Chest Pain, Oral Reactions to Common Medications, Seasonal Affective Disorder

How should patients presenting with chest pain be managed in the outpatient setting?

Twelve-lead electrocardiography should be performed on all patients in whom cardiac ischemia is suspected. The presence of ST segment changes, new-onset left bundle branch block, presence of Q waves, and new T-wave inversion increases the likelihood of acute coronary syndrome and acute myocardial infarction, warranting prompt referral to the emergency department. Patients with a low to intermediate probability of coronary artery disease not requiring acute transfer should be evaluated for coronary artery disease with exercise stress testing, coronary computed tomography angiography, or cardiac magnetic resonance imaging. Read the full article.

How should seasonal affective disorder be treated?

Light therapy, dawn simulation, and cognitive behavior therapy are effective treatments for seasonal affective disorder (SAD). Selective serotonin reuptake inhibitors may play a role in the treatment of SAD. Bupropion (Wellbutrin) may prevent SAD recurrence and is the only pharmacotherapy labeled for this use. There is insufficient evidence to recommend other antidepressants, light therapy, mindfulness-based cognitive therapy, or vitamin D supplementation for SAD prevention. Interventions should be individualized. Read the full article.

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