Chest pain is generally considered the second most common cause patients show up at the Emergency Room (ER) doorstep.  Yet only about 20% or less of patients admitted with chest pain to the hospital actually have significant coronary artery disease.   There is a wide spread of how many patients that actually have coronary artery disease which also had other complaints already diagnosed – ranging from about one percent to almost thirty percent.  That’s what makes diagnosing cardiac disease difficult.  Some authors say ER’s discharge 5 % of the chest pain patients that will have a heart attack and another five percent or so that will have a chest pain (or equivalent) unstable episode soon after the discharge.  This problem in diagnosing chest pain, and trying to pick the patients with the “real chest pain” from the heart or cardiac in origin is paramount in the ER. Even with a normal ECG (electrocardiogram) and normal blood tests a condition of serious heart disease can co-exist with the patient.  Many strategy techniques are used to try to capture the potential patient with significant heart disease.  Recently the new CT scanners that can look directly at the heart blood vessels to see potential blockages or narrowings are being used, however not all insurance companies will pay for such studies.

indecorously Other causes of chest pain that are not cardiac (heart) in origin are:

gallbladder disease


musculoskeletal disorders

herpes zoster (“shingles”)

anxiety states

peptic ulcer disease

gastroesophageal reflux disease (GERD).

Other more serious diagnoses are:

aortic dissection (a tearing of the aorta itself)

pulmonary embolism (blood clot in lungs)

pneumothorax (popped lung – usually from trauma).

Chest pain can occur in many manners with many masks.  Under the breastbone pain, aching, stabbing, with exercise especially is suspicious.  However, not all cardiac pain has true pain.  Many times pressure, a sense of fullness, shortness of breath can be equivalent to pain in seriousness.  Some patients experience profuse sweating, nausea, light-headedness, and arm, jaw, neck, or back pain.

 With the advancing of age groups, the lack of exercise in children, the growing obesity problem, and the ongoing lack of universal prevention techniques, especially in the United States – chest pain will continue to create diagnostic challenges for patients and their physicians.

Many patients do not live to tell what happened when they started having chest pain.

In 90 percent of adult victims of sudden cardiac death, two or more major coronary arteries are narrowed by fatty buildups. Scarring from a prior heart attack is found in two-thirds of victims. When sudden death occurs in young adults, other heart abnormalities are more likely causes.

About 325,000 people a year die of coronary heart disease without being hospitalized or admitted to an emergency room. That’s about half of all deaths from CHD (coronary heart disease) â€” more than 890 Americans each day. Most of these are sudden deaths caused by cardiac arrest.





(adapted:  emergmed-aha with castMD commentary)


Our “mature matters” group of the boomers increasing into their late 60’s, 70’s, and onward into their 80’s and 90’s represent a new volume of potential depressed individuals and suicidal risk candidates.

It is fairly simple for depression in the elderly to go unrecognized or missed.  Many times the depressed mood is masked by drugs such as anti-parkinson meds, narcotics, pain relievers, and heart and blood pressure meds.  Many co-morbid conditions of parkinson’s, early dementia, diabetes, mini-strokes, heart disease, neurological disorders can also mask symptoms of elderly depression and potential suicidal risk.  Depression in the elderly can suddenly change, manifesting itself as agitation, confusion, new dreams or hallucinations, but even can be a change toward new apathy or diminished or unusual caring.  Certainly, with any of these, the constant is a change from the baseline of the elderly person. 

Males suicides rates are alarming.  Rates continue to rise as men age, with a peak in the mid-80’s of age.  Meanwhile, females suicide rates peak in middle age, then decrease again in older years.

Elderly men in their 80’s have greater success in suicide attempts when compared to their younger male counterparts.  Younger men generally have more attempts, but generally are less apt to completion.  Many times planning specifics are detailed and even some have been to their doctor recently.

Elderly men typically will have a diagnosis of depression, while younger individuals will have a history of affective disorders (mood) or substance abuse disorders.  Additional risk to the elderly potential suicide victim is a group of problems including loss of spouse, loss of home, previous suicidal discussion, alcoholism, or new diagnosis of a chronic condition. 


Families and caregivers must be alert for any change in attitude, mood, eating habits, sleeping habits, or conversation or discussions of suicide – or discussion of would be better, less burdensome to their family, or hopelessness.


Elderly patients need a close eye and open ear to their concerns, wishes, demands, and needs.  A hopeful and loving family with caring friends, with professional consultation, can be literally elderly life saving…and that shows that “Mature Matters.”


What if Sally told Damian who told Susie who said Bob heard from Tony that someone was told that somebody knew about what was supposed to have happened !

What matters is:

Does your family need every kid to be “on call?”  Does the kid deserve some privacy, alone time, reflection time…

Does your family need every kid to be “on call?”  Does the kid deserve not to be in everyone’s quick pick cellphone five to stay alive?  What if no reply is sent?

It seems that the number of anxiety disorders is rising, as is the number of children with attention deficit disorder, attention deficiti hyperactivity disorder and eating disorders.  Many other illnesses such as diabetes, joint disorders, heart disease, ocd, and high cholesterol are sneakingly and alarmingly rising in our youth.

Many of the reasons that cell phones’ basic safety issues have been put to the back burner, is to train the trend setting addiction downloads and uploads to happen.   Addicted to cell?  Crazy?

The problem is – with all the uploads, downloads, text messages, pix interchanges, and annoying ringtones or games that your youth has to endure….when does the quiet moment come, when does the kid get to relax?  Flop on the couch? Jump in the lake?  Take the cell with…

Processing of information is good.  Processing of steps is good  – as in chess.  All this does come from being able to program a cell phone, take a picture, record a intro, text the message…then send the entire file to a friend or foe in record milliseconds. 

But while doing all of this, reading books, doing homework, writing poetry or music, or practicing basketball or bass guitar…even eating ice cream does NOT happen relaxed.

When people are constantly interrupted from thought, the complexity of the thought process drops.  Like in hitting baseballs or golfballs, the follow through is critical.  I say slow the burn, cell phone OFF turn !

Torture is being interrupted from a thought process over and over and over and over.  Sleep patterns, napping, resting, watching the clouds go by, day-dreaming, and wishing upon a star…are all interrupted.  It just makes for high anxiety.

Slow down, even the turkeys obey the speed limit.

Many of my colleagues would forever give up their beepers, cellphones, and pagers…for less anxiety.  What is crazy is we are creating and feeding the mental anxiety monster in youth worldwide…….

Oh, excuse me, my cell phone is vibrating………. 



Significant focus lately has been on the “models” around the world and their associated “thin” look.  American Idol, the next Super Model, and others show the associated forces of “thinness.”   Also, many articles and news reports have been on the obesity problem in the world, especially the United States.

Challenges have come so forefront with this terrific medical problem for our young women and some men, that even the modeling companies, worldwide, have taken newer roles of healthy expectations to limit the “skin on bones” starved look of current models.

Medically, the disordered eating individual includes new changes in diet in teens, especially if going from “normal” family eating habits to vegetarian, isolation during meals, or dieting.  Many time friends know of problems, but do not want to “rat” on their friend.  A sudden change in baggier “hiding” clothes may be a clue to a weight losing teen, unable to stop the spiral of destructive behavior. 

These eating disorders or better stated, disordered eating patients represent a body dysmorphism – an unhappiness of self – yet usually a symptom of feelings –sometimes brought on by the patient’s world.   Many are perfectionist personalities doing well in personal growth, school, friends, and even family.

What is anorexia nervosa?

Anorexia nervosa is an illness that usually occurs in teenage girls, but it can also occur in teenage boys, and adult women and men.  People with anorexia are obsessed with being thin. They lose a lot of weight and are terrified of gaining weight. They believe they are fat even though they are very thin. Anorexia isn't just a problem with food or weight. It's an attempt to use food and weight to deal with emotional problems.  This problem demands professional help.

What is the difference between anorexia and bulimia?

People with anorexia starve themselves, avoid high-calorie foods and exercise constantly. People with bulimia eat huge amounts of food, but they throw up soon after eating, or take laxatives or diuretics (water pills) to keep from gaining weight. People with bulimia don't usually lose as much weight as people with anorexia.

Why do people get anorexia?


Warning signs of anorexia

  • Deliberate self-starvation with weight loss
  • Fear of gaining weight
  • Refusal to eat
  • Denial of hunger
  • Constant exercising
  • Greater amounts of hair on the body or the face
  • Sensitivity to cold temperatures
  • Absent or irregular periods
  • Loss of scalp hair
  • A self-perception of being fat when the person is really too thin

The reason some people get anorexia isn't known. People with anorexia may believe they would be happier and more successful if they were thin. They want everything in their lives to be perfect. People who have this disorder are usually good students. They are involved in many school and community activities. They blame themselves if they don't get perfect grades, or if other things in life are not perfect.

What are the problems caused by anorexia?

Girls with anorexia usually stop having menstrual periods. People with anorexia have dry skin and thinning hair on the head. They may have a growth of fine hair all over their body. They may feel cold all the time, and they may get sick often. People with anorexia are often in a bad mood. They have a hard time concentrating and are always thinking about food. It is not true that anorexics are never hungry. Actually, they are always hungr
y. Feeling hunger gives them a feeling of control over their lives and their bodies. It makes them feel like they are good at something–they are good at losing weight. People with severe anorexia may be at risk of death from starvation.  As dying continues, heart rates drop, kidney damage and liver damage can occur.  Odd changes can occur, such as high cholesterol and other heart disease.

What is the treatment for anorexia?

Treatment of anorexia is difficult, because people with anorexia believe there is nothing wrong with them. Patients in the early stages of anorexia (less than 6 months or with just a small amount of weight loss) may be successfully treated without having to be admitted to the hospital. But for successful treatment, patients must want to change and must have family and friends to help them.

People with more serious anorexia need care in the hospital, usually in a special unit for people with anorexia and bulimia. Treatment involves more than changing the person's eating habits. Anorexic patients often need counseling for a year or more so they can work on changing the feelings that are causing their eating problems. These feelings may be about their weight, their family problems or their problems with self-esteem. Some anorexic patients are helped by taking medicine that makes them feel less depressed. These medicines are prescribed by a doctor and are used along with counseling.

How can family and friends help?

The most important thing that family and friends can do to help a person with anorexia is to love them. People with anorexia feel safe, secure and comfortable with their illness. Their biggest fear is gaining weight, and gaining weight is seen as loss of control. They may deny they have a problem. People with anorexia will beg and lie to avoid eating and gaining weight, which is like giving up the illness. Family and friends should not enable to an eating disorder patient’s demands.   Group therapy for the family, and even the friends can be very helpful, and much more informative for a consolidated unified front to help save the life of a disordered patient.   


Some books that castMD would recommend are: 

The Body Betrayed 

Dying To Be Thin 

Starving For Attention 

Body Traps 

(Caveat:  some discussion is extremely serious, and adult oriented but may be used with  proper counseling and medical assistance.)





adapted from:   FamPhys with commentary by castMD