Talk:Myocarditis/Archive 1

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 22 November 2021 and 19 December 2021. Further details are available on the course page. Student editor(s): Jrstultz. Peer reviewers: WjungUCSF.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 01:21, 18 January 2022 (UTC)

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 2 September 2020 and 11 December 2020. Further details are available on the course page. Student editor(s): Cailen1. Peer reviewers: Carriefish2021, Mattsoml7031.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 04:44, 17 January 2022 (UTC)

Martino

 * Martino TA, Liu P, Petric M, Sole MJ. 1995 Enteroviral myocarditis and dilated cardiomyopathy. A review of clinical and experimental studies. p291-352 IN Human Enterovirus Infections, Ed. HA Rotbart.


 * This was added. Unsure why. JFW | T@lk  07:06, 5 October 2006 (UTC)

Enteroviruses are the commonest cause of myocarditis - which is the leading cause of acquired heart disease in children, and a major cause of cardiomyopathy leading to heart failure or heart transplant in adults. This book chapter is a definative, peer reviewed, comprehensive review of clinical and experimental studies to 1995. The other reference you have on the site is only part of what is listed in this book. It is extensively cited throughout the scientific literature (as is your other reference). For anyone interested in learning more about this field, it's history, present, and possible future directions, and about many of the authorities in the field, this book chapter can be very useful. That is why I added it. A second reference, from Circulation Research and listed in PUBMED, which refers more to viral infection and dilated cardiomyopathy, was added to the page on "coxsackieviruses" (that page could really use some work!!) Regards, 24.137.200.118 23:54, 6 October 2006 (UTC)

The term "gold standard" should be replaced with a standard English phrase such as "best approach to diagnose' or "best way to diagnose." It is slangy and transient.

Tha article itself should be re-written so it is more readable. —Preceding unsigned comment added by 149.142.253.220 (talk) 20:12, 20 November 2007 (UTC)

New NEJM review article
http://content.nejm.org/cgi/content/full/360/15/1526

Should be a good resource--Wawot1 (talk) 21:25, 8 April 2009 (UTC)

Insult?
From the first paragraph of the "Diagnosis" section: ''Myocarditis refers to an underlying process that causes inflammation and injury of the heart. It does not refer to inflammation of the heart as a consequence of some other insult.''

Is the use of the word "Insult" correct there? I can't tell by my own because my medical knowledge is near to zero, but it sure seems odd.Not A Superhero (talk) 06:52, 8 December 2011 (UTC)
 * The word is ok. In this context, "insult" means "something causing disease or injury to the body or bodily processes". (wikt:insult) --Brainmachine (talk) 16:48, 1 August 2012 (UTC)

Lancet review
Doc James (talk · contribs · email) 23:20, 23 February 2015 (UTC)

Unsupportive citations / false claims (product of disruptive edits)
Re: unsuportive sources, cited by two consecutive claims, within the "epidemiology" section;

(1) "Myocarditis can't be caused by vaccination against Covid-19;[24][25]" & (2) "so, the risk of myocarditis due to vaccination does not exist,[46]"

Both claims cite literature which DOES NOT support (or even suggest) their respective assertions. Both claims are also individually contradicted (with appropriate evidence) elsewhere in the same article.

Recent edit; https://en.m.wikipedia.org/wiki/Special:MobileDiff/1050041594 Appeared to be disruptive. Revised claims made via Ipse dixit assertion only. Ponsbifacere sublimum (talk) 11:47, 21 October 2021 (UTC)

Structure
Overall, the main structure of the article contains the following sections: signs and symptoms, causes, mechanism, diagnosis, treatment, epidemiology, and a brief history. There is a section of references, followed by one external link to an eMedicine article on myocarditis (which requires login or registration to view).

Plan:
 * Add a section detailing the outcomes/prognosis of myocarditis
 * Add a section outlining previous and ongoing research in the field, including treatment per pathologic subtype
 * Consider supplementing signs and symptoms with a subsection on complications

Content
The content mentions the spectrum of acuity along which the disease can take place, but does not give any detail as to the signs and symptoms, causes, or management differences that are investigated in different subtypes of myocarditis, such as fulminant or acute. The causes section is a bit list-like, and is a lot of links without much explanation, though not much is necessary. Additionally, there is little mention of different diagnostic criteria that have been proposed and evaluated (e.g., Lake Louise criteria for cMRI, or Dallas criteria for biopsies), neither in the diagnosis section nor the history section. The treatment section offers a concise overview of the main therapy options used across all types of myocarditis, and the history section similarly gives readers a brief understanding of how the diagnosis came to be, but both could be effectively bolstered without taking away from the article.

Plan:
 * Introduce chronic, subacute, acute, and fulminant subtypes in the signs and symptoms section
 * Contribute to diagnosis and treatment and correlate the information with the different acuity subtypes mentioned above - should fit with new outcomes section
 * Outline different treatment modalities with more reference to the step-wise way in which these options might be used (analogous to heart failure)
 * Add information on diagnostic criteria (Lake Louise and Dallas) to either diagnosis, history, or research sections pending where it will be most appropriate
 * Mention potential controversy over prognosis of fulminant vs. acute presentations in history or research section
 * Highlight different pathological subtypes and the research done within each regarding treatment and prognosis
 * Update any information on both COVID-19 and COVID-19 vaccinations with any newly available (reliable) information
 * Consider revising the causes section to put more of it in prose form, or breaking off the list to its own page and highlighting the breadth of causes in prose
 * Link out to other wikipedia pages at an appropriate rate
 * Ensure citations follow the same format
 * Continuously refine edits and ensure information is presented objectively, succinctly, and accessibly

Jrstultz (talk) 02:40, 29 November 2021 (UTC)

Peer Review
In this review, I will go through the edits made by my colleague in Dec 2021. I will mainly look through the "Plan" section to determine where areas can be improved and provide feedback. Overall, the recent article changes made clearer the subtypes of myocarditis, acute, subacute, fulminant and I see no concerns with the recent edits on citations and language. My main suggestion is on improving visual representation of the recent edits, e.g. adding subheadings or listing in certain areas may help. The rest are minor comments in italics

Plan:

Add a section detailing the outcomes/prognosis of myocarditis This section may benefit visually from listing the correlation to poor prognosis e.g. wide QRS complex, LVef < 50% etc...

Add a section outlining previous and ongoing research in the field, including treatment per pathologic subtype ''I see some edits on this. But I don't see treatment based on pathologic subtype...so I guess the treatment is similar regardless of subtype?''

Introduce chronic, subacute, acute, and fulminant subtypes in the signs and symptoms section ''This may benefit from having a subheadings in this section, e.g. the page on hepatitis https://en.wikipedia.org/wiki/Hepatitis#Signs_and_symptoms. But if there's not as much info on it may just need to add one subheading "subtypes"''

Link out to other wikipedia pages at an appropriate rate Minor suggestion can add a linkout to fulminant https://en.wikipedia.org/wiki/Fulminant — Preceding unsigned comment added by WjungUCSF (talk • contribs) 23:02, 13 December 2021 (UTC)

Reply to Peer Review and WIP
Thank you, WjungUCSF, for the thorough peer review and feedback organized in regard to my work plan. It makes it a lot more straight forward to understand the work left to do, while providing me the opportunity to let others know why I did not make certain changes outlined in my work plan. My replies are below.

Responses

 * 1) Add a section detailing the outcomes/prognosis of myocarditis - This section may benefit visually from listing the correlation to poor prognosis e.g. wide QRS complex, LVef < 50% etc...
 * I agree that a short list could improve the readability of this section. I'll add it to my to-do list!


 * 1) Add a section outlining previous and ongoing research in the field, including treatment per pathologic subtype - I see some edits on this. But I don't see treatment based on pathologic subtype...so I guess the treatment is similar regardless of subtype?
 * There are some research articles summarizing findings from case reports and other primary literature (e.g., the use of immunosuppressive agents in eosinophilic and giant cell myocarditis, but the lack of perceived benefit in lymphocytic myocarditis ), but these all need to be read with a speculative eye, as other literature also proposes that over half of acute myocarditis cases resolve spontaneously, and endomyocardial biopsy is not frequently done in the practice setting due to limited access.
 * Since this could all be considered research, it could go into the research section, but I was hesitant as it seems to get into a bit too much detail without a clear consensus. Possibly another to-do?


 * 1) Introduce chronic, subacute, acute, and fulminant subtypes in the signs and symptoms section - This may benefit from having a subheadings in this section, e.g. the page on hepatitis https://en.wikipedia.org/wiki/Hepatitis#Signs_and_symptoms. But if there's not as much info on it may just need to add one subheading "subtypes"
 * There is less information about subtypes beyond acute and fulminant, as chronic myocarditis tends to be considered as existing on a spectrum with dilated cardiomyopathy. I felt like the subtypes were less relevant in the following sections, at least in their current form, so I may opt out of creating a specific subheading temporarily. It will be an eventual to-do if other writers agree with my vision for the article.

WIP / To-Do

 * Add a short list to the outcomes section detailing the findings used to predict prognosis
 * Reach out to authors of this article to inquire about using their table of causes of myocarditis
 * Build out research section with biopsy-guided treatments and caveats
 * More clearly demarcate fulminant vs. acute (vs. chronic where applicable) in signs/symptoms, treatment, outcomes, and epidemiology sections
 * Add subheadings for above mentioned subtypes

Jrstultz (talk) 04:04, 17 December 2021 (UTC)

Nutrition
cave: Proper nutrition cannot replace effective medical treatment! --Myosci (talk) 20:16, 19 January 2022 (UTC)
 * Apigenin: found in many fruits and vegetables and chamomile tea (cave: Chamomile), see Apigenin Attenuates Experimental Autoimmune Myocarditis by Modulating Th1/Th2 Cytokine Balance in Mice
 * Protective role of nutraceuticals against myocarditis

Vaccination
Is there a particular reason for singling out Covid-vaccines for a more extensive discussion, when the main subject Myocarditis is a known rare side-effect of multiple (types of) vaccine? Especially when said discussion of the Covid-vaccine mentions only one specific datapoint for one specific vaccine(brand) valid for one very specific age-group comprising only two life-years (age 16-17), and this carefully cherrypicked datapoint consists of a raw number requiring a fair bit of contextual data to be interpreted correctly, one might question the encyclopedic value of this section of the lemma.

Possibly some POV-issues might have led to such an unbalanced disussion overhere. Perhaps some cooler minds might find a more balanced approach? 213.127.127.3 (talk) 11:22, 4 February 2022 (UTC)