Talk:Myocardial infarction/Archive 2

merge Cardiac_markers
Cardiac_markers, I think, should be merged here.


 * No, it's long enough already.--Steven Fruitsmaak (Reply) 16:56, 6 December 2006 (UTC)

suggestion
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)

'Below is a mirror of the discussion on my talk page (up to date until 11:15, 16 Apr 2004 (UTC))   JFW |  T@lk

A mass-redirect question
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. I feel that Myocardial infarction is much more professional for the wiki (and just about any other encyclopedia). 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? 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)

This is, again, a question that boils down to the medical side of WikiPedia in general (WikiDoc effort). Some points: Please tell me if you need help with redirects. I'm personally in favour of moving the whole page to myocardial infarction. JFW | T@lk  18:42, 15 Apr 2004 (UTC)
 * Personally I find it educational to be redirected
 * Whenever a non-medical user types in "Heart attack" he will still see the relevant information.
 * In the scientific fields, terminology is everything. "Heart attack" is imprecise, as it does not specify the nature of the insult (chemical, biological or nuclear attack), nor the exact location of the insult (what part of the heart: pericardium? endocardium????).
 * Is every heart attack a myocardial infarction? Many patients who have suffered acute coronary syndromes have escaped with low or negative Troponin T, and have technically not had an MI, yet talk to everybody about their "heart attack".
 * I've had the same discussion with another user on neutrophil granulocyte, and the change also involved >30 redirects.


 * 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)


 * 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 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. 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 for details). JFW | T@lk  14:10, 18 Apr 2004 (UTC)


 * 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)


 * 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)

The naming issue
After Ksheka's attempt to move this page to Myocardial infarction, it became apparent that Wikipedia policy is the problematic factor. Naming is generally done with the general public in mind. This has advantages (easy to find, articles aimed at lay public etc.) but also a lot of downsides. Lay terms are imprecise, often evoke biased reactions, and can be confusing. In chemistry and biology, the articles generally follow scientific terminology, and adequate redirects are in place. The same ought to be for medicine. As this is a policy issue, I have raised this at Naming conventions for medicine. Please offer your views there. JFW | T@lk  17:02, 26 Apr 2004 (UTC)


 * Not to suggest that an issue that was settled two years ago ought to be reopened, but it didn't seem like the other side got much of a hearing here. Here's WP's naming policy in a nutshell:


 * Names of Wikipedia articles should be optimized for readers over editors; and for a general audience over specialists.


 * That's one of the things I love about Wikipedia. It's tough to say that this rule was followed in this case.


 * Of course there's reasons why doctors use terms like "myocardial infarction" rather than "heart attack"; hopefully they're not just using big words to confuse the rest of us. But there are also reasons why regular people use terms like "heart attack" rather than "myocardial infarction"; for one big thing, we don't know what "myocardial" or "infarction" mean, whereas we do know what a heart is and what an attack is.


 * I'm not saying that the article shouldn't explain the technical terminology in its lead paragraph. But if the article had stayed at "heart attack" (and again, I realize this is a done deal), it would have been an important reminder that this and every other medical article on Wikipedia should be aimed at people who think primarily in terms of "heart attacks" and not "myocardial infarctions".  One hopes doctors are not turning to Wikipedia for their medical information. Nareek 11:12, 21 August 2006 (UTC)


 * As well as issues of one-to-one common name for technical terms, there is issue of whether a common name even describes the same thing or not. So "Heart attack" gets used both for Myocardial Infarction, as well as irregular heart rhythms (VF) and (incorrectly) for anginal episodes. Similarly earache covers both otitis externa and otitis media, and "a touch of flu" would have to merge every thing from the common cold, viral & bacteria sore throats, viral bronchitis, bacterial pneumonia as well as influenza. Patients do use such terms as "myocardial infarction" and if accurate descriptions are to be given, then articles need discuss specific conditions - by all means have non-technical introductions or header disambiguation tags (or even disambiguation pages), but myocardial infarction is not the same as ventricular fibrillation or cardiac arrest each of which are substantial articles in their own right. 17:17, 21 August 2006 (UTC)


 * If the commonly used term "heart attack" refers to more than one medical condition, than people who type in "heart attack" ought to get to a page that discusses all those conditions. This makes me think that renaming the heart attack page "myocardial infarction" was a bigger goof than I thought--and perhaps one that ought to be corrected after all. Nareek 18:40, 21 August 2006 (UTC)

Sex differences
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)MoodyGroove


 * It has been covered in the article.--Steven Fruitsmaak (Reply) 16:10, 23 December 2006 (UTC)

Massive Attack
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)


 * 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)

yes good idea —The preceding unsigned comment was added by 81.150.209.145 (talk • contribs) 15:14, 18 August 2006(UTC).

Gastritis
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)
 * 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)

Unreferenced edits
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)

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

The digitalis theory
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)

Zimetbaum article
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)

WHO 1971
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)


 * 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)

Apparently there are 1971 and 1983 criteria. JFW | T@lk  14:18, 19 January 2006 (UTC)

Cardiac Arrest
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)

Leave In - I agree there is a technical distinction, but most cardiac arrests are a direct consequence of a patient having a myocardial infarction and this is where the reader will expect to see at least some mention of defibs for cardiac arrest following a heart attack. (see also discussion above re heart-attack vs myocardial infarction).
 * The risk is that we split items into loads of separate pages which are discussed at length and in so doing provide no framework of understanding to a reader without specialist knowledge. Example epistaxis, nose bleed and bleeding from the nostril is somewhat equivalent; yes a nasal polyp or tumour can cause nasal bleeding rather than the usual epistaxis from Little's areas, but not to write a singe main article of nose-bleeds (or under heading of epistaxis) would be to write a medical textbook rather than an encyclopedia.
 * A little duplication is therefore OK to prevent the reader having to excessively jump from page to page (they can follow a main link to look up on further information and differentials of course).
 * Most cardiac arrests are as a consequence of myocardial infarction and the addressing of this with community CPR & Defibrillators is important if immediate deaths from MIs is to be reduced. CPR is not that effective (witness recent change in Cardiac compression-Respiratory ratios of 15:2 to 30:2), so community CPR + Defib is much more likely to work than comunity CPR -> delay of ambulance transport (still doing CPR) -> Ambulance or Hospital defib.
 * The whole point of admitting concious patients following an MI to a Coronary Care Unit is so that they receive telemetry, the point of this being to allow prompt defibrillation (assuming no time for drug intervention for a more stabe arrhymthia).
 * The public do perceive the two terms as synonymous and so will look to this article to explain (they reach this article of course via a redirect from their search for Heart Attack ).
 * I think therefore that this is a good place to discuss community defib for cardiac arrest, as well as the more common managment of many MIs (ie with no cardiac arrest), but treatent & monitoring seeks to help prevent further conseques of an MI (including cardiac arrest). To merely redirect the reader away to cardiac arrest or CPR is not to explain the distinction of how one may form part of the management of the other, but is not exclussively so.
 * The cardiac arrest article does its role of explaining the possible causes, but the initial qualifier of mostly due to CHD is both easily overlooked and not necessarily apparent to someone searching for heart attack (meaning myocardial infarction). The depth of information given about management of other causes of cardiac arrest is daunting, so leave a little information on the topic here in myocardial infarction please :-)  David Ruben Talk 23:46, 20 January 2006 (UTC)


 * 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)


 * 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)


 * : Put like that, most deaths from any condition are due to cardiac arrest... --John24601 17:35, 21 January 2006 (UTC)


 * 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)

Arrythmias/Cardiac Arrest
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)


 * 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)


 * 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)

The point is that cardiac arrests in MI are typically ventricular arrhythmias, and that CPR may be necessary. I'll try to rephrase the sentence in question. JFW | T@lk  05:23, 6 February 2006 (UTC)

I think you're just digging holes now *rolleyes* Are we now to say that CPR is not required in cases of asystolic arrest following MI? And how is one to determine whether the arrest is VF/Pulseless VT or anything else in the context of first aid? First aiders in the UK are not even taught to check carotid pulse anymore; instead taught that cardiac arrest is confirmed in the absence of breathing - similar plans are in progress across Europe and North America and much of the rest of the world. There is absolutely no merit in including things which are not strictly relevant and only serve to confuse the situation. --John24601 06:20, 6 February 2006 (UTC)

This is an incorrect perspective. Cardiac arrest is not a term for an arrhythmia, as PEA is not an arrhythmia as such. Cardiac arrest refers to pulselessness. MoodyGroove 15:57, 23 December 2006 (UTC)MoodyGroove

Pain
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)


 * 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)

"Nose to navel" is the rule of thumb, although location and radiation are only a part of the OPQRST (onset, provoke, quality, radiation, severity, time). MoodyGroove 15:55, 23 December 2006 (UTC)MoodyGroove

Question
With the quick death of Richard Carleton today i was wondering - how often do heart attacks cause death within seconds? PMA 13:05, 7 May 2006 (UTC)


 * Without looking up any reference to back myself up, I was always taught rule of halves: half of all MIs are asymptomatic and the person is blissfully unaware of it having occured (until perhaps at a later date someone does an ECG/EKG and sees the evidence for one). Of the other half, half die immediately (difficult to know if in seconds or minutes) and the remainder get to hospital complaining of chest pain. I'm sure someone will lay into my rough ready-reconing with some actual percentages :-) David Ruben Talk 19:14, 7 May 2006 (UTC)

50% are silent MIs? I really doubt that. Diabetics and women are more likely not to report chest pain, but half is really a lot.

In response to PMA's question: ventricular fibrillation can kill within seconds, but Carleton's story does not reflect this (would cause immediate loss of conciousness). Ventricular tachycardia is a possibility - some forms are associated with cardiac output & hence maintaining conciousness. Finally, if the infarct was so large as to cause left ventricular failure, one could imagine that this would cause pulmonary oedema fairly quickly.

The pathologist will have the final word. Ruptured coronary plaque with non-recanalised thrombus. JFW | T@lk  12:40, 8 May 2006 (UTC)

True silent MIs more likely in diabetics, to quote from a study looking at diabetics: "Silent myocardial infarction was present in 3.9% of patients, or 44% of all Q-wave myocardial infarctions"

However for the general population: "approximately one third of infarcts in the Framingham Study have no clinical counterpart, only being discovered by new Q-waves in a routine 2-year examination cycle"

So I'm not sure the simplistic message I received as a medical student, and now only hazily recalled, was that far off the mark. Perhaps I mis-recall and it was a rule of thirds rather than halves ? David Ruben Talk 15:53, 8 May 2006 (UTC)

Rearanging the outline
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 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)

Lancet seminar
10.1016/S0140-6736(16)30677-8 JFW &#124; T@lk  08:23, 2 September 2016 (UTC)

ST elevation
The ECG deserves to be explained in the lead, so that the average reader has some idea of what it is talking about. I don't think this text is perfect, but we should make some attempt to explain what the ECG is.
 * Attempted addition: "An ECG, which displays the electrical currents associated with contraction of heart muscle, produces a regular form. An elevation in the ST section may indicate a type of MI."
 * Revert by (described as "adjust") back to "An ECG may confirm an ST elevation MI if ST elevation is present"

Can I point out the sentence that has been reinstated has three acronyms (ECG, ST, MI) and is tautologous ? Suggest other editors, including may need to weigh in here. --Tom (LT) (talk) 09:03, 10 April 2017 (UTC)
 * What does "produces a regular form" mean? Where does this definition come from?
 * We sell out what ECG stands for in the sentence immediately before that one. Have adjusted the linking of that sentence to make the terms more clear.
 * MI is spelled out in the first sentence of the article. Doc James  (talk · contribs · email) 09:07, 10 April 2017 (UTC)
 * Our aim should be to improve the readability of articles, so that the text written can be read and understood by readers. If possible we should reduce our use of acronyms in this light. Where do we spell out what an ECG? We state it is a test in the sentence before - that is not "spelling out". As stated above this is an attempted improvement. Would you say the sentence is perfect as is? If not, perhaps we can discuss ways to improve it. --Tom (LT) (talk) 21:03, 10 April 2017 (UTC)
 * Sure we can add a definition of ECG. How about a "a recording of the heart’s electrical activity" with this as a ref
 * Thus we get this Doc James (talk · contribs · email) 22:44, 10 April 2017 (UTC)
 * I'd call that a definite improvement over what was there before, but we still don't explain what the ST segment is, let alone why ST elevation is bad, just wikilinks it. I think anything contained in the lead of an article should be self-contained, and question whether the best way forward is to explain everything, or rather to abbreviate further in the lead and leave the detailed, acronym-filled explanation to the body text. Oh, and thanks for the ping. Jclemens (talk) 05:02, 11 April 2017 (UTC)
 * How about An ECG, which is a recording of the heart's electrical activity, may confirm an ST elevation MI (STEMI) if a change known as ST elevation is present. ?
 * Doc James (talk · contribs · email) 17:22, 11 April 2017 (UTC)

(shrug) I'd be tempted to add something along the lines of "... ST elevation, an abnormality of the final phase of the heart's per-beat electrical cycle which can indicate ischemia or infarction, is present." But I know good and well that's waaaaay too detailed for the lead. I'm just not one to introduce a term without providing at least a minimal amount of contextualization, even if it is wikilinked. Jclemens (talk) 04:13, 12 April 2017 (UTC)
 * Hum. We could leave out "if a change known as ST elevation is present" altogether. Doc James  (talk · contribs · email) 05:31, 12 April 2017 (UTC)
 * This seems like the best solution. --Tom (LT) (talk) 01:05, 17 April 2017 (UTC)

Pathophysiology subheadings
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)
 * Sounds good. Doc James  (talk · contribs · email) 21:27, 18 April 2017 (UTC)

Differential
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)
 * Thanks, noted. --Tom (LT) (talk) 20:36, 25 April 2017 (UTC)

Classification section?
Am thinking about a "classification" section at the top. I think it would be very useful for readers to have a clear definition of what an MI is at the top, that it is an ACS, and that there are ST and non-ST variants. I think this would add to (rather than only duplicate) the lead, and that it would help clarify the peace-meal presentation of this in the article below. Thoughts? --Tom (LT) (talk) 01:02, 17 April 2017 (UTC)
 * Haved moved an existing sentence to this section. If there's consensus to keep, I will expand it further. --Tom (LT) (talk) 02:02, 17 April 2017 (UTC)
 * @, any thoughts here? --Tom (LT) (talk) 21:10, 18 April 2017 (UTC)
 * Sure happy with a section on classification going first. Doc James  (talk · contribs · email) 21:26, 18 April 2017 (UTC)
 * Agreed--and then let's make sure it's inclusive, at least mentioning the appropriate zebras. Jclemens (talk) 00:42, 19 April 2017 (UTC)
 * @ you have removed the initial "classification" section with this summary " MEDMOS/ this sectionis REPEATED in the 'Diagnosis' section, thank you". I am hoping to introduce some basic concepts to the reader by including this section, rather than leaving them somewhat confused by our peacemeal mentions until they hit the diagnosis section. This section does not just repeat the 'diagnosis' section as it covers the relationship between ACS and AMI and some basic concepts to help orientate the reader.
 * As you can see there are some other editors who support this too and I am in the process of expanding this as stated above ("I will expand it further"). Also not too sure what you mean by "MEDMOS" -- perhaps have a look at WP:MEDORDER? Classification is the first section. So to summarise: please read the talk page, the MEDMOS, and the article before removing a chunk of text in an active GA in the future.--Tom (LT) (talk) 20:36, 25 April 2017 (UTC)
 * so...per Manual of Style/Medicine-related articles, I removed the section as it seemed repetitive, as such a sub-section usually goes under diagnosis.Now then, if your "creating" something different in the body of the article, well that's different(I've reverted myself, though I believe it should follow MEDMOS)--Ozzie10aaaa (talk) 21:02, 25 April 2017 (UTC)

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

Merging 'prevention' and 'secondary prevention'
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)
 * 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)
 * 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)

NEJM
10.1056/NEJMra1606915 - review. JFW &#124; T@lk  08:39, 25 May 2017 (UTC)
 * @ 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)

Management
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)
 * 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)
 * 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)
 * This review provides a good overview.  Doc James  (talk · contribs · email) 05:54, 28 May 2017 (UTC)


 * @ even the abstract (I can't access full text from home) states "Fibrinolysis is not recommended in patients with non-ST elevation acute coronary syndrome; therefore, these patients should be treated with medical management if they are at low risk of coronary events or if percutaneous coronary intervention cannot be performed". Further:
 * "Early risk stratification of patients with myocardial infarction allows for prognostication and triage via initiation of one of several vital treatment pathways" (Reed et al., 2017)
 * "Risk stratification is important because it guides the use of more complex pharmacological and interventional treatment" (Davidsons, 2010)
 * I would really like to include some reference to risk stratification in the management section, and I think there are sufficient verifiable references to support their use in management. Is there a way you would be happy for me to include this information? --Tom (LT) (talk) 11:25, 6 June 2017 (UTC)
 * Fibrinolysis is definitely contraindicated in NSTEMIs. It is only given in STEMIs. That decision is made based on the ECG rather than risk stratification. The TIMI or GRACE scoring system is not really explicitly used outside of trials. Management is partly based on the risk the person is having a myocardial infarction. I would be okay with that, just do not think the stratification belongs. Doc James  (talk · contribs · email) 13:20, 6 June 2017 (UTC)

Morphine
Concerns of negative effects in AMI Doc James  (talk · contribs · email) 18:02, 27 May 2017 (UTC)
 * Lots of refs cover this. Have added a bit. Doc James  (talk · contribs · email) 18:09, 27 May 2017 (UTC)
 * 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)

Symptom not noted in this article:
numbness in the hands and neck discomfort

But I don't know how to insert it into the "Other symptoms" part...

https://www.ncbi.nlm.nih.gov/pubmed/15017150

The patients experiencing MI reported significantly more nausea (46% vs. 32%), vomiting (19% vs. 2%), indigestion (42% vs. 16%), and fainting (9% vs. 2%). The patients experiencing UA reported significantly more chest discomfort (97% vs. 87%), lightheadedness (52% vs. 39%), numbness in the hands (43% vs. 28%), and neck discomfort (31% vs. 13%). Patients with MI rated the peak intensity of the chest discomfort higher than patients with UA (mean 8.4 vs. mean 7.7).

Universal definition
Now updated 10.1161/CIR.0000000000000617 JFW &#124; T@lk  12:46, 26 August 2018 (UTC)

Per this text
" 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)
 * 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)
 * These are also relatively common in older people and diabetics. Have shortened. Doc James  (talk · contribs · email) 03:57, 31 December 2018 (UTC)

A small verifiability issue
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)
 * 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)

NLRP3 inflammasome
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)


 * 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)


 * Yes, a textbook or formal guideline would be ideal. --Chris Howard (talk) 09:27, 3 March 2020 (UTC)