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GA Review

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Reviewer: Jclemens (talk · contribs) 05:35, 27 July 2016 (UTC)[reply]

Rate Attribute Review Comment
1. Well-written:
1a. the prose is clear, concise, and understandable to an appropriately broad audience; spelling and grammar are correct. Issues identified, awaiting resolution. Improved as requested.
1b. it complies with the Manual of Style guidelines for lead sections, layout, words to watch, fiction, and list incorporation. Lead identified as long enough, but not comprehensively addressing all portions of the article. Update: IAR accepting this, because with this length and importance of an article, the alternatives are to a) short-change the existing coverage to add coverage of culture, cuisine, art, and such, or b) lengthen the lead further to cover those topics, or c) remove coverage of those topics from the article. THUS, my decision is that the existing lead appropriately summarizes the core points of the article, while complying with the MOS for lead length.
2. Verifiable with no original research:
2a. it contains a list of all references (sources of information), presented in accordance with the layout style guideline. Generally good throughout, with a few identified exceptions. Unreferenced sections have been referenced appropriately now.
2b. reliable sources are cited inline. All content that could reasonably be challenged, except for plot summaries and that which summarizes cited content elsewhere in the article, must be cited no later than the end of the paragraph (or line if the content is not in prose). A couple of dead links have been identified for revision. Fixed.
2c. it contains no original research. Other than the unreferenced sections towards the end of the article, no original research has been identified.
2d. it contains no copyright violations or plagiarism. No copyvio identified with automated tools--single hit appears to be a mirror of a prior version of the article, complete with Wikipedia markup.
3. Broad in its coverage:
3a. it addresses the main aspects of the topic. Good, comprehensive article on the human heart
3b. it stays focused on the topic without going into unnecessary detail (see summary style). I'm pretty sure some of the sections should be moved into other articles. After discussion, calling this a pass.
4. Neutral: it represents viewpoints fairly and without editorial bias, giving due weight to each. No issues noted.
5. Stable: it does not change significantly from day to day because of an ongoing edit war or content dispute. No issues noted.
6. Illustrated, if possible, by media such as images, video, or audio:
6a. media are tagged with their copyright statuses, and valid non-free use rationales are provided for non-free content. All reviewed, no defects or concerns found.
6b. media are relevant to the topic, and have suitable captions. Excellent selection.
7. Overall assessment. Not going to let the technicalities of lead length/coverage hold this article up from passing. It's come a long way.

Initial Thoughts

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Firstly, thanks very much for taking up this mammoth review of a very complex organ. I'm reassured when I see the huge amount of reviews, barnstars and GA nominations that this will be a thorough and systematic review. Please take your time and be systematic and I'll try and address your concerns as we go. If you could be specific when you mention something that will make this easier to address. IF you're not sure about something you can ask here or at WT:MED or WT:ANAT for some help. Iztwoz and CFCF were both significant editors to this article and may help with the review. I look forward to your review :) --Tom (LT) (talk) 08:50, 27 July 2016 (UTC)[reply]

Heh, or I'll just break out my own Netter's or related works. I'm not a zoologist or an anatomist, but I am a practicing clinician and have access to a wide variety of professional medical resources on the topic. Jclemens (talk) 09:02, 27 July 2016 (UTC)[reply]
Great to hear. I should add most of my work and responses will be on the weekends, --Tom (LT) (talk) 09:21, 29 July 2016 (UTC)[reply]

First detailed text read-through

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Lead

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  • "the human heart is located in the middle compartment of the mediastinum in the chest"
  • "In a healthy heart blood flows one way through the heart" Wouldn't there be a comma after the first heart?
  • I think describing all of four-chambered heart circulation and mechanical action in paragraph 3 of the lead is likely to be a good spot to trim, in order to make room to cover the parts of the article not currently summarized in the lead. I note that the entire paragraph seems to be referring to the mammalian/bird heart.
BTW, I completely endorse updating the lead LAST. Jclemens (talk) 19:09, 3 August 2016 (UTC)[reply]
As an update on this, I like how the lead reads currently, but it does not even begin to touch on history, culture, or non-human hearts. How do you think that should be addressed? Jclemens (talk) 21:33, 17 August 2016 (UTC)[reply]

Structure

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 Done Resolved
  • Structure section: first sentence needs to specify human heart.
  • You might note that human lung has only two lobes on the left vs. three on the right, rather than just noting its smaller volume... or you might not. I didn't know that until I took A&P for the first time and thought it was really cool, so that may just be my subjectivity.
    •  Not done an interesting piece of information (don't forget the lingula of the left lung though), but the article is already information dense as it is, so I will leave this out. --Tom (LT) (talk) 00:06, 30 July 2016 (UTC)[reply]
  • "The heart is supplied by the coronary circulation" Supplied with what? Its own myocardial blood supply, obviously, but the sentence reads a bit awkwardly since coronary circulation gets its own section later, while the pericardium is discussed immediately and in detail.
  • "A stethoscope can be placed directly over the apex so that the heartbeats can be counted." That's funny, I can count heartbeats adequately with my stethoscope placed pretty much anywhere in the anterior thorax. Is there something this is trying to get across I'm missing?
  • Unlike the other important structures of the heart, I really don't see a unified paragraph anywhere describing the pericardium. References to pericardial structure, function, and pathology seem to be scattered throughout the article.
  • "Cardiac muscle tissue has autorhythmicity, the unique ability to initiate a cardiac action potential at a fixed rate – spreading the impulse rapidly from cell to cell to trigger the contraction of the entire heart. This autorhythmicity is still modulated by the endocrine and nervous systems.[7]" This is absolutely true, but are we at the right level here? How does a less educated reader get that cardiac muscle tissue tends to beat despite the lack of external stimulus? Are we writing at too high of a grade level here?
  • Atria and ventricles should be introduced in the overall 'structure' section before being referred to in the 'heart wall' subsection.
  • Valves "These muscles prevent the valve from falling back into the atrium." How about adding 'during ventricular contraction'? Or just leaving this off as the entire action of the papillary muscles is covered two paragraphs down in more detail?
  • pulmonary valve, pulmonary artery, and aortic valve are all wikilinked. Should we not also wikilink aorta for symmetry?
  • in the Right Heart section, there's a pretty detailed discussion of perinatal changes in fetal circulation. I get that the remnant parts are appropriate to discuss in the context of landmarks of the right atrium, but I wonder if, like the pericardium, fetal circulation would benefit from an entire section discussing it in detail.
  • "While most ventricular filling occurs while the atria are relaxed, they do demonstrate a contractile phase when they actively pump blood into the ventricles just prior to ventricular contraction." So is this about the right heart or both? It's in the right heart section, but it also makes it seem like the 'atrial kick' is just an afterthought.
  • Similar to the above, do we need to discuss the action of the chordae tendineae and papillary muscles again? The 'right heart' section is a subsection to 'valves', which is where I believe the action should be discussed in most detail.
  • "When the right ventricle contracts, it ejects blood into the pulmonary artery, which branches into the left and right pulmonary arteries that carry it to each lung." I know the antecedent reference is likely correct, but wouldn't 'that blood' be clearer than 'it'?
  • Why are we discussing the pulmonary valve yet again at the end of the right heart section? We just covered it above.
  • Left Heart "Only the left atrial appendage contains pectinate muscles. " Which do what? Actually, I can't even tell from following that wikilink, which 1) seems to contradict that statement, and 2) doesn't actually mention what they DO do.
  • Coronary circulation section seems to be a bit terse overall.
  • Final thoughts on the Structure section and its subsections: We have a lot of overlap and redundancy here, and so a lot of things have scattered mentions throughout, rather than concentrated discussion in one place. It probably is about the right length overall, but could stand to be reorganized, a few redundancies trimmed, and a few things fleshed out a bit. Again, the whole section only refers to the human heart, which I get that the article is using as a baseline and discussing how other non-human hearts differ. I haven't gone through the references in detail, but really have just been concentrating on the flow of topics.
    • Thanks. Many sections probably need a bit more organising throughout the article - the current state is a result of the attention this article gets and a the numerous editors which have worked on it. Animal hearts are discussed at the end. --Tom (LT) (talk) 00:37, 30 July 2016 (UTC)[reply]
      • Those changes and responses look reasonable, but it may take me a bit to get back to them, as I intend to keep going through section-by-section for a first pass before reexamining any of these sections. Cheers, Jclemens (talk) 01:36, 30 July 2016 (UTC)[reply]

I will try to do at least one additional section per day, but will be in class for the next few days. I think work on this section is going to be relatively self-contained, so if my questions prompt changes, feel free to start in on them. Jclemens (talk) 19:51, 27 July 2016 (UTC)[reply]

Development section

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 Done Resolved

Of the sections, my personal familiarity with this is weak. The text seems reasonable and straightforward.

Physiology section

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 Done Resolved
  • You've got a choice to make: Where is blood flow discussed, in the Structure of Physiology section? Trying to cover it in both would be redundant. It's possible to combine the sections, and discuss the heart part-by-part covering both anatomy and function as well. I'm pretty sure that covering blood flow twice isn't the right way to go about it, though.
    •  Partly done I have removed and transferred some content from the 'structure' section. I try and follow the structure & function scheme for most anatomy articles that I edit because it is the easiest for readers to understand. I makes logical sense to put it all together, but it ends up being more complicated to read. So I've tried to keep the "structural" information about blood flow (A->B -> C) and then information about the oxygenation of blood in the physiology section. --Tom (LT) (talk) 07:51, 31 July 2016 (UTC)[reply]
  • Oh, and Human cardiac physiology should probably be specified up top.
  • The Blood Flow subsection seems to imply that only the systemic circulation branches into ever-smaller divisions.
  • Shouldn't the first section of the Cardiac Cycle subsection specify ventricular systole and diastole? Or, even better and a concurrent improvement, cover atrial function too? The image shows how they overlap and interact better than the current text of the subsection does, I fear.
  • "This causes a rise in pressure in the ventricles, and in ventricular systole blood will be pumped into the pulmonary artery." And the Aorta? Are we leaving it out on purpose?
  • In Cardiac Output: "The average cardiac output, using an average SV of about 70mL, is 5.25 L/min, with a range of 4.0–8.0 L/min." Shouldn't that be an "average range" or "normal range"?
  • "Preload can also be affected by a person's hydration status." True, but wouldn't "circulating blood volume" or something like that be more accurate?
  • "Positive inotropes that cause stronger contractions include high blood calcium and drugs such as Digoxin, which will act to stimulate the sympathetic nerves in the fight-or-flight response." I'm not sure fight-or-flight belongs in this sentence, as while it may be one sort of sympathetic response causing positive inotropy, it's far from the only one and is unrelated to the others previously mentioned... so it needs to be moved around if it is to be mentioned at all, I suspect.
  • In Electrical conduction: "In the ventricles the signal is carried by specialized tissue called the Purkinje fibers which then transmit the electric charge to the cardiac muscle." Cardiac muscle is not mentioned in the atrial physiology, at the start of the paragraph. I think it can either safely be taken out, OR it should be made clear that both atrial and ventricular contraction rely on cardiac muscle.
  • Is the Sinoatrial Node subsection really the best place to talk about depolarization, ion pumps, and action potentials?
  • Is the Sinoatrial Node subsection really the best place to introduce troponins?
  • In the Influences section: "Norepinephrine binds to the beta–1 receptor. High blood pressure medications are used to block these receptors and so reduce the heart rate." Unless the reader already knows about beta blockers, do we expect them to correctly connect these two adjacent sentences?
  • The final paragraph in the Influences section seems a bit terse: People other than athletes can have bpm's lower than 60, although many of them are quite sick.
  • Most of the Influences section seem to be cited to reference #7.
    •  Comment. yes, this is an artefact of the way the article started. We used a public domain source to provide some of the anatomy and physiology information, then significantly edited, reorganised and sliced the article up. But many references remain. --Tom (LT) (talk) 05:34, 2 August 2016 (UTC)[reply]
  • In the Heart Sounds subsection, the illustration "File:2029 Cardiac Cycle vs Heart Sounds.jpg" seems like it would be better suited here than in Cardiac Output, above.
    •  Question: this is such a classic representation of the cardiac cycle I'm inclined to leave it there. I do however have a question - it seems we have two images - cardiac cycle against ECG (one in cardiac cycle, one in ECG). I think I should remove one. I find the current one at the top not very useful. What's your opinion on what should be chopped? --Tom (LT) (talk) 05:34, 2 August 2016 (UTC)[reply]

Overall, there's a lot to work on here, both in terms of figuring out what goes where, but also in terms of making sure that the text is clear and complete. Again, feel free to start working on identified problems at any point, as I continue marching through the text. Jclemens (talk) 03:18, 29 July 2016 (UTC)[reply]

Clinical Significance

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 Done Resolved
  • Is this section titled properly? It really seems to be about diseases and their diagnosis and treatment.
  • Does this article use US or UK English variants? Either is fine, but I see we seem to have a mixture.
    • As far as I know this isn't a requirement of a GA review - please (please, please) do not make me spend hours and hours trawling through this article to correct this. --Tom (LT) (talk) 07:58, 31 July 2016 (UTC)[reply]
  • In Disease, lots of overlinkage, and we don't need a roll call of medical professionals who treat heart conditions.
    • I disagree here. Unfortunately there is a lot to mention - I don't think we're overlinking pointlessly, nor duplicating previous mentions. I think it's very pertinent to mention the main professionals involved in care - and we haven't listed THAT many, really. --Tom (LT) (talk) 07:58, 31 July 2016 (UTC)[reply]
  • "In the worst case this may cause cardiac arrest, a sudden and utter loss of output from the heart." Would not hurt to mention consequent unconsciousness and death except in cases of rapid intervention.
    • I think that's a little dramatic and I try to avoid disease mentioning "which in the worst case could lead to death" (Which most can) - and similarly even rapid intervention is not very effective for sudden cardiac arrest, unfortunately. --Tom (LT) (talk) 07:58, 31 July 2016 (UTC)[reply]
  • Should heart murmurs be combined with heart sounds, above?
    • No, because I try very hard to keep what's physiological and what's pathological separate. Otherwise things get very lengthy & complicated very fast, as every sentence has to have an exception clause... makes it very difficult to read for unacquainted readers--Tom (LT) (talk) 07:58, 31 July 2016 (UTC)[reply]
  • "An irregular rhythm is classified as atrial or ventricular fibrillation depending if the electrical activity originates in the atria or the ventricles." Pretty sure there are more arrhythmias than that.
  • The Diagnosis section could stand to summarize its subsections. History is a bare wikilink, and blood testing is not specifically called out at all.
  • In Examination, what joint sign is significant enough to mention when we don't discuss dependent edema?
  • Isn't any BP measuring device a sphygmomanometer? Our article on that topic seems to think so.
  • Palpation and "felt for any transmitted vibrations" are both used in this subsection, but not tied to each other.
  • Auscultation, on the other hand, is explained twice.
  • "A normal heart has two hearts sounds - additional heart sounds or heart murmurs may also be able to be heard." Ugh. Take this sentence out and shoot it, please. :-) Or at least completely rewrite it.
  • "Additional tests may be conducted to assess a person's heart murmurs if they are present, and signs of peripheral heart disease such as swollen feet or fluid in the lungs may be assessed." Oh, wait, we DO see edema, finally. However, I'm pretty sure this should say peripheral signs of heart disease, since I've never seen a peripheral heart, let alone a diseased one. (Sorry, this section is making me a bit snarky, I know it's not your fault)
  • Electrocardiogram Do we need to say that the heart's electrical activity is complex?
  • 10 wires are typically attached to the body for a 12-lead ECG. 4 limb leads including a ground, and V1-V6.
  • I'm not sure I'd call T or P waves "points" on an ECG. Features, perhaps?
  • I've always heard QRS described as solely ventricular depolarization, and that atrial repolarization was "lost" in the relatively larger electrical discharge.
  • Deflection upwards or downwards depends on the direction of the electrical flow relative to the lead in question.
  • "Testing when exercising can be used to provoke an abnormality" With all the overlinking scattered around this article, I'm surprised there's no wikilink to cardiac stress tests here.
  • "...if a rhythm abnormality is suspected to be present but not present at the time of assessment."
  • Imaging I would think that the fact that an echocardiogram is essentially an ultrasound of the heart should be mentioned up front. I've never seen a cardiac PET, but rather a lot of SPECT. Traditional angiography seems to have largely given way to MRA, so from my experience, the modalities are listed in least to most commonly used order, backwards of what I would expect.
  • Treatment Why are we mentioning digoxin if we're not going to go into what it does and why it's less typically used now?not done}}
    •  Not done other than Aspirin, Digoxin is probably the most classic of the cardiac drugs that is still widely used. How it works is not yet
  • Overall, this section doesn't seem to be differentiating well between long-term treatments and emergent interventions.
  • GTN, really? Is that really used anywhere as a synonym for NTG, or did we just have a dyslexic contributor somewhere along the line. I note that it wikilinks properly...
  • I'm not sure if we want to go into statins and cholesterol-lowering drugs here at all. The section is large and confusing enough without them.
    • I disagree. Statins and cholesterol-lowering drugs are often an essential part of treatment of cardiac disease, which often involves some form of secondary or tertiary prevention. --Tom (LT) (talk) 06:08, 2 August 2016 (UTC)[reply]
  • Likewise, I'm not sure how much we really want to go into prevention in a treatment section. I'd prefer that we cover prevention separately if we're going to go into it.
  • At least in the systems where I work, Novel Anticoagulation (NOAC) is deprecated, and target-specific anticoagulation (TSAC) was proposed as the alternative, after there was a misinterpretation of the abbreviation NOAC as meaning "no Anticoagulation". Not sure where the RS'es are on this one yet.
  • Surgery "In this operation, one or more arteries surrounding the heart that have becominge narrowed are bypassed."
    •  Done

... and that's enough for tonight. Jclemens (talk) 04:44, 30 July 2016 (UTC)[reply]

History

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 Done Resolved
  • Ancient entire section is unsourced.
  • Modern Otto Frank is wikilinked to Anne Frank's father, a separate person.
  • The description of pathologies and their treatments seem quite brief... but not terribly representative.
    • Not too sure what to do with this one. Unfortunately I'm not a historian yet either to fully expand it (there is however a book you can buy titled "History of the Heart" I found during research), but I'd say this section conveys the main milestones and is suitably broad for GA. --Tom (LT) (talk) 02:05, 14 August 2016 (UTC)[reply]

Overall, this section doesn't seem to contribute a lot to the article, and my knowledge of this is admittedly sparse. Jclemens (talk) 04:28, 31 July 2016 (UTC)[reply]

Society and Culture

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  • Symbolism No real comments here. Ancient Egyptian thought seems to get relatively more weight. Well, Broken Heart and Cupid seem grafted onto the end of cross-cultural descriptions of heart significance.
  • Food Well referenced, and feels like it belongs in a completely different article. Jclemens (talk) 04:28, 31 July 2016 (UTC)[reply]

How about we break this entire section off into a separate article? The rest of the article is a pretty solid A&P article, but this whole section seems to be out of place--more so than the history section which is terse and somewhat sparsely referenced in places. Jclemens (talk) 04:30, 31 July 2016 (UTC)[reply]

  •  Comment. as an anatomy editor I think it's very important to keep historical and social and cultural information on articles. There is a tendency to view organs from a medical perspective (perhaps because of the editing cohort) but it's important to remember organs existed far longer that we've known about them, and their importance doesn't just end at the exit door of a doctor's surgery. Social, cultural and historical information is fascinating and very informative and as these sections are not too long, I think they should stay on the main page. --Tom (LT) (talk) 07:13, 2 August 2016 (UTC)[reply]

Other Animals

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 Done Resolved
  • Could the main section be written without an assumption that the reader is conversant with taxonomies?
  • Double Circulatory System The double circulatory system isn't really explained in this section, and there doesn't appear to be a main article where I could go and read more about this.
  • The fully divided heart this section actually seems to be quite well written, compared to the previous section.
  • Fish No real comments here, but again, this is not a part of the article where I am terribly familiar with the subtopic.
  • Invertebrates unreferenced, without a main article referenced either.

OK, so that's the end of the first pass. Jclemens (talk) 05:03, 31 July 2016 (UTC)[reply]

Comments by Dunkleosteus77

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It'll take a couple minutes, it's just copy/paste again and again
it's now ref 115

In response to this, I want to point out that verifiability, not an impeccable list of references, is what is required for GA status (WP:GA?). That said thanks for your attention and I've tried to adress as many of these as I can. Unfortunately because I've edited I've lost track of the reference numbers, so if you can let me know the reference names/authors I'll fix the ones I've lost track of.--Tom (LT) (talk) 09:24, 14 August 2016 (UTC)[reply]

  • The good news about multiple people nitpicking things in good faith during a GA review is that by fixing all of that up you are just that much closer to FAC once all is said and done...  :-) Jclemens (talk) 00:05, 15 August 2016 (UTC)[reply]
  • ref 125, ref 126, and ref 133 are missing a title, authors, year of publication, and publishers
  • ref 110 and ref 132 shows a cite error
  • the title for ref 102 would be "Look up All Chinese Words in a Text?"
  • ref 116 should look like Rombauer, Irma S.; Becker, Marion Rombauer; Becker, Ethan (1975). The Joy of Cooking. The Bobbs-Merrill Company. p. 508. ISBN 978-0-0260-4570-4.
  • what is ref 112 supposed to be?
  • the ISBN for ref 100 (Death and the Afterlife in Ancient Egypt) is 978-0-2267-9164-7
  •  Done --Tom (LT) (talk) 00:35, 20 August 2016 (UTC)[reply]
  • the ISBN for ref 99 (Middle Egyptian: An Introduction to the Language and Culture of Hieroglyphs) is 978-1-1076-6328-2
  • any reason why the title for ref 120 is in all caps?

Second full read-through

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  • In Valves, we've got two adjacent sentences (1st and 2nd paragraphs) which begin "The valves between the atria and ventricles"
  • Coronary circulation "Blood circulates through the coronary circulation cyclically" How about "through the coronary vessels" to avoid circulation/ates twice in one sentence?
  • "It does this by smaller branching arteries - diagonal and septal branches." How about "It does this by branching into smaller arteries" or something like that?
  • Nerve supply "The heart receives nerves from the sympathetic trunk and the vagus nerve." The heart is innervated by? Receives nerve signals from? I'm sure there's an equally correct and less awkward way to say it than "receives nerves"
  • Disease I'm still struggling with this sentence: "Many other medical professionals are involved in treating diseases of the heart, including doctors such as general practitioners, cardiothoracic surgeons and intensivists, and allied health practitioners including physiotherapists and dieticians." From my perspective as a practicing PA (that is, as a medical practitioner, NOT allied health), dieticians and physiotherapists do very little compared to what I do actively managing hypertension, anticoagulation, and the like. How about something like: "Cardiologists manage heart problems, with interventionalists managing the electrical and coronary circulation problems with solutions such as pacemakers and percutaneous coronary interventions (stents). Cardiothoracic surgeons repair structural defects with open heart surgery, coronary artery bypass surgery, and similar interventions. Multiple other medical and allied health professions help in the prevention and treatment of heart disease."
    •  Not done lol, it is tempting to see one as the crux of treatment (which you probably are) but there is a whole ecosystem of allied health that works within hospitals, rehabilitation and in outpatient settings to help manage heart failure. Allied health play an important role in the management of heart disease, so I won't be changing this sentence.--Tom (LT) (talk) 01:01, 20 August 2016 (UTC)[reply]
  • "Heart failure is where the heart can't beat enough blood" deliver enough blood, perhaps?
  • "or cause the heart to dilate and impact on the effiency of its beating" I think the 'on' is extra there.
  • "Murmurs are graded by volume, from 1) the quietest, to 6) the loudest." I'm thinking "1 (the quietest) to 6 (the loudest)" is probably a better way to format that.
  • "the frequency of the sound as determined by the side of the stethoscope by which they are heard" This assumes that all stethoscopes have a bell/diaphragm configuration, which is not universally true.
  • In Treatment the link to implantable defibrillator should probably be Implantable cardioverter-defibrillator rather than the general defibrillator article.
  • Since we seem to have different acronyms across the pond, how about we just spell out "nitroglycerin[e]"?
  • Since this is a scientific article without particular religious impacts, should we not be using BCE/CE rather than BC/AD?
  • "The breakthrough came with the publication of De Motu Cordis..." Which breakthrough? Into widespread modern understanding of cardiac function?
  • "In Catholicism, there has been a long tradition of worship of the heart," I suspect 'veneration' may be more appropriate than worship in that context.
  • The first two paragraphs of double circulatory systems appear somewhat redundant.
  • Excellent work cleaning up the fish heart section, BTW.
  • ... and that's all for this pass. I'll hat some stuff and adjust things now. Jclemens (talk) 21:29, 17 August 2016 (UTC)[reply]
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