Talk:Myocardial infarction

From Wikipedia, the free encyclopedia
Jump to: navigation, search
Cscr-former.svg Myocardial infarction is a former featured article candidate. Please view the links under Article milestones below to see why the nomination failed. For older candidates, please check the archive.
          This article is of interest to the following WikiProjects:
Wikipedia Version 1.0 Editorial Team / v0.7 / v0.5
WikiProject icon This article has been reviewed by the Version 1.0 Editorial Team.
Taskforce icon
This article has been selected for Version 0.7 and subsequent release versions of Wikipedia.
Taskforce icon
This article has been selected for Version 0.5 and subsequent release versions of Wikipedia.
 
B-Class article B  This article has been rated as B-Class on the quality scale.
WikiProject Medicine / Cardiology / Translation (Rated B-class, Top-importance)
WikiProject icon This article is within the scope of WikiProject Medicine, which recommends that this article follow the Manual of Style for medicine-related articles and use high-quality medical sources. Please visit the project page for details or ask questions at Wikipedia talk:WikiProject Medicine.
B-Class article B  This article has been rated as B-Class on the project's quality scale.
 Top  This article has been rated as Top-importance on the project's importance scale.
Taskforce icon
This article is supported by the Cardiology task force (marked as Top-importance).
Taskforce icon
This article is supported by the Translation task force (marked as Top-importance).
 
Note icon
This article was previously a Medicine Collaboration of the Week.
edit·history·watch·refresh Stock post message.svg To-do list for Myocardial infarction:

Here are some tasks awaiting attention:
  • Article requests: Sort out information that belongs elsewhere (under acute coronary syndrome, for example) to off-load the article. Be sure to leave stub explanations that create sufficient content for the readers who want to know exclusively about this topic.
  • Cleanup: Remove sources that fail WP:MEDRS
  • Stubs: So
  • Other:
    Please improve this "to do"-box.

Easy find[edit]

Is there any way to make duckduckgo link to this page upon a search for "ischemic heart disease"? Some way to add a tag or a search attribute? 117.199.12.93 (talk) 20:27, 19 June 2014 (UTC)

Use of "heart attack" within the text[edit]

I noticed that "heart attack" is used a number of times within the text, interchangeably with "Myocardial Infarction". I wonder if this needs to be standardised to using one or the other, or if their equivalence could be emphasised and then the more familiar "heart attack" could be used more in the body text. It would improve readability greatly if we were able to use "heart attack" more often in the body text, and would presumably not be less accurate than "MI" if it were clearly stated that "heart attack" = "MI" for the purposes of this article. Just wanted to know what people thought of such use, or whether we need to avoid the use of "heart attack" completely.

Nren4237 (talk) 07:38, 4 April 2014 (UTC)

Refs[edit]

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)

"Not enough" vs "lack of" oxygen[edit]

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)

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)
So "lack of" will not translate very well? Tommyt (talk) 20:14, 23 September 2013 (UTC)

Type 2 MI[edit]

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)

Medical / common name[edit]

I agree myocardial infarction is accurate and professional name of the disease, but I since professional names don't have advantage over most commonly used ones (current name of the article is pretty unfamiliar with most of the readers) and this is not a dictionary of medical terms, we should rename the article to simply hearth attack, but then I'm not sure that would be correct, since most of the practitioners would disagree. I'm asking for opinions. Thanks. Alex discussion 15:25, 26 November 2013 (UTC)

Heart attack also means cardiac arrest which is not necessarily myocardial infarction. This is why we have a dab for heart attack. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:55, 26 November 2013 (UTC)
I agree that heart attack sounds a little unspecified. But, at least, "myocard" isn't quite an English word, could we use heart infarction (or even cardiac muscle infarction) instead? Alex discussion 16:57, 26 November 2013 (UTC)
For technical topics we use the technical name pre WP:MEDMOS We have discussed this a bunch before. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:10, 26 November 2013 (UTC)
@Jmh649: out of interest, where has this been discussed a bucnh before? I think there's an interesting question going on here, because personally I think articles like this shuold use the common name, not the medical one, and also the guideline outlined at WP:MEDMOS seems to be in contradiction to the policy of WP:COMMONNAME. Offhand, I can think of three types of readers who may come to this article, (1) People involved in the medical profession, or medical students. (2) Non-medical people with a general interest in a medical topic. (3) Patients seeking advice. For category (1) it would make sense to use the scientific term, but really such people would be far better served reading actual medical journals, Wikipedia is not really intended to be a tool for academic study. For category (2), the common name would appear to be the best one because that will be the term most lay people associate with the disease; of course, the scientific name would appear prominently in the lead and infobox to assist those people's learning. As for category (3), I fully appreciate all the amazing work that you and the med project guys do to ensure that no spurious or misleading health "advice" creeps into Wikipedia articles, that might be used erroneously by a patient; however, I think those people are also served best by titling articles at the common name; if I think I might be having a heart attack, it would make sense to check out the symptoms at the Wikipedia Heart attack page, not that for Myocardial infarction. On your point about heart attack being ambiguous, that seems to be a slight red herring because heart attack is already a redirect to myocardial infarction. If there's really ambiguity, then that redirect should be a disambiguation page. Thanks  — Amakuru (talk) 14:47, 6 March 2014 (UTC)
Amakuru"Heart attack" is an unusual case. The term is supposed to mean myocardial infarction, but people say "heart attack" when they mean myocardial infarction, cardiac arrest, heart failure, stroke, died in sleep, died of old age, or any peaceful cause of death. Whereas what you say applies to almost any other health article, in this case since people use the term "heart attack" to mean all kinds of things, when they want medical information it seems best to clarify exactly what they are reading. Everyone here wants to use the simplest possible language without confusing people but since the term "heart attack" already has confusion around it, right now the consensus is that emphasizing the term "heart attack" would not help layman readers. Blue Rasberry (talk) 15:29, 6 March 2014 (UTC)
Here are some previous discussions. Obviously a lot of people are confused but I do not think that the solution is more ambiguous information. Blue Rasberry (talk) 15:33, 6 March 2014 (UTC)
Actually, you make a very good point there. Although that does add weight to the notion that heart attack should be a disambig page rather than a redirect. In the current arrangement people who think a cardiac arrest is a heart attack would land up on this page regardless, and might end up inferring information about the wrong condition. In fact I first started looking at this question because I was on the Diabetes mellitus page and was surprised to find that it wasn't called just "diabetes" given that that's a redirect. Well similar logic applies, because there's diabetes insipidus as well, but having a redirect from the general term to the specific doesn't really help there either IMHO.  — Amakuru (talk) 15:56, 6 March 2014 (UTC)
It seems that by using redirect from HA to MI, we are somehow telling readers that by heart attack they should mean MI. I don't think that is our business; Instead I favor a disamb page where we could list the options and briefly explain them
  • Myocardial infarction (Heart Muscle Injury)
  • Acute coronary syndrome (Heart damage risk)
  • Sudden death (from any cause)
etc Bakerstmd (talk) 22:29, 6 March 2014 (UTC)

Trial to Assess Chelation Therapy (TACT). Its relevance here.[edit]

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:

Here is the abstract of the study:

The full article can be downloaded free as a PDF document:

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."[1] 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)

Reviews[edit]

  • 2012 Writing Committee, Members; Jneid, H; Anderson, JL; Wright, RS; Adams, CD; Bridges, CR; Casey DE, Jr; Ettinger, SM; Fesmire, FM; Ganiats, TG; Lincoff, AM; Peterson, ED; Philippides, GJ; Theroux, P; Wenger, NK; Zidar, JP; Anderson, JL; American College of Cardiology, Foundation; American Heart Association Task Force on Practice, Guidelines (2012 Aug 14). "2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/Non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.". Circulation 126 (7): 875–910. PMID 22800849. 
  • O'Gara, PT; Kushner, FG; Ascheim, DD; Casey DE, Jr; Chung, MK; de Lemos, JA; Ettinger, SM; Fang, JC; Fesmire, FM; Franklin, BA; Granger, CB; Krumholz, HM; Linderbaum, JA; Morrow, DA; Newby, LK; Ornato, JP; Ou, N; Radford, MJ; Tamis-Holland, JE; Tommaso, CL; Tracy, CM; Woo, YJ; Zhao, DX; Anderson, JL; Jacobs, AK; Halperin, JL; Albert, NM; Brindis, RG; Creager, MA; DeMets, D; Guyton, RA; Hochman, JS; Kovacs, RJ; Kushner, FG; Ohman, EM; Stevenson, WG; Yancy, CW; American College of Cardiology Foundation/American Heart Association Task Force on Practice, Guidelines (2013 Jan 29). "2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.". Circulation 127 (4): e362–425. PMID 23247304. 

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

Biomarkers[edit]

Bakerstmd is keen to add something about biomarkers in the diagnosis of MI. I am really not sure why the reader might still have any interest in CK-MB, which is historical like ASOT and LDH, and I am not aware of a single clinician who uses BNP, CD40, CRP etc in the diagnosis of MI, whether STEMI or NSTEACS. Sometimes "less is more" applies. We might actually need to talk more about standard versus highly sensitive troponin assays. JFW | T@lk 21:49, 19 April 2014 (UTC)

Agree. I guess maybe CKMB is still used in parts of the world? Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:35, 20 April 2014 (UTC)
See PMID: 21545940. These were the newest guidelines for NSTEMI that I could find, from 2011. While it is recognized that CK-MB is less specific than Troponin for diagnostic purposes, it has a role in being serially measured as an index of infarct size. It also has the advantages of being recognized by older physicians. Per section 2.2 "Early Risk Stratification", there is still a level IIb "consideration" allowed for measuring CK-MB. I don't work up ACS patients in the ER, but I am occasionally asked by older attending physicians to order a CK-MB for patients on the ward with suspicion of cardiac ischemia. One of the hospitals where I work includes it in the default panel of cardiac markers. Therefore it seems wrong not to mention it on the page about MI. Bakerstmd (talk) 01:09, 21 April 2014 (UTC)
@jfdwolff Jmh649
Yes it is not that old and I am sure it is still used in some parts. We have removed it from out default panel of cardiac markers maybe 5 years ago. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:00, 19 June 2014 (UTC)

Genetics[edit]

I added a list of genes associated with MI, as determined by GWAS, under Causes. I'm not sure if this is the best place to put this information. Please let me know if it should go somewhere else!Salubrious Toxin (talk) 12:52, 27 June 2014 (UTC)