Table 3.

Examples of knowledge deficiencies and scientific inaccuracies in the English cardiovascular Wikipedia entries and suggestions for improvements

Wikipedia topic (entry)	Number of updates (edits in past 12 months)	Areas of deficiency/inaccuracy	Suggestions for improvements
Angina pectoris	Edited 979 times (150 times in past 12 months)	There is no mention of staging of angina. The pathophysiology is incomplete and not scientifically correct. Although it was mentioned that, “some cases may have associated symptoms such as breathlessness, sweating, and nausea”, there were no indications that these symptoms were due to sympathetic stimulation triggered by pain. Another paragraph stated, “some patients experience autonomic symptoms” without linking the symptoms, stated earlier, to the autonomic system and giving an explanation The statements about Prinzmetal's angina are incomplete and not scientifically correct and should be amended in light of the current literature. Also, there is no mention under diagnosis of key investigations	The Canadian Cardiovascular Society Grading Scale and or the New York Heart Association Classification should be added An understanding of the pathophysiology of angina starting from coronary atherosclerosis, endothelial dysfunction, cholesterol accumulation and key molecular and biochemical changes should be added It should be mentioned that the diagnosis of Prinzmetal's angina is based on the documentation of transient ST segment elevation during an episode of chest pain in the absence of severe, fixed coronary stenosis. Associated Raynaud phenomenon and migraine headache have been described in some of these patients, suggesting that the syndrome is due to a more generalised vasospasm disorder. Although the pain is always at rest, one-third of patients experience pain during exercise It should be stated that the evaluation of chest pain depends on a careful history and physical examination. The assessment of a patient with stable ischaemic heart disease includes 12-lead ECG, measurement of biochemical and inflammatory markers, and non-invasive diagnostic tests. The first goal is to assess the patient's probability of ischaemia so that emergency treatment can be expedited. Investigations such as non-invasive stress testing with a standard electrocardiographic treadmill or bicycle exercise, radionuclide imaging, stress echocardiography, cardiac magnetic resonance and positron emission tomography, need to be added.
Chest pain	Edited 357 times (23 times in past 12 months)	There is no mention of the signs and symptoms of patients presenting with chest pain Although several causes of chest pain are listed under differential diagnosis, some important causes were not stated such as aortic stenosis, aortic dissection, oesophageal spasms and oesophageal rupture	It is important to add key clinical features of a patient presenting with chest pain and how the medical history is important in defining the possible cause. Key issues in the history that should be added are: (1) site of pain, (2) onset, when did start? (3) character of pain, type of pain, description of pain, (4) radiation, does the pain go anywhere else? (5) associated features, (6) time/pattern. Is it any worse at a particular time of the day? In relation to activity, cough or movement? (7) exacerbating and relieving factors, and (8) severity on a scale from 1 to 10 (pain intensity, interference with sleep). The differential diagnosis should be organised under common causes and uncommon causes. It can also be grouped under emergency causes and non-emergency causes
Pulmonic regurgitation	Edited 22 times (4 times in past 12 months)	Although several causes of pulmonic regurgitation are mentioned, it may be important to state that pulmonic regurgitation is often secondary to an underlying pulmonary hypertension or dilated cardiomyopathy rather than due to primary valvular defect. There are no links provided for this topic	Pathologically, three possible mechanisms may result in pulmonic regurgitation: (1) dilation of pulmonic valve ring, (2) acquired change in pulmonic valve leaflets and (3) congenital defects in valve leaflets. Important links from the American Heart Association (also has two videos): http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/Problem-Pulmonary-Valve-Regurgitation_UCM_450884_Article.jsp should be added
Pulmonic stenosis	Edited 26 times (10 times in past 12 months)	Common causes of pulmonic stenosis are not clearly stated The symptoms and signs of pulmonic stenosis are not mentioned Pathophysiology: the statement that “if right ventricular failure develops, right atrial pressure will increase and this may result in a persistent opening of the foramen ovale, shunting of unoxygenated blood from the right atrium into the left atrium”, is not scientifically accurate	Common causes of pulmonic stenosis are: (1) isolated valvular stenosis (90% of causes). This forms about 10–12% of all congenital heart diseases, (2) subvalvular obstruction: obstruction or narrowing of the subinfandibular region and normal valve, and (3) supravalvular obstruction at the level of pulmonary artery bifurcation and/or more peripherally Symptoms and signs should be stated. The stenosis ranges from mild (without symptoms) to severe (which usually worsens) and requires surgery. Main symptoms are: shortness of breath, chest pain, loss of consciousness and fatigue Usually, persistent opening of the foramen ovale is related to other congenital anomalies in the heart occurring in these patients An external link such as Mayo Clinic [http://www.mayoclinic.org/diseases-conditions/pulmonary-valve-stenosis/basics/definition/con-20013659] can be added