Chest Pain Diagnosed as Gastroesophageal Reflux

p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.0px Helvetica; background-color: #fefefe}A 50-something male presented to a clinic for one day of intermittent substernal chest and jaw pain. He had had several episodes of pain since onset; it was described as pressure-like and lasts about 5-15 minutes and resolves spontaneously. He had been pain free for about an hour.  He had some " pre-diabetes, " but no h/o hypertension, no known family history of heart disease, and he smokes about 1-2 cigarettes per day. An ECG was recorded:The computer read:Normal ECGWhat do you think?Smith Comment:This is definitely not a normal ECG.There is less than 1 mm of ST depression in II, III, aVF, and in V3-V6.The STD is nearly 1 mm in III and V6.There is a tiny amount of ST Elevation in aVLTheST vector is around -60 degrees, so that there is some STE in aVL and a bit in I, and zero in aVRWhat is a normal ST segment?--First, one must be sure that the QRS is normal. An abnormal QRS (abnormal depolarization), such as in LBBB, LVH, RBBB, or RVH, may result in abnormal ST-T (abnormal repolarization). In this case, theQRS is normal: normal axis, duration, and amplitude, without abnormal Q-waves.When the QRS is normal--The normal ST vector is towards leads II and V5 (anterior and leftward)--Leads I, II, and aVF should not haveany ST depression, as the normal ST vector is leftward and anterior. It is common to have some normal variant ST eleva...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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I was recently hired as a consultant to review claims for services provided by about 2 dozen DPMs. The fraud and the abuse are staggering. Most of those involved are young associates in private practices. The practice owners impressed these associates with how much money they can make if they bill as instructed. I have reviewed cases for an initial visit with unilateral heel pain. The patient ended up with BILATERAL xrays, ultrasound and fluoroscopy all for “comparison”. Patients... Fraud
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Podiatric Residents & Physicians Source Type: forums
Today, The Department of Justice issued an announcement that was “the first ever criminal action against an EHR vendor.” Criminal action The core of the criminal action was something inevitable:  the tension between better health and better profit.  Here’s what I saw … all of which caused me to be not-so-surprised today when the news broke. In 2008 I was the CMIO at Allscripts.  Much of my work was focused on how our customers could use our products to improve the health of our patients.  We implemented clinical practice guidelines in the software as a way to help clinical teams...
Source: Docnotes - Category: Primary Care Authors: Tags: Uncategorized Source Type: blogs
CONCLUSIONS: Lifestyle subgroups of patients were determined by stress, emotional problems, and age. The groups were significantly associated with Aβ42 and diagnostic outcome. This pattern may confound the differentiation between objective and subjective memory problems. Asking about lifestyle variables, in conjunction with neuropsychological testing, could potentially identify individuals who are not likely to have objective memory impairment and guide interventions. PMID: 31982880 [PubMed - as supplied by publisher]
Source: Dementia and Geriatric Cognitive Disorders - Category: Psychiatry Tags: Dement Geriatr Cogn Disord Source Type: research
Eggs are back on the menu in a big way, and the science supports keeping them there for most people, suggests a large-scale study that analyzed dietary data across six continents.
Source: Healthcare News - Category: Pharmaceuticals Authors: Source Type: news
Authors: Jain B PMID: 31982311 [PubMed - as supplied by publisher]
Source: The American Journal of Geriatric Psychiatry - Category: Psychiatry Tags: Am J Geriatr Psychiatry Source Type: research
No abstract available
Source: Nursing - Category: Nursing Tags: Department: CLINICAL QUERIES Source Type: research
I posed this question recently: Given the extravagant health successes people are experiencing by living the Wheat Belly lifestyle, are we on the dawn of an age of self-direction in health? If doctors misdiagnose/misclassify our acid reflux, irritable bowel syndrome, intractable constipation, migraine headaches, chronic sinusitis, asthma, depression, binge eating disorder, type 2 diabetes, rheumatoid arthritis, ulcerative colitis, autoimmune hepatitis, and hundreds of other conditions, which we then reverse on our own with the lifestyle changes we introduce . . . who needs the doctors? Christine provided her perspective: &...
Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: Wheat Belly Success Stories gluten grains microbiome nutrients self-directed health undoctored Source Type: blogs
Authors: Xu S, Xue Y Abstract Pediatric or childhood obesity is the most prevalent nutritional disorder among children and adolescents worldwide. Approximately 43 million individuals are obese, 21-24% children and adolescents are overweight, and 16-18% of individuals have abdominal obesity. The prevalence of obesity is highest among specific ethnic groups. Obesity increases the risk of heart diseases in children and adults. Childhood obesity predisposes the individual to insulin resistance and type 2 diabetes, hypertension, hyperlipidemia, liver and kidney diseases and causes reproductive dysfunction in adults. Obe...
Source: Experimental and Therapeutic Medicine - Category: Journals (General) Tags: Exp Ther Med Source Type: research
Debbie posted this comment on the Wheat Belly Facebook page: “I posted a few weeks back about our scare from our primary care doctor. My husband had a calcium score of 1200. We panicked! Messaged Dr. Davis and went the next day to a cardio doctor and had a stress test, ultrasound, and blood test (inflammatory markers). Got him on recommended supplements per Dr Davis. “Latest update: Cardio doctor says, being as you started ‘Wheat Belly’ back in October, 2014, your score could have been higher and already started to improve, we don’t know. What we DO know is, because of this new way of eating,...
Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: Wheat Belly Lifestyle calcium score cholesterol fish oil gluten grains heart disease iodine Thyroid vitamin D Weight Loss Source Type: blogs
Background: When patients present to the emergency department with a complaint concerning for heart disease, this often becomes the primary focus of their evaluation. While patients with noncardiac causes of chest pain outnumber those with cardiac causes, noncardiac etiologies are frequently overlooked. We investigated symptoms and noncardiac conditions in a cohort of patients with chest pain at low risk of cardiac disease. Methods: We analyzed data from a prospective registry of patients who were evaluated in our chest pain evaluation center. Registry participants completed standardized and validated instruments for depre...
Source: Critical Pathways in Cardiology - Category: Cardiology Tags: Original Articles Source Type: research
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