atherosclerosis can that section be moved out from MI article? DOCtraind (talk) 00:31, 28 February 2009 (UTC)
thread_title:  Too long 

message: This article has numerous issues.  Have started to try and fix many of them.  Organized the text to fit MOS.  There are however many small inaccuracies.  Much of the text is disorganized with info in one section that belongs in another.
Do not think it is either A or GA at this point.  There is no section on history, economic impact, or public health.  The section on epidemiology does not yet provide a good world overview.  The prose is kind of rambling.
--Doc James (talk · contribs · email) 22:18, 21 March 2009 (UTC)
thread_title:  Issues 

message: In view of peer reviewed data Baroldi and Silver summarize in"The Etiopathogenesis of Coronary Heart Disease: A Heretical Theory Based on Morphology" http://www.baroldi.com/public/baroldi.pdf  the first paragraph of the article needs to be corrected:
quote from Baroldi and Silver publication
"“We present above much morpho-functional and clinical data that make us doubt the value of the currently accepted simplistic “unifying theory” and the cause/effect relationship between an occlusive coronary thrombus and all forms of myocardial necrosis. Rather, we believe that morpho-functional and clinical data support a secondary role for plaque rupture, thrombosis and embolism and that metabolic mechanisms rather than ischemia explain complications and deaths in acute and chronic ischemic syndromes (Fig. 25). Amongst morphologic variables we have listed all those which may allow a reinterpretation of the natural history of our epidemic.”
" In contrast to the current belief our data show that: 1. In human hearts coronary collaterals exist and compensate severe atherosclerotic stenoses. At the initial presentation of coronary heart disease in apparenlty normal subjects, severe single or multiple coronary stenoses preexisted in absence of symptoms and signs.
2. Atherosclerosis is due to increased hemodynamic stress on the vessel wall secondary to recurrent or stable regional myocardial dysfunction and increased peripheral resistance. The latter is due to extravascular compression of the intramural vessels within an asynergic zone of myocardium. All changes seen at the plaque level (hemorrhage, rupture, thrombosis) are secondary phenomena to obstruction of flow.
3. Coronary atherosclerosis in man has a different history and structure from atherosclerosis following hypercholesterol diet or familial hypercholesterolemia.
4. Myocardial necrosis in coronary heart disease is not a pool of different myocardial changes (coagulation necrosis, contraction band necrosis or apoptosis) due to ischemia.1 It is a collection of distinct forms of myocardial injury each with its own etiopathogenesis: blood flow reduction for infarct necrosis, catecholamine myonecrosis for contraction band necrosis linked to malignant arrhythmia/ventricular fibrillation and colliquative myocytolysis due to a non ischemic metabolic disorder of myocardial cells ending in congestive heart failure.
5. Morphologic data support the hypothesis that coronary heart disease is more an adrenergic stress-dependent disease than a hydraulic problem."
--Koronarfürst (talk) 08:52, 3 May 2009 (UTC)
replies: text: This seems like a novel theory rather than the commonly accepted ones? Appears to be somewhat logical but we need a reliable review to show that this kind of theory is widely accepted. Otherwise it's Wikipedia:Recentism. --Steven Fruitsmaak (Reply) 08:56, 3 May 2009 (UTC)
replies: text:  Baroldi and Silver present facts, not just a theory! have you read the real-time observation of an infarction they describe on page 60 in their report? what else do we need? science is not politics, science is about facts, not about opportunistic voting. 
quote from Baroldi and Silver:
“for millennia the earth remained the center of the universe; an unquestionable, objective fact documented already from the first man by looking every morning from his cavern, at the rise of the sun and its course from East to West. A few, by looking at the stars, questioned this undeniable fact and, despite the Inquisition, were right” (Baroldi, 1978). However the truth was recognized after almost 800 years from Aristarco (270 BC) to Copernico and Galileo (1550 AC). Today, dogma provides another supposedly undeniable fact viz—it “is hardly credible that there should be continuing debate about what is ostensibly so simple a morphologic problem: the relationship of coronary thrombosis to acute myocardial infarction” (Davies et al, 1976). This has in turn promoted and promotes sophisticated, highly technological, preventive and therapeutic procedures, ranging from manipulation of gene expression that will stop plaque rupture, to new vessel growth to vascularize myocardial scar and hibernating myocardium to implantations of new myocardial cells to resolve insufficient contractility, all under the aegis of the “thrombocentric” CHD universe. These are fascinating perspectives for the new millenium amongst which the old Virchowian concept on the inflammatory nature of atherosclerosis (“chronic endoarteritis deformans; 1856) is revitalized by (a) a relation between the severity of the latter and antibodies against Clamydia pneumoniae (Ericson et al, 2000); or (b) by C-reactive and amyloid A proteins as generic indicators of inflammation related to higher mortality (Liuzzo et al, 1994, 1998; Morrow et al, 1999); or (c) monocytic/granulocytic activation in CHD (Neri Serneri et al, 1992; Mazzone et al, 1998). We were able to see medial neuritis only at the proteoglycan stage of the atherosclerotic plaqu as an unique (autoimmune?) process in the natural history of coronary heart disease. The impression is that CHD needs to be reinterpreted, or, unfortunatelly, it will remain an important if unknown “universe” jeopardizing our evolution."
so, please correct the first paragraph.
--Koronarfürst (talk) 08:42, 4 May 2009 (UTC)

text: Actually, in Medieval times, Wikipedia would say that the earth is flat, until it would be generally believed that it were not. We don't blindly follow new theories. If the authors themselves say it is a heretical theory, we are unlikely to use it. --Steven Fruitsmaak (Reply) 09:13, 4 May 2009 (UTC)
replies: text:  why don't you read the book before posting?
 so a last quote:
"Heresy from the Greek (αιρεσισ) means “choice” and semantically indicates an opinion or doctrine at variance with what is currently
orthodox. A heresy is mainly considered an error by the orthodox and one that must be eradicated to preserve current thought and their dominion. Nevertheless, human knowledge, including science, progresses through paradoxes or heresies. It takes time for the latter to be proven wrong or be accepted. ... In proposing a heretical scientific opinion one must define the natural history, step-by-step and fact by fact, rationalizing the construction of the opinion and its right to exist."
In exactly such a carefull manner Baroldi and Silver proof that myocardial infarction is not due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque. If you can proof them wrong, show us peer reviewed results, otherwise correct the article.
--Koronarfürst (talk) 10:45, 4 May 2009 (UTC)
thread_title:  first paragrah needs to be corrected 

message: A sentence was included which stated that Aspirin was the only first line agent that had been shown to reduce mortality. However the refence stated that Aspirin and Streptokinase both were effective in reducing mortality (I actually knew this earlier so I think the study is right!) so for starters, the statement is proven wrong by the reference.
Secondly, the reference did NOT say that other treatments were ineffective (perhaps they are? but the reference doesn't back that up). I'm not aware of any evidence to suggest morphine does aid at all, but I'm not a cardiologist either... M0rt (talk) 08:14, 4 May 2009 (UTC)
thread_title:  Reference didn't match the statement 

message: Article intro is too long by far. It should be a concise paragraph. Whole article looks pretty long though. ROxBo (talk) 15:58, 13 August 2009 (UTC)
thread_title:  Article intro 

message: Shouldn't this article be moved to 'Heart Attack'? This will be more intuitive to general public as many of us are not aware about the current technical title. Probably, the current title should be a redirect to 'Heart Attack', instead of the other way. Thanks. 99.32.118.211 (talk) 07:45, 23 July 2009 (UTC)
replies: text: Oppose. It is MI. Wiki is encyclopedic.ROxBo (talk) 15:58, 13 August 2009 (UTC)
thread_title:  Move to -> Heart Attack 

message: as someone has deleted the topic in whole
* http://scholar.google.com/scholar?as_q=myocardial+infarction+diet&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en
--222.64.218.235 (talk) 09:20, 20 January 2010 (UTC)
thread_title:  Dietary concern.....Repost from the topic of [[Heart attack]] to here... 

message: *Have a copy of this review and will add / update.  Doc James (talk · contribs · email) 07:27, 22 February 2010 (UTC)
thread_title:  References 

message: I was actually not so surprised to read in Nicholas Culpeper's herbal, that wintergreen boiled in wine and water "takes away any inflammations rising upon pains of the heart".  Though I might go too far if I draw the conclusion myself, it would seem that the idea of using aspirin after a heart attack is not new at all. Wnt (talk) 05:36, 7 March 2010 (UTC)
thread_title:  Salicylate therapy in 1653 

message: I started a review a while back regarding A class status   There are a number of ongoing issues with this page.  Probably the most prominent is that parts need to be summarized a split off to make it a little less technical.  It is also as a mentioned limited in scope.  Thus changed to B.Doc James (talk · contribs · email) 04:10, 21 February 2010 (UTC)
replies: text: I totally agree that this article needs work to get up to GA standard. I'm not even sure how much actually needs to be split off (although subpages on STEMI, NSTEMI and primary PCI are probably needed). There are currently way too many references - most of them are observational studies or clinical trials that don't meet WP:MEDRS. We also need to discuss TIMI, GRACE, the 5 types of MI per the latest classification, and so on. JFW | T@lk 11:09, 21 February 2010 (UTC)
thread_title:  A class review 

message: I have added references, to the section, shall I remove the unreferenced tag, and about the last sentences, its just an explanation on why we shouldn't refer to MI by heart failure or cardiac arrest?? what references do we need there??, By the way I can improve references more if they are not satisfactory. MaenK.A.Talk 10:00, 17 April 2010 (UTC)
thread_title:  [[Myocardial_infarction#Classification|Classification section]] 

message: I believe there should be some mention in the article about the lack of an evolved cognisance of a heart attack.  It would be impossible for a "sense" of a heart attack to evolve because that sense would not influence the survival of the carrier.  Imagine a mutant individual who was aware they were experiencing a myocardial infarction. This individual would not benefit from this information because he cannot influence the odds of his own survival by averting the heart attack in some way.  Such a sensor in the body would not get itself propagated into subsequent generations because the carrier of the sensor would not live longer or leave more children just because he can sense heart attacks.  Any sensations that we can attribute to a heart attack is purely incidental to the side effects, such as numbness in the fingers due to the lack of blood flow.
This addition would be useful because #1) it raises awareness of the importance of evolutionary considerations in medicine #2) it is a truthful statement about the nature of our awareness of our heart and the nervous system that has evolved between our heart and brain #3) it fights the implication that we have nerves connected to our heart so that we can "feel" our heart.  if this were true why then don't we have nerves to every other organ so we can be aware of their malfunctioning?  —Preceding unsigned comment added by 63.77.95.90 (talk) 23:44, 11 November 2010 (UTC)
replies: text: Nothing the body could do would have any good effect in the course of the heartattack or in the harm to the body? --TiagoTiago (talk) 06:44, 12 November 2011 (UTC)
thread_title:  evolutionary considerations 

message: Looking at the contents of this article, I'm curious why there is no section titled "Treatment".  To me "treatment" is "short-term" and "management" is "longer-term".  But those are only my perceptions.  
From a medical POV, what is the distinction between "treatment" and "management"?  Thanks, Wanderer57 (talk) 17:02, 2 June 2011 (UTC)
thread_title:  Treatment? 

message: "Classical symptoms of acute myocardial infarction include sudden chest pain (typically radiating to the left arm or left side of the neck), shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety (often described as a sense of impending doom)." This is a terrible sentence. It justs lists a set of things that are in so many conditions -- like, almost all of them -- so as to be useless. If anyone knows the more dramatic, more obvous symptoms of this (nail or mouth color change for instance) they would be far more useful. Currently, its the type of sentence that terrifies already paniced people, so I think we should make absolutely clear the most dangerous signs, not all of them. 74.128.56.194 (talk) 13:42, 2 July 2011 (UTC)
thread_title:  Symptoms. 

message: So why doesn't WP:COMMONNAME apply to this article? 99.99% of people wouldn't known what a myocardial infarction is but they sure have heard of heart attacks. The article cancer isn't named malignant neoplasm. Most Wikipedia readers aren't medical professionals or students. SpeakFree (talk) 18:54, 29 September 2011 (UTC)
thread_title:  Common name 

message: The article intro says of symptoms "Classical symptoms of acute myocardial infarction include sudden chest pain (typically radiating to the left arm or left side of the neck)"; the image (AMI_pain_front.png) in the "Signs and symptoms" section has pain zones extending up and to what is anatomically the the right side of the body in the image (although it is viewer-left). Unless this follows some convention generally in medicine, anatomy, or diagnosis guides, the image is contradicted by the text.  — Preceding unsigned comment added by 66.67.51.190 (talk) 23:55, 14 May 2012 (UTC)
thread_title:  Contradiction 

message: There seems to be a continuity error in the section relating to silent MI's, which first says that it is more common in young people, then says it is more common in the elderly.  — Preceding unsigned comment added by 122.148.213.48 (talk) 14:31, 5 September 2012 (UTC)
replies: text: Thanks, have adjusted text accordingly. Yobol (talk) 21:52, 9 September 2012 (UTC)
thread_title:  Signs & Symptoms 

message: The cross section of the heart is probably the short axis view (see here), and is a similar view as if one were looking at a CT scan (R side of the body is on the left of the image). This means the area in question would be the anterior of the heart. Yobol (talk) 17:06, 24 August 2012 (UTC)
thread_title:  Anterior vs posterior 

message: http://eurheartj.oxfordjournals.org/content/early/2012/08/23/eurheartj.ehs184.full Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:55, 8 October 2012 (UTC)
thread_title:  New definition as of 2012 

message: http://eurheartj.oxfordjournals.org/content/early/2012/08/23/eurheartj.ehs184.full Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:55, 8 October 2012 (UTC)
thread_title:  New definition as of 2012 

message: Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:49, 16 January 2013 (UTC)
thread_title: 2013 AHA guidelines

message: doi:10.1001/2013.jamainternmed.1001 - too much is bad. JFW | T@lk 17:21, 30 January 2013 (UTC)
thread_title:  Don't transfuse too much! 

message: Hi. Sorry if I'm mistaken, but I believe this is a pretty clear case of WP:COMMONNAME for a speedy rename to the heart attack article. TBrandley 01:02, 8 April 2013 (UTC)
replies: text: Heart attack is not specific for myocardial infarction. People also use heart attack to mean cardiac arrest. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:46, 8 April 2013 (UTC)
replies: text: Maybe Talk:Myocardial_infarction/Archive_1#Article_move was archived too soon? Steveozone (talk) 02:14, 8 April 2013 (UTC)

text: See Wikipedia:Manual of Style/Medicine-related articles#Naming conventions for another reason why this article is titled Myocardial infarction instead of Heart attack. Flyer22 (talk) 01:35, 12 May 2013 (UTC)
thread_title:  Rename article? 

message: 2013 Lancet http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61454-3/abstract http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61453-1/abstract Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:16, 20 August 2013 (UTC)
thread_title: Refs

message: Why use "not enough" in the introductory paragraph when "lack of" is shorter & more concise? Thoughts anyone? Sounds more encyclopedic & professional. If this is an online encyclopedia, it should read like one. Tommyt (talk) 03:24, 19 September 2013 (UTC)
replies: text: I thought "not getting enough" to "not enough" was a fair compromise. Our goal is to write, at least the lead, in easy to understand language. We are trying to write a general encyclopedia which is accessible to as many people as possible. This article will be eventually translated (after I get around to improving / updating it) into as many languages as possible per Wikipedia:WikiProject_Medicine/Translation_task_force. The translators have really emphasized the importance for simple languages especially for languages with smaller vocabulary.Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:37, 19 September 2013 (UTC)
replies: text: So "lack of" will not translate very well? Tommyt (talk) 20:14, 23 September 2013 (UTC)
thread_title:  "Not enough" vs "lack of" oxygen 

message: doi:10.1016/j.amjmed.2013.09.031 - type 2 MI is frequently encountered in clinical practice, but diagnostic and therapeutic strategies are unclear. This is a review of this particular entity. JFW | T@lk 13:12, 21 October 2013 (UTC)
thread_title:  Type 2 MI 

message: I'm surprised this article hasn't gotten a request for inclusion of this study as a source since it is relevant to the closely related subjects of myocardial infarction and diabetes, so I'm going to drop some information here. We have discussed it at the Chelation therapy article and rejected using it. You can read the discussion and the reasons for rejection here:
* Talk:Chelation_therapy#TACT_Study_Re-Analysis_of_Diabetic_Subgroup
Here is the abstract of the study:
* Escolar E., et al. The Effect of an EDTA-based Chelation Regimen on Patients With Diabetes Mellitus and Prior Myocardial Infarction in the Trial to Assess Chelation Therapy (TACT), American Heart Association, Circulation, Published online before print November 19, 2013, doi: 10.1161/​CIRCOUTCOMES.113.000663
The full article can be downloaded free as a PDF document:
* http://circoutcomes.ahajournals.org/content/early/2013/11/19/CIRCOUTCOMES.113.000663.full.pdf+html
In the "Methods and Results" section of the abstract you'll find this: "However, after adjusting for multiple subgroups, those results were no longer significant." There was no effect on the group of patients without diabetes nor a mechanism of action to explain why it would work on diabetes patients, but not other patients. The difference was about 11 patients out of 300+ patients or about 3%. So, it is probably just chance rearing its ugly head and giving misleading results. As the study authors say: "These findings support efforts to replicate these findings and define the mechanisms of benefit. However, they do not constitute sufficient evidence to indicate the routine use of chelation therapy for all post–myocardial infarction patients with diabetes mellitus."
It is definitely an interesting study and we'll be allowed to report this in the article when it clears our WP:MEDRS rules, which will be when reviews of multiple studies are finished. These are preliminary and uncertain results: "...more studies are needed before it’s known whether this promising finding leads to a treatment option." We don't use primary studies like this as sources, IOW we don't present the latest findings and "promising studies". We are not a news agency when it comes to medical matters. If anyone disagrees, they can go to the MEDRS talk page and try to get the rules changed. We can't do anything until that is done. -- Brangifer (talk) 17:52, 1 December 2013 (UTC)
thread_title:  Trial to Assess Chelation Therapy (TACT). Its relevance here. 

message: *
*
Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:08, 2 February 2014 (UTC)
thread_title: Reviews

message: Myocardial infarction with normal coronary arteries - reviewed in detail doi:10.1161/CIRCULATIONAHA.114.011201:
* Prevalence 6% in people with MI, more patients younger and female with less hyperlipidaemia but otherwise similar proportions of risk factors
* Mortality lower than with confirmed coronary artery disease
* Only 24% have CMR appearance suggestive of coronary ischaemia, and 33% had myocarditis with 26% no abnormality at all
* 27% had inducible coronary artery spasm, and 14% had some form of detectable thrombophilia
Unsure how to work this into the article. JFW | T@lk 21:43, 9 March 2015 (UTC)
replies: text: I can start a classification section and it could probably be integrated into a section like that. TylerDurden8823 (talk) 22:46, 9 March 2015 (UTC)
replies: text: Better yet, there's already a classification section under diagnosis, we can simply expand it and include this content. TylerDurden8823 (talk) 22:47, 9 March 2015 (UTC)
replies: text: Could fit under cause, mechanism or diagnosis. Doc James (talk · contribs · email) 06:00, 10 March 2015 (UTC)
thread_title: MINOCA

message: This 2014 BMJ review  was called outdated and replaced by a 2011 paper ? Doc James (talk · contribs · email) 18:57, 28 April 2015 (UTC)
replies: text: Will look at it further. There does seem to be contention on this point. Doc James (talk · contribs · email) 06:28, 30 April 2015 (UTC)
replies: text: User:Hyoib I guess there are two question 1) do they need to be given before PCI which appears to be no and 2) do they need to be given for 12 months which the EU guideline recommends yes. Adjusted text to reflect both Doc James (talk · contribs · email) 14:19, 30 April 2015 (UTC)
thread_title: Outdated

message: Is this statistic worth including in the article?
I did not find death rates listed.
In the USA: The coronary heart disease death rate disease has decreased 38 percent in the 10 years ending 2013.
Sources:
http://www.nytimes.com/2015/06/21/health/saving-heart-attack-victims-stat.html?emc=edit_th_20150621&nl=todaysheadlines&nlid=58413496&_r=0
http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf
Thank you,--Jcardazzi (talk) 17:21, 21 June 2015 (UTC)
replies: text: The CDC ref is good. What page is that info on? Doc James (talk · contribs · email) 19:46, 21 June 2015 (UTC)
replies: text: Okay AHA is good awell. Maybe the NY Times got the 38 / 39 bit wrong. Doc James (talk · contribs · email) 12:23, 22 June 2015 (UTC)

text: Actual ref says "From 2001 to 2011, death rates attributable to CVD declined 30.8%."  Doc James (talk · contribs · email) 13:02, 22 June 2015 (UTC)
thread_title:  USA Death Rates decline 

message: Hello fellow Wikipedians,
I have just added archive links to  on Myocardial infarction. Please take a moment to review my edit. If necessary, add  after the link to keep me from modifying it. Alternatively, you can add  to keep me off the page altogether. I made the following changes:
*Added archive https://web.archive.org/20100521050422/http://www.focusonfirstaid.co.uk:80/Magazine/issue15/index.aspx to http://www.focusonfirstaid.co.uk/Magazine/issue15/index.aspx
*Added archive https://web.archive.org/20060925134349/http://www.americanheart.org/presenter.jhtml?identifier=3010002 to http://www.americanheart.org/presenter.jhtml?identifier=3010002
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thread_title:  External links modified 

message: I am not able to understand the meaning of coronary intervention in the following sentence "A cardiac troponin rise accompanied by either typical symptoms, pathological Q waves, ST elevation or depression, or coronary intervention is diagnostic of MI"
Does coronary intervention means angioplasty? If it is, how can it be a cause (part of diagnosis) of MI? Thank you. -- Abhijeet Safai (talk) 09:46, 2 May 2017 (UTC)
replies: text: Would mean angiogram. Doc James (talk · contribs · email) 17:15, 2 May 2017 (UTC)
replies: text:  Ok. Great. But in that case, "......ST elevation or depression, or findings in coronary intervention is diagnostic of MI" would be more appropriate. I am changing the sentence as a result. Kindly modify if not found accurate. Thank you. -- Abhijeet Safai (talk) 10:25, 3 May 2017 (UTC)
replies: text:  It seems that, that particular sentence is removed. So I could not make this change. But thank you for the information. -- Abhijeet Safai (talk) 10:31, 3 May 2017 (UTC)
thread_title:  Meaning of a sentence not clear  

message: I remember that I have read in the autobiographical book by Dr. Abhay Bang that the sensitivity of ECG to diagnose MI is only 30%. If I am not wrong he has referred to books by Eugene Braunwald. This reference can be found out and can be used in the article if found appropriate and if the article does not mention it. Thank you. -- Abhijeet Safai (talk) 06:31, 2 May 2017 (UTC)
replies: text: Yes NSTEMIs often have normal ECGs Doc James (talk · contribs · email) 17:22, 2 May 2017 (UTC)
replies: text:  Thank you. -- Abhijeet Safai (talk) 10:26, 3 May 2017 (UTC)
thread_title:  Sensitivity of ECG to diagnose an MI is about 30% 

message: doi:10.1161/CIR.0000000000000336 JFW | T@lk 16:38, 16 March 2016 (UTC)
thread_title:  Primary PCI for STEMI