Talk:Myocardial infarction/Archive 2

message: Cardiac_markers, I think, should be merged here.
:No, it's long enough already.--Steven Fruitsmaak (Reply) 16:56, 6 December 2006 (UTC)
thread_title:  merge [[Cardiac_markers]]

message: Under chest pain, I suggest you add the term "angina pectoris" or "anginal pain". The characteristis of angina pectoris are:  1. Usually provoked by exertion, excitement.  2. The pain is dominated by a sense of pressure in the precordium with radiation commonly to the left arm.  3.  The pain may be sensed from the eyballs to the umbilicus; e.g. jaw pain may be the only manifestation.  4.  It is relieved by rest within 15 minutes  ( if it lasts longer consider acute infarction.  5.  It is usually relieved by sublingual nitroglycerin.
----
Shouldn't this entire page be under "Myocardial Infarction", with a redirection from Heart Attack to that page? Myocardial infarction is the medical term for the condition, so it should probably be used in the Wiki.
Anyone object to me making the switch over?
Ksheka 16:03, Apr 15, 2004 (UTC)
:In favour; argumentation on my talk page.  JFW | T@lk 18:43, 15 Apr 2004 (UTC)
thread_title: suggestion

message: Hi.  I've been working on a few medical pages, and the page for Heart attack really annoys me a bit.  Maybe that's not the right word -- I would like to move the entire page over to Myocardial infarction, and have "Heart attack" redirect over there.  The problem is that there's a lot of pages that reference the page.<BR>
I feel that Myocardial infarction is much more professional for the wiki (and just about any other encyclopedia).<BR>
Is it okay to do the move?  Do I need to get permission from someone?  Does it need to be orchestrated in some way?  Or should I just let sleeping dogs lie?<BR>
The last thing I want to do is break a hundred pages by doing this move...
Ksheka 16:27, Apr 15, 2004 (UTC)
:Heart attack is the common name for the problem.  As a general interest reference this seems appropriate to Wikipedia.  I understand what you mean, though.  Kd4ttc 17:16, 15 Apr 2004 (UTC)
replies: text: Okay.  I'll do the move this weekend.  Any tips on redirection would be appreciated.  I guess that the proper way to do it is to manually change all the links??? Ksheka 01:41, Apr 16, 2004 (UTC)
Previous experience has taught me that - unless you're capable of writing a bot do to it - moving it manually is the best way. I'll see if I can find some time on Saturday night (after Shabbat, when I'm dewikified) to help to perform the procedure.  JFW | T@lk 11:11, 16 Apr 2004 (UTC)

text: hmmm... I tried using the "Move this page" link on the left of the page, but that didn't work because "Myocardial infarction" already has a page history (It's just to redirect to Heart attack, but it's a history, none the less. :-(  So I put Myocardial infarction on Wikipedia:Redirects for deletion, with the thought that after the deletion, we can do the page move (preferably before anyone re-creates Myocardial infarction).  Is this the proper way?  If I just cut and pasted the text, we lose all history for the page.Ksheka 13:25, Apr 18, 2004 (UTC)
You've been very good. I once made the mistake of moving a complete page (Haemochromatosis), upsetting some people (Talk:Haemochromatosis). This is probably the best way, indeed. I'll help you with the double-redirects when the move has become official.<BR>
PS I had some correspondence with User:Meelar, who's an admin, and he said he would support one of the WikiDoc members to become an admin, to deal with exactly these kind of problems. I think this in something to keep in mind; I'll remind him in a few weeks (see User_talk:Jfdwolff#Cgi-bin for details).  JFW | T@lk 14:10, 18 Apr 2004 (UTC)

text: At the moment, the vote is 50/50... I'll see if I can rally some support through the WikiDoc network...  JFW | T@lk 10:36, 22 Apr 2004 (UTC)

text: I noticed. :-(  Any idea how long the vote should go on? Ksheka 10:38, Apr 22, 2004 (UTC)
I completely agree with the redirect in question.
Benjaminstewart05 11:51, 12 April 2006 (UTC)
thread_title:  A mass-redirect question 

message: I've heard (from reliable sources) that the symptoms of a heart attack are very different for women than for men.  Assuming this is true, can somebody (who knows more about this than me) write up something on this for the section on symptoms?
They may be different. Men tend to experience classical symptoms (e.g. a poorly localized and uncomfortable squeezing or pressure in the center of the chest lasting for 15 minutes or more) while women may experience epigastric pain often mistaken for heart burn. Other groups at risk for atypical symptoms include diabetics (who may not experience any pain) and the elderly (who often complain of new exertional dyspnea). MoodyGroove 16:03, 23 December 2006 (UTC)
replies: text: It has been covered in the article.--Steven Fruitsmaak (Reply) 16:10, 23 December 2006 (UTC)
thread_title:  Sex differences 

message: Something I hoped to find out from this article but didn't: is there any actual technical meaning to the oft-heard term "massive heart attack"? Is there anything that makes one heart attack massive and another not? Or is the word "massive" in this context just padding? Bonalaw 12:51, 15 Aug 2004 (UTC)
replies: text: It's a specification of severity. Heart attacks can be mild, serious or life-threatening. In itself, Massive Attack (yes, I know it's a band) has little specific meaning, apart from the fact that the patient is doing poorly (e.g. cardiac shock, arrhythmias, requiring cardiopulmonary resuscitation...) JFW | T@lk 13:10, 15 Aug 2004 (UTC)
thread_title:  Massive Attack 

message: I was told that gastritis may have confusingly similar symptoms, at least to those without a medicine background. Is it true? -- Paddu 06:41, 21 Oct 2004 (UTC)
replies: text: Yes, lots of things can be confused with a myocardial infarction, and gastritis is one of them. Another is esophagitis (i.e. heartburn). Medical training alone doesn't allow these conditions to be reliably distinguished on the basis of symptoms only: even those with advanced training need such tests as EKGs and cardiac enzymes in order to diagnose a myocardial infarction. - Nunh-huh 06:49, 21 Oct 2004 (UTC)
thread_title: Gastritis

message: An anonymous editor inserted a lot of material, citing "studies" and "standards of care" that were completely unreferenced. Wikipedia is now in the business of citing references, and this important article lacks anything but Herrick's 1912 article that I cited. Adding bossy terms ("standards of care") without backing them up is extremely unencyclopedic. Furthermore, they were very much USA-biased (in the UK, troponin I or T are used in isolation).
Large articles on areas which are highly evidence-based (such as this one) should be properly referenced, or run the risk of being listed for cleanup. JFW | T@lk 10:15, 6 Feb 2005 (UTC)
thread_title:  Unreferenced edits 

message: A related article, Obesity, is currently nominated to be improved on Wikipedia:This week's improvement drive. Please vote for this article there.--Fenice 08:38, 9 August 2005 (UTC)
thread_title: Improvement drive

message: I removed lengthy discussions, mainly with an unregistered user from Brazil, about inclusion of an alternative theory on this page. Despite numerous requests, this user has been unwilling to explain how many cardiologists actually lend credence to this theory. Under WP:NPOV, only significant views warrant inclusion in Wikipedia. I have now archived the discussion to Archive 1. JFW | T@lk 11:34, 11 December 2005 (UTC)
thread_title: The digitalis theory

message: I suggest using this article for the ECG diagnosis section. It is fairly comprehensive:
* Zimetbaum PJ, Josephson ME. Use of the electrocardiogram in acute myocardial infarction. N Engl J Med 2003;348:933-40. .
Anyone interested? JFW | T@lk 23:22, 11 December 2005 (UTC)
thread_title:  Zimetbaum article 

message: I've tried hard to find a reliable reference for the 1971 WHO criteria. It seems these were redefined in principle by the JACC/ECC. Any comments? What should we represent? JFW | T@lk 00:30, 19 January 2006 (UTC)
replies: text: You are probably looking for this: Nomenclature and Criteria for Diagnosis of Ischaemic Heart Disease (Circulation, 1979, Vol. 59, No. 3, 607609)  Can't find it on pubmed though... --WS 10:47, 19 January 2006 (UTC)
thread_title:  WHO 1971 

message: Is it really nescessary to go into detail about cardiac arrest in this article? It is a very common mistake by healthcare professionals and lay people alike that Heart Attack = Cardiac Arrest; and by mentioning treatment of cardiac arrest here we are doing nothing to dispell the myth. It is true that MI can be a cause of arrest (thrombosis, particularly of the heart, is the 4th of the 4Ts), but they are not the same thing. Any talk of treatment general to any arrest (such as defibrillation, VF, VT, asystole) are not really relevant to this article (other than perhaps a "In some cases, MI leads to cardiac arrest, for which the normal treatment is given" type comment under treatment). What do others think? --John24601 22:21, 20 January 2006 (UTC)
replies: text: I do take your point, alot of out of hospital cardiac arrests are due to MI (two thirds springs to mind, although I'm not sure where I got that from); and community defibrillation using AEDs has been shown to improve the time to return of circulation (although some studies show it has no effect on the eventual outcome), and it's important that wikipedia tells readers this. But you don't see detailed information about treatment of cardiac arrest in the articles on any of the other causes (see Hypoxia, Hypovolemia, Hyperkalemia, Hypokalemia, Hypothermia, Tension pneumothorax, Cardiac tamponade, Pulmonary embolism etc... ). I'm not disputing that cardiac arrest occurs, but it does not warrant lengthy explanation here, because it is already well covered in the article on cardiac arrest, and it only adds to the confusion whereby many people think that arrest and MI are the same thing. It's be like saying that occasionally angioplasty leads to complications and requires emergency cardiothoracic surgery, and then going on to give an explanation of what cardiothoracic surgery is - nobody doubts that it happens, but it's not relevant. --John24601 10:50, 21 January 2006 (UTC)

text: I basically agree with you, its just that cardiac arrests are mostly due to MIs and conversely most deaths from an MI are due to cardiac arrest (vs say allergic reaction to medication given). So when I think of cardiac arrests, I associated this with MIs and not hypoxia/hypothermia etc etc. I agree there is no need discuss at length (cardiac arrest has its own good article), but a brief mention does need to be made (with suitable caveats of course advising that many patients with an MI will not arrest). David Ruben  Talk  17:13, 21 January 2006 (UTC)
replies: text:  Put like that, most deaths from any condition are due to cardiac arrest... --John24601 17:35, 21 January 2006 (UTC)
replies: text: True, but this is not a medical textbook and it is precisely because the non-medical reader associates cardiac arrests as occuring from MIs that this article needs make some reference, the question is how much to mention. Too little will seem like missing out entirely that MI's can cause arrests and deaths (for which rescus+defib sometimes helpful), too much I agree is excessive and both reinforces that all MIs result in an arrest and fails to suggest that there are many other causes of an arrest. David Ruben  Talk  22:36, 21 January 2006 (UTC)
thread_title:  Cardiac Arrest 

message: I'm not responsible for the removal, but in retrospect I do agree with it - Cardiac arrest is just a term for a group of 4 arrythmias - asystole, PEA, VF and Pulseless VT. Adding "in case of arrythmias or..." or whatever makes it sound asthough you may have to do CPR for other arrythmias too, which is not true - those 4 are the only 4 which require CPR. Most people having an MI will have an arrythmia before, during and indeed after their MI, but none of those arrythmias require CPR... I suggest reverting the latest edit to put this comment back in --John24601 10:59, 5 February 2006 (UTC)
replies: text: The most common cause of death after MI is an arrhythmia. Removing this is simply incorrect. JFW | T@lk 11:12, 5 February 2006 (UTC)

text: This may or may not be correct, I have no idea; but what does that have to do with the edit in question? --John24601 13:21, 5 February 2006 (UTC)
thread_title:  Arrythmias/Cardiac Arrest 

message: I've heard, from a reliable source, that pain originating in a myocardial ischemia, will never be felt above the mandible (lower jaw). 
:If you could identify this reliable source we can debate whether it is worth mentioning in the article. JFW | T@lk 21:22, 29 April 2006 (UTC)
replies: text: In Harrison's Principles of Internal Medicine, chapter 228 about ST elevation MI, it says that pain of STEMI may radiate as high as the occipital area but not below the umbilicus. Ehudzel 22:23, 19 May 2006 (UTC)
thread_title: Pain

message: I would consider rearranging the outline of this article.  After the introduction rather than starting with symptoms and diagnosis I would start with a basic section on normal cardiac anatomy and physiology.  This section could explain the normal cadiac function with emphasis on cardiac vascular anatomy and the concept of myocardial oxygen demand.  The pathophysiology section would then follow, however I would consider the addition elaboration of the concept of acute coronary syndromes (ACS) which is integral to the understanding of current diagnosis and treatment of myocardial infarction.  At this point the difference between Anterior MI's (patients more likely to be tachycardiac and hypertensive with evidence of sympathetic nervous system hyperactivity) and Inferior MI's (patients tend to be bracycardic and hypotensive with predominance of the parasympathetic nervous system) as well as right ventricular MI's could be discussed.
:Above posted by User:Sesquiculus on 04:22, 16 May 2006  
A discussion of what is normal to help then illustrate the abnormal seems a reasonable approach, but a few cautions:
* We don't want to excessively duplicate information on normal functioning that might be found on heart.
* A long section on normal anatomy/physiology might distract from quickly getting on and discussing what the article is about, so keep it very short (just as a primer setting the scene). 
* There is an informal preferred style of writing articles on medical topics, see Wikipedia:WikiProject Clinical medicine/Template for medical conditions. Where the basic order is normally : Classification, Symptoms and signs, Cause/Etiology, Diagnosis, Pathophysiology, Treatment/Management, Prognosis, Prevention/Screening, Epidemiology, History, Social Impact, Notable cases, References, See also & External links. David Ruben  Talk  17:18, 16 May 2006 (UTC)
thread_title:  Rearanging the outline 

message: To split up content into logical groups I've added the subheadings 'atherosclerosis', 'infarction' and 'complications'. This (I hope) will help separate out the discussion. It will also help split up coverage so that non atherosclerosis-related MI can be covered in a less confusing way. Thoughts? --Tom (LT) (talk) 01:11, 17 April 2017 (UTC)
replies: text: Sounds good. Doc James (talk · contribs · email) 21:27, 18 April 2017 (UTC)
thread_title:  Pathophysiology subheadings 

message: Typically is part of the section on diagnosis not signs and symptoms per MEDMOS. Doc James (talk · contribs · email) 03:40, 17 April 2017 (UTC)
replies: text: Thanks, noted. --Tom (LT) (talk) 20:36, 25 April 2017 (UTC)
thread_title: Differential

message: In this diagram, more area towards right side is colored which should be left instead as I understand. The diagram can be changed accordingly. -- Abhijeet Safai (talk) 06:41, 2 May 2017 (UTC)
replies: text: But I am reading following sentence too which says that "The pain most suggestive of an acute MI, with the highest likelihood ratio, is pain radiating to the right arm and shoulder." Hence if the diagram is correct, it need not be changed. Thank you. -- Abhijeet Safai (talk) 06:44, 2 May 2017 (UTC)
replies: text: Yes rt sided chest pain is more specific while left side from what I understand is more common Doc James (talk · contribs · email) 17:22, 2 May 2017 (UTC)

text:  Thanks a lot for sharing that. -- Abhijeet Safai (talk) 10:23, 3 May 2017 (UTC)
thread_title:  Diagram of Areas where pain is experienced 

message: I am inclined to merge 'prevention' and 'secondary prevention' and put the combined section after treatment, given that both refer really to a common underlying process of atherosclerosis and coronary artery disease. This is a bit of a grey area in WP:MEDMOS... I think because there is a fair amount of overlap between these two sections, it is logical to group them, and if they are to be grouped, this would be best done after the treatment section. Secondary prevention is best, I think, described after ACS, once medications and surgical procedures have been introduced.
:@, , thoughts? --Tom (LT) (talk) 09:33, 22 May 2017 (UTC)
replies: text: I agree with the spacing and grouping in principle.  There are multiple good ways to address the grouping, so I have no strong preferences. Jclemens (talk) 17:46, 22 May 2017 (UTC)
replies: text: For gout we have place primary prevention under "prevention" and secondary prevention under treatment. I have no strong preference either. Doc James (talk · contribs · email) 21:56, 22 May 2017 (UTC)
thread_title:  Merging 'prevention' and 'secondary prevention' 

message: doi:10.1056/NEJMra1606915 - review. JFW | T@lk 08:39, 25 May 2017 (UTC)
replies: text: @ unbelievable, two detailed reviews within months. It was clearly time to summarise where we're at. Thanks for plopping this down, will trawl through this shortly. --Tom (LT) (talk) 21:31, 27 May 2017 (UTC)
thread_title:  NEJM 

message: Treatment does not begin with "risk factor stratification using a scoring system such as the thrombosis in myocardial ischaemia (TIMI) or GRACE scores".
Treatment begins with giving ASA (and maybe clopidogrel or ticagralor), give O2 if sats are low, starting an iv, giving nitro if the BP is okay, reading the ECG and giving TNK if their are no contraindications / doing PCI if the ECG shows a STEMI. Doc James (talk · contribs · email) 17:55, 27 May 2017 (UTC)
replies: text: Disagree, this is a simplistic view of emergency management. As you know treatment happens in parallel rather than sequential fashion in the ED, and begins with a practitioner's assessment of stability and urgency of treatment required for each condition, whether they realise it or not. Risk factor stratification is important and mentioned in multiple sources. I will replace this sentence with "may include" risk factor stratification to assuage your concerns.--Tom (LT) (talk) 21:27, 27 May 2017 (UTC)
replies: text: Usually one starts initial treatments such as ASA and addresses ABCs before risk stratifying. Risk stratification is more used when determining discharge and workup. Would put it under diagnosis or prognosis not treatment. As risk stratification is NOT treatment. By the way TIMI is dealt with here Doc James (talk · contribs · email) 00:11, 28 May 2017 (UTC)
replies: text: This review  provides a good overview. Doc James (talk · contribs · email) 05:54, 28 May 2017 (UTC)

text: Lots of refs cover this. Have added a bit. Doc James (talk · contribs · email) 18:09, 27 May 2017 (UTC)
replies: text: Thanks for your addition. It has been difficult to strike a balance comprehensiveness between deep discussion of treatment vs. maintaining readability and avoiding prescriptive guides. --Tom (LT) (talk) 21:27, 27 May 2017 (UTC)
thread_title: Management

message: Concerns of negative effects in AMI Doc James (talk · contribs · email) 18:02, 27 May 2017 (UTC)
replies: text: Lots of refs cover this. Have added a bit. Doc James (talk · contribs · email) 18:09, 27 May 2017 (UTC)
replies: text: Thanks for your addition. It has been difficult to strike a balance comprehensiveness between deep discussion of treatment vs. maintaining readability and avoiding prescriptive guides. --Tom (LT) (talk) 21:27, 27 May 2017 (UTC)
thread_title: Morphine

message: Now updated doi:10.1161/CIR.0000000000000617 JFW | T@lk 12:46, 26 August 2018 (UTC)
thread_title:  Universal definition 

message: " Pain in arm(s), back, neck, jaw or stomach (for women)"
These symptoms are not exclusively in women. Doc James (talk · contribs · email) 09:06, 26 December 2018 (UTC)
replies: text: No one said any of these symptoms were “exclusively” in women; they are symptoms that the AHA wants women to recognize that they are likely to experience differently than men. Reading comprehesion. The very lede of the article already says, “Women more often present without chest pain and instead have neck pain, arm pain, or feel tired.” Grammatically incorrect but no different than what I put in the infobox. Trillfendi (talk) 17:07, 30 December 2018 (UTC)
replies: text: These are also relatively common in older people and diabetics. Have shortened. Doc James (talk · contribs · email) 03:57, 31 December 2018 (UTC)
thread_title: Per this text

message: Hi . I have seen that you have restored this ref:  "2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction"  but I have had a look at it and couldn't locate a discussion on risk factors. Can you help? Thanks, Cinadon36 07:49, 25 February 2020 (UTC)
replies: text: User:Cinadon36 you are correct. Have removed it. Thank for finding a reference that does support the text. Doc James (talk · contribs · email) 00:23, 26 February 2020 (UTC)
thread_title:  A small verifiability issue 

message: There are two review articles discussing the role of the NLRP3 inflammasome in relation to myocardial infarction. Could someone check, please, whether there is something in this that is worth mentioning in the article?
* 
* 
Thanks --Chris Howard (talk) 05:18, 5 October 2019 (UTC)
replies: text: Hi . I 've had a look and these two papers are indeed interesting reviews. Maybe we could mention NLRP3 somewhere but we risk turning the article too technical. -4-5 Textbooks on cardiology or MI that I have searched do not mention it though- (apart one mention at Morrow 2016- see article for full citation). This could be due to a variety of factors. I would feel much more comfortable if I could find a classic textbook or a formal guideline discussing the NLRP3 inflammasome. One more factor is that the article does not discuss cardiac remodeling after an MI and therefor neither the inflammatory cascade is mentioned. Anyway, I will work on it and I will let you know. Cinadon36 08:00, 25 February 2020 (UTC)
replies: text: Yes, a textbook or formal guideline would be ideal. --Chris Howard (talk) 09:27, 3 March 2020 (UTC)
thread_title:  NLRP3 inflammasome