A 50-something Australian with sudden severe epigastric and chest pain presented looking extremely ill.

A 50-something with sudden severe epigastric and chest pain presented looking extremely ill.Here is her ECG:What do you think?There is ST Elevation in V2-V6, worrisome for ischemia.Or is it?Notice the very large R-waves and the very prominent J-point notching, with small S-waves.This is typical ofBenign T-wave Inversion, which is commonly seen in black patients of African heritage.This case was sent from Australia and the patient was aboriginal.  I have never heard of or seen benign T-wave inversion in Australian aboriginal blacks.The cath lab was activated and the patient was taken for angiogram, which was normal.The lipase returned at 16,000.  The patient had pancreatitis.One other tip:Pancreatitis often causes chest pain, but usually has severe epigastric tenderness; acute MI, though it may cause epigastric pain, usually does not have severe epigastric tenderness.If the patient did have severe tenderness, and you recognize this benign pattern on the ECG, then you would be dissuaded from activating the cath lab.If there was no other etiology of pain found, and you are not certain about the ECG, it is of course not wrong to activate the cath lab.In either pathology, the patient may appear very ill.The link above has 11 cases, one of which is this one (if you only want to read one):15 yo AAM with ST Elevation and T-wave Inversion. Hypertrophic Cardiomyopathy or Normal ( " Variant " )?
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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The objectives of this article are the following: 1) to examine fibromyalgia and somatic symptom disorder analogy. 2) to discuss stress-evoked neuropathic pain sexual dimorphism, and 3) to propose a neuropathic pathogenesis that may explain how stressed women could develop fibromyalgia. Recent research demonstrates a clear link between fibromyalgia and small fibre neuropathy. Dorsal root ganglia contain the small nerve fibre nuclei. In rodents, physical, chemical, or environmental stressors lead to dorsal root ganglia phenotypic changes and to hyperalgesia. This phenomenon is much more frequent in females. Prolactin, oestr...
Source: Clinical and Experimental Rheumatology - Category: Rheumatology Tags: Clin Exp Rheumatol Source Type: research
Authors: van Campen C(MC, Rowe PC, Verheugt FWA, Visser FC Abstract OBJECTIVES: Muscle pain and fibromyalgia (FM) are common among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). We recently demonstrated that during orthostatic stress testing, adults with ME/CFS reported increased pain. In the current study, we hypothesised that pain pressure thresholds (PPT) would decrease and temporal summation (windup) would increase after head-up tilt testing (HUT), and that the presence of co-morbid FM would be associated with greater change in both measures. METHODS: We studied adult ME/CFS p...
Source: Clinical and Experimental Rheumatology - Category: Rheumatology Tags: Clin Exp Rheumatol Source Type: research
CONCLUSIONS: Despite the relatively small sample size of the South Australian cohort, clinical and serological characteristics correspond closely with international descriptions. PMID: 32940213 [PubMed - as supplied by publisher]
Source: Clinical and Experimental Rheumatology - Category: Rheumatology Tags: Clin Exp Rheumatol Source Type: research
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Source: Interventional Neuroradiology - Category: Radiology Tags: Interv Neuroradiol Source Type: research
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Source: Guardian Unlimited Science - Category: Science Authors: Tags: Coronavirus outbreak Infectious diseases Science World news Source Type: news
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Source: Guardian Unlimited Science - Category: Science Authors: Tags: South Australia Australia news Space Australian politics Science Source Type: news
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Source: Guardian Unlimited Science - Category: Science Authors: Tags: Australia news Coronavirus outbreak Victoria Infectious diseases Science Daniel Andrews Australian politics Victorian politics Queensland Queensland politics Source Type: news
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Source: Journal of Dermatological Treatment - Category: Dermatology Tags: J Dermatolog Treat Source Type: research
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