“Hibernating” Myocardium: Not Only a Matter of Semantics
To the Editor:
The recent article by Kalra et al1 reiterates the use of the term “hibernating myocardium,” which was introduced by Diamond et al in 19782 to indicate a state of chronically ischemic noninfarcted myocardium. The term is incorrect and should be abandoned. In Dorland’s Illustrated Medical Dictionary, hibernation is defined as “the dormant state in which certain animal species pass the winter; it is characterized by narcosis and by sharp reduction in body temperature and metabolic activity.”3 The so-called “hibernating myocardium” is a condition of viable but dormant myocardium, which has nothing to share with reduction in body temperature. The term hibernation is derived from the Latin “hiberna,” which means “winter” and clearly refers to cold temperature. We are aware of only one condition of hibernating myocardium in humans, and that is the heart during hypothermic circulatory arrest in cardiac surgery.
“Hibernating” myocardium is a misnomer due to lack of knowledge of classics, and it is depressing to realize how much modern medicine accepts unsound neologisms with supine resignation. Sawyer and Loscalzo in their editorial4 define it as a “reversible sleep.” We believe that the best term is myocardial “lethargy.” In the Shorter Oxford English Dictionary, lethargy, which derives from the Greek word lethargia (ληθαργια), is defined as “morbid drowsiness or prolonged and unnatural sleep”; in other words, a pathological dormant state.5
Whatever the final choice of nomenclature, the use of accurate terminology has basic implications in science for a precise way of thinking and for a better understanding of disease processes. Semantics, which is the study of the meanings of words and the rules of their use, is wrongly thought to be useless. Modern medicine is science in so far as it respects the relationship between language and significance. In the past, it was popularly believed that study of Latin, if not of Greek, was a prerequisite for the study of medicine. Although this is no longer enforceable, by leafing through a medical dictionary, one can estimate that as much as 75% of scientific words are of Greek or Latin derivation.
- ↵Kalra DK, Zhu X, Ramchandani MK, et al. Increased myocardial gene expression of tumor necrosis factor-α and nitric oxide syntase-2: a potential mechanism for depressed myocardial function in hibernating myocardium in humans. Circulation. 2002; 105: 1537–1540.
- ↵Dorland WAN. Dorland’s Illustrated Medical Dictionary. 26th ed. Philadelphia, Pa: WB Saunders Company; 1981.
- ↵Sawyer DB, Loscalzo J. Myocardial hibernation: restorative or preterminal sleep? Circulation. 2002; 105: 1517–1519.
- ↵Little W, Fowler HW, Coulson J. The Shorter Oxford English Dictionary. 3rd ed. Oxford, UK: Oxford University Press; 1978.
We agree with the comments of Basso et al regarding our article1 and the precise meaning of the term “hibernating myocardium.” However, some terms in medicine are retained because they have become established and well recognized and convey a specific meaning that goes beyond their etymological roots. For instance, the term doctor is derived from the Latin term “docere,” which means to teach. It is obvious, however, that most practicing doctors spend only a fraction of their time teaching. In fact, the most important aspect of a doctor’s job, which is to provide healing care, is not inherent in the Latin interpretation. Furthermore, the English language is full of colorful misnomers like guinea pig (which is neither a guinea nor a pig), eggplant (which has no egg in it), and English muffins and French fries (which did not originate in these countries)!
Nonetheless, we fully endorse the urging of Basso et al to not accept flimsy neologisms into our medical language and to use a semantic and scientific pragmatism when introducing new words into our medical vocabulary.