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What Does My Lab Test Report Indicate?
Question: Hi Dr Ilir...I have spoken with you regarding my heart palpitations and I went for result s yesterday. Well the loop showed no atrial fibrillation, just some sinus tachycardia attributed to stress and skipped beats (pacs) I believe...so i was quite relieved but then after I left I realized I forgot to ask a question....the dr said there was no svt but I specifically remember having a bout of palpitations that started suddenly last yabe 4 palps and then stopped ...I thought this was svt .....but he said there was no svt....could this have been the sinus tachycardia....does sinus tachycardia start and stop suddenly? I feel confused and scared again now because Im not sure what that episode was...I put a call into the cardiologist to clear that up but he isn;t in until tomorrow. Overall he said they didn't call me because there was nothing significant that showed up. I just wish I had asked about that bout of palpitations...is it possible it was just a run of skipped beats I was feeling or the sinus tachycardia..I have the exact time and day written down when I felt this particular palpitation....should he be able to go to the loop tracings and see what happened? Overall he seemed unconcerned with anything, yet I still feel scared
also the other day I had one skipped beat about 5 minutes into a workout on the treadmill and then proceeded to workout for an hour with no other palps ( I was extremely anxious proper to going to the gym as it was my first time working out in some time and of course I was focused on my heart)..I also worked out today with no [problems..my cardiologist said not to worry about it and ignore them....I had a negative stress test 4 years ago....he seemed unconcerned....is this correct?
He did not seem beta blockers were indicated as most of the time my heart rate was in the 60's and 70's, and only went up to 130 with the sinus tachycardia. Also he was worried about it making me sluggish and depressed as I am already fighting depression and anxiety
I saw a psychiatrist regarding my phobias of my heart and he has kept me on cipralex and ativan for the time being.....
Also I am worried I have coronary artery disease. I'm 36 I have ok blood pressure. I have had a high normal cholesterol test years ago but have had two normal ones since. My mom did have a stroke at 53 caused by high blood pressure and atrial fibrillation. She also had high cholesterol. She drank everyday and was a smoker in her youth. I lead a very different lifestyle. I have never smoked, only occasionally have a social drink and I eat well ( with the exception of occasional sweets) and I exercise as well. I am so worried that because my mom had early heart disease I will too. Is it unlikely at my age of 36 that I have cad. I had a normal stress echo a couple years ago. Normal Echo and ekg just last month.
also the other day I had one skipped beat about 5 minutes into a workout on the treadmill and then proceeded to workout for an hour with no other palps ( I was extremely anxious proper to going to the gym as it was my first time working out in some time and of course I was focused on my heart)..I also worked out today with no [problems..my cardiologist said not to worry about it and ignore them....I had a negative stress test 4 years ago....he seemed unconcerned....is this correct?
He did not seem beta blockers were indicated as most of the time my heart rate was in the 60's and 70's, and only went up to 130 with the sinus tachycardia. Also he was worried about it making me sluggish and depressed as I am already fighting depression and anxiety
I saw a psychiatrist regarding my phobias of my heart and he has kept me on cipralex and ativan for the time being.....
Also I am worried I have coronary artery disease. I'm 36 I have ok blood pressure. I have had a high normal cholesterol test years ago but have had two normal ones since. My mom did have a stroke at 53 caused by high blood pressure and atrial fibrillation. She also had high cholesterol. She drank everyday and was a smoker in her youth. I lead a very different lifestyle. I have never smoked, only occasionally have a social drink and I eat well ( with the exception of occasional sweets) and I exercise as well. I am so worried that because my mom had early heart disease I will too. Is it unlikely at my age of 36 that I have cad. I had a normal stress echo a couple years ago. Normal Echo and ekg just last month.
Brief Answer:
You just need to keep an eye open on anxiety.
Detailed Answer:
Hello dear XXXX!
I am glad to discuss with you again! I reviewed all our previous discussions and your nice image too.
After a few weeks we are here again with the loop recorder results. I am happy to hear that my on your overall healthy cardiac conditions have been successfully concluded. The results seem so promising for thinking positively hereinafter and starting on an optimistic strategy to manage your persistent anxiety on cardiac issues.
Those episodes of normal sinus tachycardia and separated PACs are quite irrelevant; without clinical significance; they lack any predictive ability for hypothetical future important arrhythmia. Everyone of us has experienced such small cardiac tricks during his life. So relax my dear! You are quite fine, a pretty young lady, with a wonderful perspective for enjoying a happy long life free of any pathological cardiac issues.
Regarding those bouts of palpitation (surrounded by excessive anxiety), sinus tachycardia or a few PACs may be responsible. I believe that a few PACS may have created the wrong idea of a short SVT. It is quite possible to match your time records with those of the loop recorder. You just need t oask to the technician.
You are a physically active person. Your look does confirm that. You don’t need another cardiac stress test for further investigating this issue, as your daily physical activity is the best test. Believe me!
Regarding a beta-blocker option, I totally agree with your cardiologist, not only justified by your average heart rates, but, because, there isn’t any rationale medical indication for its use. You are totally free of any cardiac arrhythmias. KEEP THIS IN YOUR MIND!
Furthermore, using beta-blocker (as they are negative inotropic agents) to a young healthy lady, would lead to some drawbacks, like decreased overall physical performance, sexual ability, etc.
Sinus tachycardia in a normal individual (of your age) may reach theoretically 190 bpm. So, nothing to worry about. It is a normal physiological reaction. Beta-blockers are out of discussion.
Regarding Escitalopram use, I would say, it is quite preferred by psychiatrist when dealing with anxiety and depression on young individuals. In your conditions, it is quite safe to be used. But, it may exert some unpleasant adverse effects (like decreased libido, anorgasmia, etc). If such effects become worrying, you should discuss with your therapist for safer options,
Remember (as I have mentioned you before): Ativan (Lorazepam) should not be continually used for periods longer than 2 -3 weeks, as it may risk dependence, tolerance, and when interrupted abruptly withdrawal syndrome. Ativan is necessary to be used at the beginning of Escitalopram therapy, until it shows its effectiveness (2-3 weeks).
Regarding the concern about possible coronary heart disease, I would like to assure you: THIS IS OUT OF A RATIONALE DISCUSSION. You are so young, without any obvious coronary risk factors (no hypertension, no close smoking contacts, no dyslipidemia, no diabetes, no clear family history for CAD [as your mother seems to have suffered the consequences of her careless life style regimen, and not any strong heredity]). So your probability for hypothetical future coronary events is extremely low (if you keep following such a healthy life style and diet).
REMEMBER, YOU HAVE A PERFECTLY NORMAL CARDIAC STRUCTURE AND FUNCTION (CONCLUDED BY ALL THE PERFORMED TESTS).
Just keep an eye opened over your anxiety.
I apologize for a bit late, but because of my professional commitment.
Hope to have been helpful!
Let me know about your ongoing health condition, and progression on anxiety management.
Best wishes! Hugs! Dr. Iliri
You just need to keep an eye open on anxiety.
Detailed Answer:
Hello dear XXXX!
I am glad to discuss with you again! I reviewed all our previous discussions and your nice image too.
After a few weeks we are here again with the loop recorder results. I am happy to hear that my on your overall healthy cardiac conditions have been successfully concluded. The results seem so promising for thinking positively hereinafter and starting on an optimistic strategy to manage your persistent anxiety on cardiac issues.
Those episodes of normal sinus tachycardia and separated PACs are quite irrelevant; without clinical significance; they lack any predictive ability for hypothetical future important arrhythmia. Everyone of us has experienced such small cardiac tricks during his life. So relax my dear! You are quite fine, a pretty young lady, with a wonderful perspective for enjoying a happy long life free of any pathological cardiac issues.
Regarding those bouts of palpitation (surrounded by excessive anxiety), sinus tachycardia or a few PACs may be responsible. I believe that a few PACS may have created the wrong idea of a short SVT. It is quite possible to match your time records with those of the loop recorder. You just need t oask to the technician.
You are a physically active person. Your look does confirm that. You don’t need another cardiac stress test for further investigating this issue, as your daily physical activity is the best test. Believe me!
Regarding a beta-blocker option, I totally agree with your cardiologist, not only justified by your average heart rates, but, because, there isn’t any rationale medical indication for its use. You are totally free of any cardiac arrhythmias. KEEP THIS IN YOUR MIND!
Furthermore, using beta-blocker (as they are negative inotropic agents) to a young healthy lady, would lead to some drawbacks, like decreased overall physical performance, sexual ability, etc.
Sinus tachycardia in a normal individual (of your age) may reach theoretically 190 bpm. So, nothing to worry about. It is a normal physiological reaction. Beta-blockers are out of discussion.
Regarding Escitalopram use, I would say, it is quite preferred by psychiatrist when dealing with anxiety and depression on young individuals. In your conditions, it is quite safe to be used. But, it may exert some unpleasant adverse effects (like decreased libido, anorgasmia, etc). If such effects become worrying, you should discuss with your therapist for safer options,
Remember (as I have mentioned you before): Ativan (Lorazepam) should not be continually used for periods longer than 2 -3 weeks, as it may risk dependence, tolerance, and when interrupted abruptly withdrawal syndrome. Ativan is necessary to be used at the beginning of Escitalopram therapy, until it shows its effectiveness (2-3 weeks).
Regarding the concern about possible coronary heart disease, I would like to assure you: THIS IS OUT OF A RATIONALE DISCUSSION. You are so young, without any obvious coronary risk factors (no hypertension, no close smoking contacts, no dyslipidemia, no diabetes, no clear family history for CAD [as your mother seems to have suffered the consequences of her careless life style regimen, and not any strong heredity]). So your probability for hypothetical future coronary events is extremely low (if you keep following such a healthy life style and diet).
REMEMBER, YOU HAVE A PERFECTLY NORMAL CARDIAC STRUCTURE AND FUNCTION (CONCLUDED BY ALL THE PERFORMED TESTS).
Just keep an eye opened over your anxiety.
I apologize for a bit late, but because of my professional commitment.
Hope to have been helpful!
Let me know about your ongoing health condition, and progression on anxiety management.
Best wishes! Hugs! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks again Dr.
So I may have misconstrued a few extra heartbeats in a row as an svt?
In regards to coronary artery disease. Even though I had a high normal test ( well one when I was 20 - my diet was horrible then, and a borderline one about 6 years ago but we retested 6 months later and everything was normal, plus I had another one a year or two later and it was normal. Is it still safe to say I don't have any coronary artery disease. Also does my white coat hypertension count towards cad?
My dad also had high cholesterol and high Bp but again an unhealthy sedentary lifestyle and diet. My family is British and they eat horribly.
I just worry so much that I am going to inherit heart disease fromy parents. How much does family history play into it?
I had a normal stress test four years ago. Would I have developed coronary artery disease from them to now? Now long does it take to develope
As a woman. At what age do I need to start worrying about cad? After menopause?
Can I officially stop worrying that I have cad?
So I may have misconstrued a few extra heartbeats in a row as an svt?
In regards to coronary artery disease. Even though I had a high normal test ( well one when I was 20 - my diet was horrible then, and a borderline one about 6 years ago but we retested 6 months later and everything was normal, plus I had another one a year or two later and it was normal. Is it still safe to say I don't have any coronary artery disease. Also does my white coat hypertension count towards cad?
My dad also had high cholesterol and high Bp but again an unhealthy sedentary lifestyle and diet. My family is British and they eat horribly.
I just worry so much that I am going to inherit heart disease fromy parents. How much does family history play into it?
I had a normal stress test four years ago. Would I have developed coronary artery disease from them to now? Now long does it take to develope
As a woman. At what age do I need to start worrying about cad? After menopause?
Can I officially stop worrying that I have cad?
Brief Answer:
Just stop worrying actually about that impossible option for you.
Detailed Answer:
Hi XXXX!
I believe it is exactly what you said. A few ectopic beats may be perceived as a short run of SVT. That’s one of the reasons, why those loop recorders are worth for.
Could it be possible to upload a written report of the loop recorder??
Regarding coronary artery disease, I would explain that exercise stress tests are indicated in clinically suspicious individuals who are presumed to have intermediate positive pretest probability.
On your case, as you are clinically completely silent, without any obvious coronary risk factors (white coat hypertension isn’t considered a coronary risk factor, even heredity shouldn’t be considered as your parents hadn’t an adequate life-style profile to better differentiate this matter), you are classified as having a very low positive pretest probability. So, performing repeated stress tests wouldn’t be worthy.
Your family history of CAD isn’t a pure heredity influence.
There is not a clear cut line between numerous coronary risk factors your parents have possessed. Unfortunately, I am afraid we will never know the percentage of heredity influence on their CAD occurrence. But, I am sure, with your healthy life-style profile; possible heredity implication on your heart issues will be quite minimal.
As a general rule, women show clinically coronary artery disease, on average 10 years later then men do. This corresponds commonly with more advance age, after menopause. But, the most important clue is to properly screen your health status with periodic medical checkups.
At your age and very healthy profile, you shouldn’t even think about CAD.
So, just start to stop worrying about CAD.
Instead, think about the happiest moment of your life.
Best regards, Dr. Iliri
Just stop worrying actually about that impossible option for you.
Detailed Answer:
Hi XXXX!
I believe it is exactly what you said. A few ectopic beats may be perceived as a short run of SVT. That’s one of the reasons, why those loop recorders are worth for.
Could it be possible to upload a written report of the loop recorder??
Regarding coronary artery disease, I would explain that exercise stress tests are indicated in clinically suspicious individuals who are presumed to have intermediate positive pretest probability.
On your case, as you are clinically completely silent, without any obvious coronary risk factors (white coat hypertension isn’t considered a coronary risk factor, even heredity shouldn’t be considered as your parents hadn’t an adequate life-style profile to better differentiate this matter), you are classified as having a very low positive pretest probability. So, performing repeated stress tests wouldn’t be worthy.
Your family history of CAD isn’t a pure heredity influence.
There is not a clear cut line between numerous coronary risk factors your parents have possessed. Unfortunately, I am afraid we will never know the percentage of heredity influence on their CAD occurrence. But, I am sure, with your healthy life-style profile; possible heredity implication on your heart issues will be quite minimal.
As a general rule, women show clinically coronary artery disease, on average 10 years later then men do. This corresponds commonly with more advance age, after menopause. But, the most important clue is to properly screen your health status with periodic medical checkups.
At your age and very healthy profile, you shouldn’t even think about CAD.
So, just start to stop worrying about CAD.
Instead, think about the happiest moment of your life.
Best regards, Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
So even with those two high normal cholesterol tests followed by normal ones I shouldn't worry? My Dr has only ever told me it was a high normal and to watch my diet. Followed up by normal results. Can I stol worrying about my cholesterol and just get screened as I get older? I worry hat the Dr said it was. High normal at 20 but have had normal tests since...... The joys of anxiety.
Brief Answer:
You have to know your mind tricks first.
Detailed Answer:
XXXX!
As you have actually normal blood cholesterol profile, cholesterol isn’t considered a risk factor, but you should maintain a high level of alertness and prevent such a wonderful equilibrium from adverse diet and bad habits influences.
At the end, we possess wonderful therapeutic option for unfavorable cholesterol levels. So, no place for panic!
By the way, could you upload a recent cholesterol profile result?
I would like to know: besides consulting your psychiatrist and having those drugs, what alternative measures are you trying for better facing with your anxiety? I am curious to understand how you are facing your daily activity.
Does anxiety influence on your social relationships, or is just a heart issues fan?
You should know better how your mind works, in order to be able for positively influencing your thoughts and feelings.
Regards,
Dr. Iliri
You have to know your mind tricks first.
Detailed Answer:
XXXX!
As you have actually normal blood cholesterol profile, cholesterol isn’t considered a risk factor, but you should maintain a high level of alertness and prevent such a wonderful equilibrium from adverse diet and bad habits influences.
At the end, we possess wonderful therapeutic option for unfavorable cholesterol levels. So, no place for panic!
By the way, could you upload a recent cholesterol profile result?
I would like to know: besides consulting your psychiatrist and having those drugs, what alternative measures are you trying for better facing with your anxiety? I am curious to understand how you are facing your daily activity.
Does anxiety influence on your social relationships, or is just a heart issues fan?
You should know better how your mind works, in order to be able for positively influencing your thoughts and feelings.
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok. I see a therapist and we are working on cognitive behaviour therapy. I'm getting by ok right now but considering a change in medications to see if there is one that perhaps can control my ocd a bit better
My last and final questions about my heart and then I'm going to try to put it to bed
The one palpitation I felt while exercising is of no concern. My cardiologist didn't seem concerned
I am afraid my loop monitor missed the one bout of palpitations I thought was svt. Is this possible. I pushed the button and it said recording but I'm afraid it missed it and therefore my Dr is missing a diagnosis. I know this is most likely my anxiety taking control is there a chance the loop missed it?
My last and final questions about my heart and then I'm going to try to put it to bed
The one palpitation I felt while exercising is of no concern. My cardiologist didn't seem concerned
I am afraid my loop monitor missed the one bout of palpitations I thought was svt. Is this possible. I pushed the button and it said recording but I'm afraid it missed it and therefore my Dr is missing a diagnosis. I know this is most likely my anxiety taking control is there a chance the loop missed it?
Brief Answer:
There is nothing to worry about!
Detailed Answer:
Dear XXXX!
That ectopic beat you felt during exercising is quite irrelevant. So relax!
Regarding that bout of palpitations, my believe is that it was in fact a reflection of a few PACs.
I would like to assure you it's quite impossible loop hasn't recorded that. You just need to ask to the technician to verify that time frame. Don't worry about! It's just your anxiety (OCD)!
I wish you a good sleep and sweet dreams!
Regards,
Dr. Iliri
There is nothing to worry about!
Detailed Answer:
Dear XXXX!
That ectopic beat you felt during exercising is quite irrelevant. So relax!
Regarding that bout of palpitations, my believe is that it was in fact a reflection of a few PACs.
I would like to assure you it's quite impossible loop hasn't recorded that. You just need to ask to the technician to verify that time frame. Don't worry about! It's just your anxiety (OCD)!
I wish you a good sleep and sweet dreams!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks again I put a call into my Dr to ask about that time frame:). Thank you again for you wonderful help:)
Brief Answer:
You are welcome, XXXX!
Detailed Answer:
Please, let me know how things are going on!
I am at your disposal whenever you will need.
Wish you a good health!
Regards,
Dr.Iliri
You are welcome, XXXX!
Detailed Answer:
Please, let me know how things are going on!
I am at your disposal whenever you will need.
Wish you a good health!
Regards,
Dr.Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
When do ectopic a or palpitations considered dangerous during exercise? If I have a few here and there it is ok. If it were a problem would there be other symptoms?
Also in regards to the cholesterol two borderline tests followed by a normal profile are insignificant and wound not have caused me to have cad at a young age as mine?
Just trying to be clear:).
I also just joined a yoga studio to help with my anxiety
Also in regards to the cholesterol two borderline tests followed by a normal profile are insignificant and wound not have caused me to have cad at a young age as mine?
Just trying to be clear:).
I also just joined a yoga studio to help with my anxiety
Brief Answer:
You seem to be on the right way!
Detailed Answer:
Dear XXXX!
Seems that you are on the way, as yoga, aerobics, and other physical activities are so helpful in improving a bad humor, relieving chronic pain, obviating anxiety, etc.
They also have beneficial effects on blood circulation, improve lipid profile, and protect your heart.
I strongly encourage you to keep going such way (I regret not being part of such recreational activities, because of my professional commitments).
Meanwhile, I would like to assure that neither your occasional palpitations, nor your previously transient borderline cholesterol, could not find the chance to damage your coronary arteries and your heart.
As your heart appears structurally perfect, those palpitations are nothing but an expression of your anxiety disorder (OCD); not an expression of any present cardiomyopathy.
Palpitations or ectopic heart beats could be considered dangerous if they would reflect a serious structural cardiac damage and subsequent complex arrhythmia.
But, this is not the case with you. Loop recorder results confirm you don’t suffer from any complex arrhythmia, or a frequent extra systolic arrhythmia. Besides, your cardiac ultrasound concludes no structural damages.
So, there exists no criteria, to support rational fears about a potential life-threatening cardiac arrhythmia, or evidences of coronary atherosclerosis and its consequences.
I would conclude, there is nothing to worry about those unpleasant thoughts (that perturb your mind)!
What is constantly remaining, and real: a pretty young lady, with a perfect normal heart, nice looking, a bit anxious, but very willing to improve her way of positive thinking. And this is important.
I hope to be helpful to you in some way. I would be very glad in such case.
Do not hesitate to write me you progressive improvements.
My best wishes for a pleasant weekend! Dr. Iliri
You seem to be on the right way!
Detailed Answer:
Dear XXXX!
Seems that you are on the way, as yoga, aerobics, and other physical activities are so helpful in improving a bad humor, relieving chronic pain, obviating anxiety, etc.
They also have beneficial effects on blood circulation, improve lipid profile, and protect your heart.
I strongly encourage you to keep going such way (I regret not being part of such recreational activities, because of my professional commitments).
Meanwhile, I would like to assure that neither your occasional palpitations, nor your previously transient borderline cholesterol, could not find the chance to damage your coronary arteries and your heart.
As your heart appears structurally perfect, those palpitations are nothing but an expression of your anxiety disorder (OCD); not an expression of any present cardiomyopathy.
Palpitations or ectopic heart beats could be considered dangerous if they would reflect a serious structural cardiac damage and subsequent complex arrhythmia.
But, this is not the case with you. Loop recorder results confirm you don’t suffer from any complex arrhythmia, or a frequent extra systolic arrhythmia. Besides, your cardiac ultrasound concludes no structural damages.
So, there exists no criteria, to support rational fears about a potential life-threatening cardiac arrhythmia, or evidences of coronary atherosclerosis and its consequences.
I would conclude, there is nothing to worry about those unpleasant thoughts (that perturb your mind)!
What is constantly remaining, and real: a pretty young lady, with a perfect normal heart, nice looking, a bit anxious, but very willing to improve her way of positive thinking. And this is important.
I hope to be helpful to you in some way. I would be very glad in such case.
Do not hesitate to write me you progressive improvements.
My best wishes for a pleasant weekend! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for your advice, information, words of wisdom and sentiments. I appreciate your patience and compassion so much. I know patients like me are probably difficult to deal with but havin Drs like you makes it so much easier. Thank you for being a kind soul:)
Brief Answer:
You are welcome!
Detailed Answer:
I hope to hear that you cardiac issues fear will be relieved. If you need support on doing that, I will be here to give my modest contribution. Just let me know!
Wish you a pleasant evening!
You are welcome!
Detailed Answer:
I hope to hear that you cardiac issues fear will be relieved. If you need support on doing that, I will be here to give my modest contribution. Just let me know!
Wish you a pleasant evening!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Just heard back from my dr......you were right that bout of palps were just skipped beats.....he said nothing to worry about.....
I didn't have a chance to ask him but is it ok if they are in a row like that? I assume so since he said it was nothing to be concerned about
Also do I ever need to have these rechecked if nothing changes?
Again thank you...wish I could give you a big hug~!
also a few skipped beats during exercise doesn't warrant a stress test correct? My cardio said only if I had a lot of them during exercise
I didn't have a chance to ask him but is it ok if they are in a row like that? I assume so since he said it was nothing to be concerned about
Also do I ever need to have these rechecked if nothing changes?
Again thank you...wish I could give you a big hug~!
also a few skipped beats during exercise doesn't warrant a stress test correct? My cardio said only if I had a lot of them during exercise
Brief Answer:
No further cardiac tests, just be more optimistic!
Detailed Answer:
XXXX!
Those skipped beats are separated and quite irrelevant. So everything is OK!
You don't need to recheck your heart rhythm again for a long period hereinafter.
Also those few skipped beats deserves nothing more attention (no cardiac stress test). Just keep going on your physical fitness activities!
Hope to have been of some help! My best wishes! Dr. Iliri
No further cardiac tests, just be more optimistic!
Detailed Answer:
XXXX!
Those skipped beats are separated and quite irrelevant. So everything is OK!
You don't need to recheck your heart rhythm again for a long period hereinafter.
Also those few skipped beats deserves nothing more attention (no cardiac stress test). Just keep going on your physical fitness activities!
Hope to have been of some help! My best wishes! Dr. Iliri
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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