HYDROCEPHALUS
ANENCEPHALY
Top Medical sites 2008
1 WebMD.com
6,742,178 - Inbound Links 11,264,170 - Compete Monthly Visitors 12,000,000 - Quantcast Monthly Visitors 1,653 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
2 NIH.gov
11,433,993 - Inbound Links 7,557,134 - Compete Monthly Visitors 9,000,000 - Quantcast Monthly Visitors 363 - Alexa Ranking. Page Rank: 9Top 20 Health Websites Posted 08/19/2008 eBizMBA
3 MayoClinic.com
409,085 - Inbound Links 3,751,224 - Compete Monthly Visitors 5,100,000 - Quantcast Monthly Visitors 3,792 - Alexa Ranking. Page Rank: 8Top 20 Health Websites Posted 08/19/2008 eBizMBA
4 MedicineNet.com
1,301,253 - Inbound Links 3,653,861 - Compete Monthly Visitors 4,600,000 - Quantcast Monthly Visitors 3,240 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
5 everydayHealth.com
12,535 - Inbound Links 4,771,021 - Compete Monthly Visitors 3,400,000 - Quantcast Monthly Visitors 12,764 - Alexa Ranking. Page Rank: 5Top 20 Health Websites Posted 08/19/2008 eBizMBA
6 Healthline.com
79,366 - Inbound Links 2,184,783 - Compete Monthly Visitors 3,000,000 - Quantcast Monthly Visitors 6,792 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
7 RevolutionHealth.com
765,016 - Inbound Links 2,103,307 - Compete Monthly Visitors 2,900,000 - Quantcast Monthly Visitors 13,344 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
8 Drugs.com
828,653 - Inbound Links 1,945,465 - Compete Monthly Visitors 2,300,000 - Quantcast Monthly Visitors 6,287 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
9 MedHelp.org
99,673 - Inbound Links 1,578,331 - Compete Monthly Visitors 2,000,000 - Quantcast Monthly Visitors 8,042 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
10 RxList.com
1,171,219 - Inbound Links 1,525,818 - Compete Monthly Visitors 2,000,000 - Quantcast Monthly Visitors 11,657 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
11 eMedicine.com
1,157,159 - Inbound Links 1,233,573 - Compete Monthly Visitors 1,500,000 - Quantcast Monthly Visitors 5,835 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
12 RealAge.com
41,051 - Inbound Links 1,577,068 - Compete Monthly Visitors 1,700,000 - Quantcast Monthly Visitors 8,852 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
13 QualityHealth.com
64,299 - Inbound Links 1,201,368 - Compete Monthly Visitors 1,500,000 - Quantcast Monthly Visitors 28,221 - Alexa Ranking. Page Rank: 5Top 20 Health Websites Posted 08/19/2008 eBizMBA
14 eDiets.com
136,820 - Inbound Links 1,238,852 - Compete Monthly Visitors 1,400,000 - Quantcast Monthly Visitors 8,239 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
15 familydoctor.org
474,004 - Inbound Links 856,565 - Compete Monthly Visitors 1,100,000 - Quantcast Monthly Visitors 12,655 - Alexa Ranking. Page Rank: NATop 20 Health Websites Posted 08/19/2008 eBizMBA
16 diet.com
119,873 - Inbound Links 1,160,260 - Compete Monthly Visitors 328,084 - Quantcast Monthly Visitors 10,629 - Alexa Ranking. Page Rank: 5Top 20 Health Websites Posted 08/19/2008 eBizMBA
17 Prevention.com
116,542 - Inbound Links 853,420 - Compete Monthly Visitors 685,947 - Quantcast Monthly Visitors 20,991 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
18 Healthology.com
2,774,943 - Inbound Links 580,139 - Compete Monthly Visitors 355,631 - Quantcast Monthly Visitors 32,541 - Alexa Ranking. Page Rank: 8Top 20 Health Websites Posted 08/19/2008 eBizMBA
19 MensHealth.com
180,139 - Inbound Links 439,530 - Compete Monthly Visitors 381,350 - Quantcast Monthly Visitors 7,744 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
20 WHO.int
1,848,622 - Inbound Links 205,802 - Compete Monthly Visitors NA - Quantcast Monthly Visitors 4,236 - Alexa Ranking. Page Rank: 8Top 20 Health Websites Posted 08/19/2008 eBizMBA
6,742,178 - Inbound Links 11,264,170 - Compete Monthly Visitors 12,000,000 - Quantcast Monthly Visitors 1,653 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
2 NIH.gov
11,433,993 - Inbound Links 7,557,134 - Compete Monthly Visitors 9,000,000 - Quantcast Monthly Visitors 363 - Alexa Ranking. Page Rank: 9Top 20 Health Websites Posted 08/19/2008 eBizMBA
3 MayoClinic.com
409,085 - Inbound Links 3,751,224 - Compete Monthly Visitors 5,100,000 - Quantcast Monthly Visitors 3,792 - Alexa Ranking. Page Rank: 8Top 20 Health Websites Posted 08/19/2008 eBizMBA
4 MedicineNet.com
1,301,253 - Inbound Links 3,653,861 - Compete Monthly Visitors 4,600,000 - Quantcast Monthly Visitors 3,240 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
5 everydayHealth.com
12,535 - Inbound Links 4,771,021 - Compete Monthly Visitors 3,400,000 - Quantcast Monthly Visitors 12,764 - Alexa Ranking. Page Rank: 5Top 20 Health Websites Posted 08/19/2008 eBizMBA
6 Healthline.com
79,366 - Inbound Links 2,184,783 - Compete Monthly Visitors 3,000,000 - Quantcast Monthly Visitors 6,792 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
7 RevolutionHealth.com
765,016 - Inbound Links 2,103,307 - Compete Monthly Visitors 2,900,000 - Quantcast Monthly Visitors 13,344 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
8 Drugs.com
828,653 - Inbound Links 1,945,465 - Compete Monthly Visitors 2,300,000 - Quantcast Monthly Visitors 6,287 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
9 MedHelp.org
99,673 - Inbound Links 1,578,331 - Compete Monthly Visitors 2,000,000 - Quantcast Monthly Visitors 8,042 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
10 RxList.com
1,171,219 - Inbound Links 1,525,818 - Compete Monthly Visitors 2,000,000 - Quantcast Monthly Visitors 11,657 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
11 eMedicine.com
1,157,159 - Inbound Links 1,233,573 - Compete Monthly Visitors 1,500,000 - Quantcast Monthly Visitors 5,835 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
12 RealAge.com
41,051 - Inbound Links 1,577,068 - Compete Monthly Visitors 1,700,000 - Quantcast Monthly Visitors 8,852 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
13 QualityHealth.com
64,299 - Inbound Links 1,201,368 - Compete Monthly Visitors 1,500,000 - Quantcast Monthly Visitors 28,221 - Alexa Ranking. Page Rank: 5Top 20 Health Websites Posted 08/19/2008 eBizMBA
14 eDiets.com
136,820 - Inbound Links 1,238,852 - Compete Monthly Visitors 1,400,000 - Quantcast Monthly Visitors 8,239 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
15 familydoctor.org
474,004 - Inbound Links 856,565 - Compete Monthly Visitors 1,100,000 - Quantcast Monthly Visitors 12,655 - Alexa Ranking. Page Rank: NATop 20 Health Websites Posted 08/19/2008 eBizMBA
16 diet.com
119,873 - Inbound Links 1,160,260 - Compete Monthly Visitors 328,084 - Quantcast Monthly Visitors 10,629 - Alexa Ranking. Page Rank: 5Top 20 Health Websites Posted 08/19/2008 eBizMBA
17 Prevention.com
116,542 - Inbound Links 853,420 - Compete Monthly Visitors 685,947 - Quantcast Monthly Visitors 20,991 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
18 Healthology.com
2,774,943 - Inbound Links 580,139 - Compete Monthly Visitors 355,631 - Quantcast Monthly Visitors 32,541 - Alexa Ranking. Page Rank: 8Top 20 Health Websites Posted 08/19/2008 eBizMBA
19 MensHealth.com
180,139 - Inbound Links 439,530 - Compete Monthly Visitors 381,350 - Quantcast Monthly Visitors 7,744 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
20 WHO.int
1,848,622 - Inbound Links 205,802 - Compete Monthly Visitors NA - Quantcast Monthly Visitors 4,236 - Alexa Ranking. Page Rank: 8Top 20 Health Websites Posted 08/19/2008 eBizMBA
Chest Pain Differential Diagnosis
Myocardial Ischaemic Pain
The main feature of myocardial ischaemia (impending infarction) is usually prolonged chest pain. Typical characteristics of the pain include:
Duration usually over 20 minutes
Located in the retrosternal area, possibly radiating to the arms (usually to the left arm), back, neck, or the lower jaw
The pain is described as pressing or heavy or as a sensation of a tight band around the chest; breathing or changing posture does not notably influence the severity of the pain.
The pain is continuous, and its intensity does not alter
The symptoms (pain beginning in the upper abdomen, nausea) may resemble the symptoms of acute abdomen. Nausea and vomiting are sometimes the main symptoms, especially in inferoposterior wall ischaemia.
In inferoposterior wall ischaemia, vagal reflexes may cause bradycardia and hypotension, presenting as dizziness or fainting.
Electrocardiogram (ECG) is the key examination during the first 4 hours after pain onset, but normal ECG does not rule out an imminent infarction.
Markers of myocardial injury (cardiac troponins T and I, creatine kinase-MB mass) start to rise about 4 hours after pain onset. An increase of these markers is diagnostic of myocardial infarction irrespective of ECG findings.
Minor signs of myocardial infarction in ECG, see Table 1 in the original guideline document
Nonischaemic Causes of Chest Pain
Illness/condition Differentiating symptoms and signs
Reflux oesophagitis, oesophageal spasm
No ECG changes
Heartburn
Worse in recumbent position, but also while straining, like angina pectoris
The most common cause of chest pain
Pulmonary embolism
Tachypnoea, hypoxaemia, hypocarbia
No pulmonary congestion on chest x-ray
Clinical presentation may resemble hyperventilation.
Both arterial oxygen pressure (PaO2) and partial arterial pressure of carbon dioxide (PaCO2) decreased.
Pain is not often marked.
D-dimer assay positive
Hyperventilation
Hyperventilation Syndrome
The main symptom is dyspnoea, as in pulmonary embolism.
Often a young patient
Tingling and numbness of the limbs, dizziness
PaCO2 decreased, PaO2 increased or normal
Secondary Hyperventilation
Attributable to an organic illness/cause; acidosis, pulmonary embolism, pneumothorax, asthma, infarction, etc.
Spontaneous pneumothorax
Dyspnoea is the main symptom.
Auscultation and chest x-ray
Aortic dissection
Severe pain with changing localization
Type A dissection sometimes obstructs the origin of a coronary artery (usually the right) with signs of impending inferoposterior infarction
Pulses may be asymmetrical
Sometimes broad mediastinum on chest x-ray
New aortic valve regurgitation
Pericarditis
Change of posture and breathing influence the pain.
A friction sound may be heard.
ST-elevation but no reciprocal ST depression
Pleuritis
A stabbing pain when breathing. The most common cause of stabbing pain is, however, caused by prolonged cough
Costochondral pain
Palpation tenderness, movements of chest influence the pain
Might also be an insignificant incidental finding
Early herpes zoster
No ECG changes, rash
Localized paraesthesia before rash
Ectopic beats
Transient, in the area of the apex
Peptic ulcer, cholecystitis, pancreatitis
Clinical examination (inferior wall ischaemia may resemble acute abdomen)
Depression
Continuous feeling of heaviness in the chest, no correlation to exercise
ECG normal
Alcohol-related
A young male patient in a casualty department, inebriated
ST changes resembling those of acute ischaemia
ST segment elevation
Early repolarization in V1–V3. Seen particularly in athletic men ("athlete's heart")
Acute myopericarditis in all leads except V1, aVR. Not resolved with a beta-blocker.
Pulmonary embolism – in inferior leads
Hyperkalaemia
Hypertrophic cardiomyopathy
ECG
ST segment depression
Sympathicotonia
Hyperventilation
Pulmonary embolism
Hypokalaemia
Digoxin
Antiarrhythmics
Psychiatric medication
Hypertrophic cardiomyopathy
Reciprocal ST depression of an inferior infarction in leads V2–V3–V4
Circulatory shock
QRS changes resembling those of Q wave infarction
Hypertrophic cardiomyopathy
Wolff-Parkinson-White (WPW) syndrome
Myocarditis
Blunt cardiac injury
Massive pulmonary embolism (QS in leads V1–V3)
Pneumothorax
Cardiac amyloidosis
Cardiac tumours
Progressing muscular dystrophy
Friedreich's ataxia
ST changes resembling those of a non-Q wave infarction
Increased intracranial pressure – subarachnoid bleed – skull injury
Hyperventilation syndrome
Post-tachyarrhythmia state
Circulatory shock – haemorrhage – sepsis
Acute pancreatitis
Myopericarditis
The main feature of myocardial ischaemia (impending infarction) is usually prolonged chest pain. Typical characteristics of the pain include:
Duration usually over 20 minutes
Located in the retrosternal area, possibly radiating to the arms (usually to the left arm), back, neck, or the lower jaw
The pain is described as pressing or heavy or as a sensation of a tight band around the chest; breathing or changing posture does not notably influence the severity of the pain.
The pain is continuous, and its intensity does not alter
The symptoms (pain beginning in the upper abdomen, nausea) may resemble the symptoms of acute abdomen. Nausea and vomiting are sometimes the main symptoms, especially in inferoposterior wall ischaemia.
In inferoposterior wall ischaemia, vagal reflexes may cause bradycardia and hypotension, presenting as dizziness or fainting.
Electrocardiogram (ECG) is the key examination during the first 4 hours after pain onset, but normal ECG does not rule out an imminent infarction.
Markers of myocardial injury (cardiac troponins T and I, creatine kinase-MB mass) start to rise about 4 hours after pain onset. An increase of these markers is diagnostic of myocardial infarction irrespective of ECG findings.
Minor signs of myocardial infarction in ECG, see Table 1 in the original guideline document
Nonischaemic Causes of Chest Pain
Illness/condition Differentiating symptoms and signs
Reflux oesophagitis, oesophageal spasm
No ECG changes
Heartburn
Worse in recumbent position, but also while straining, like angina pectoris
The most common cause of chest pain
Pulmonary embolism
Tachypnoea, hypoxaemia, hypocarbia
No pulmonary congestion on chest x-ray
Clinical presentation may resemble hyperventilation.
Both arterial oxygen pressure (PaO2) and partial arterial pressure of carbon dioxide (PaCO2) decreased.
Pain is not often marked.
D-dimer assay positive
Hyperventilation
Hyperventilation Syndrome
The main symptom is dyspnoea, as in pulmonary embolism.
Often a young patient
Tingling and numbness of the limbs, dizziness
PaCO2 decreased, PaO2 increased or normal
Secondary Hyperventilation
Attributable to an organic illness/cause; acidosis, pulmonary embolism, pneumothorax, asthma, infarction, etc.
Spontaneous pneumothorax
Dyspnoea is the main symptom.
Auscultation and chest x-ray
Aortic dissection
Severe pain with changing localization
Type A dissection sometimes obstructs the origin of a coronary artery (usually the right) with signs of impending inferoposterior infarction
Pulses may be asymmetrical
Sometimes broad mediastinum on chest x-ray
New aortic valve regurgitation
Pericarditis
Change of posture and breathing influence the pain.
A friction sound may be heard.
ST-elevation but no reciprocal ST depression
Pleuritis
A stabbing pain when breathing. The most common cause of stabbing pain is, however, caused by prolonged cough
Costochondral pain
Palpation tenderness, movements of chest influence the pain
Might also be an insignificant incidental finding
Early herpes zoster
No ECG changes, rash
Localized paraesthesia before rash
Ectopic beats
Transient, in the area of the apex
Peptic ulcer, cholecystitis, pancreatitis
Clinical examination (inferior wall ischaemia may resemble acute abdomen)
Depression
Continuous feeling of heaviness in the chest, no correlation to exercise
ECG normal
Alcohol-related
A young male patient in a casualty department, inebriated
ST changes resembling those of acute ischaemia
ST segment elevation
Early repolarization in V1–V3. Seen particularly in athletic men ("athlete's heart")
Acute myopericarditis in all leads except V1, aVR. Not resolved with a beta-blocker.
Pulmonary embolism – in inferior leads
Hyperkalaemia
Hypertrophic cardiomyopathy
ECG
ST segment depression
Sympathicotonia
Hyperventilation
Pulmonary embolism
Hypokalaemia
Digoxin
Antiarrhythmics
Psychiatric medication
Hypertrophic cardiomyopathy
Reciprocal ST depression of an inferior infarction in leads V2–V3–V4
Circulatory shock
QRS changes resembling those of Q wave infarction
Hypertrophic cardiomyopathy
Wolff-Parkinson-White (WPW) syndrome
Myocarditis
Blunt cardiac injury
Massive pulmonary embolism (QS in leads V1–V3)
Pneumothorax
Cardiac amyloidosis
Cardiac tumours
Progressing muscular dystrophy
Friedreich's ataxia
ST changes resembling those of a non-Q wave infarction
Increased intracranial pressure – subarachnoid bleed – skull injury
Hyperventilation syndrome
Post-tachyarrhythmia state
Circulatory shock – haemorrhage – sepsis
Acute pancreatitis
Myopericarditis
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