substernal vs retrosternal chest pain

When the heart is compressed, it cannot pump enough blood and can result in decreased blood pressure and a depressed heart rate. Sign up and get unlimited access. In this article, the authors describe a simple, effective and minimally invasive technique for complex sternal closure using new titanium hooks applied parasternally and achieving adequate sternal stabilization. Chest pain can be divided into cardiac vs non-cardiac origin. lewisham mobile testing unit substernal vs retrosternal chest pain. While injury in this joint causes discomfort and pain in the upper sternum. Joint injury symptoms include swelling or mild pain in the upper chest and difficulty in shoulder movement. Some types of chest pain should send you to the emergency room particularly if it lasts for at least five minutes. Collarbone trauma like swelling or bruising, Mild pain and swelling in the upper chest. ​What causes chest pain and when to consult a doctor. Monitoring & Managing Patients with Arterial & Venous Sheaths, Chest Contusion | Symptoms, Treatment & Recovery. Only a dr. can tell you which one Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease . Suggested by: central or epigastric burning pain, onset over hours, dyspepsia, worse lying flat, worsened by food, alcohol, NSAIDs. Gulati M, Levy PD, Mukherjee D, et al. Pleurisy may cause severe chest pain when a person is breathing, sneezing, coughing, or moving. Classic coronary pain--or angina--involves a substernal pressure that commonly begins with exertion and is relieved by rest. Acid reflux is commonly known as Gastroesophageal reflux disease. https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/esophageal-motility-disorders#:~:targetText=Symptoms%20of%20esophageal%20motility%20disorders,pain%2C%20and%2For%20heartburn. Whats Causing Pain in the Right Side of My Chest? Typically, a retrosternal hematoma will fully resolve in two to nine weeks without further complications. Stress and rest image of the left ventricular myocardium using Tc-99m . A 52-year-old female presents to the Emergency Department with c/o fever, severe retrosternal chest pain which is worse when lying down, dysphagia, restlessness, irritability, anxiety, weakness & malaise. Pleura is the tissue sheet between the ribcage and lungs; inflammation in these sheets is known as pleurisy. Medical Disclaimer: The information on this site is for your information only and is not a substitute for professional medical advice. Your email address will not be published. A 52-year-old man presents to the Emergency Department via ambulance with substernal chest pain. Chest pain is a warning to seek medical attention. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. R07.89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. T= 100.2 F; HR = 108. Critical Care Nursing: Scenarios & Case Studies, Therapeutic Communication Techniques & Examples | Communication in Nursing, Reflex Arc Function & Loop | Components of Reflex Arc. Get unlimited access to over 88,000 lessons. Ghadri J-R, Wittstein IS, Prasad A, et al. Therefore, a retrosternal hematoma is a clotted pool of blood directly behind the sternum, with no other fat or tissue between clotted blood and bone. Oblique coronary CT angiogram shows occlusion of the distal right coronary artery with calcified and noncalcified plaque distal to occlusion. To unlock this lesson you must be a Study.com Member. . It has been a pretty slow day but dispatch just notified her that there has been a motor vehicle accident. These medicines can prevent the amount of stomach acid produced in acid reflux patients. There are different symptoms of hiatal hernia, such as heartburn, frequent burping, problems in swallowing, dry cough, blood vomiting, and loss of appetite. laryngeal mask airway [LMA], i-Gel), orthopnoea and paroxysmal nocturnal dyspnoea (PND), Differential diagnosis for cyanosis (central), Differential diagnosis for right upper quadrant (ruq) abdominal pain, Differential diagnosis for large prostate, Differential diagnosis for urinary incontinence, Differential diagnosis for cough with pink frothy sputum. Evidence. 9 The same authors also . It is hard for you to swallow, as if you feel like it's all going to come right back up. Yancy CW, Jessup M, Bozkurt B, et al. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. References The word retrosternal means ''behind the sternum,'' and hematoma means ''a collection of blood outside of the blood vessels.'' Although it's likely that pain behind the breastbone relates to the organs located there, such as the heart and esophagus, sometimes the pain originates elsewhere but is felt in this area. Your email address will not be published. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. Chest pain: Substernal, pressing, occasionally radiating to left arm. A retrosternal goiter often causes no symptoms for years. The diagnostic evaluation of undifferentiated chest pain aims to first rule out immediately life-threatening causes of chest pain and then determine the etiology, guided by the pretest probability of the diagnoses under consideration. Julie instructed her to manage her pain with cold packs to the chest and to use pain medication if needed. Diuretic Strategies in Patients with Acute Decompensated Heart Failure. It protects the heart and other organs and is compressed during CPR to help pump the heart due to its proximity to the organ. Others may confuse heart attack pain with less serious problems, such as a panic attack. Around 20% of western countries have been affected by acid reflux, which is most common in women. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Ranasinghe AM, Strong D, Boland B, Bonser RS. Computed tomography of the neck and chest . Chest pain of any nature prompts medical professionals to think of cardiogenic issues first. If untreated, it could cause death. To accurately assign an ICD-10-CM code for a Myocardial Infarction, coders will need to know both the wall and the artery involved in the Myocardial Infarction. And many of those causes are serious enough to warrant a trip to your doctor for an evaluation. Bronchitis may cause severe cough, chest pain, breathing problems, wheezing or sore throat. These medicines are used to relax arteries and permit them to work efficiently. However, due to the nature of the pain and its presenting symptoms, those who experience retrosternal pain will often be worked up to rule out any potential cardiogenetic cause. We avoid using tertiary references. If its caused by bacterial pneumonia, your doctor will prescribe an antibiotic. As for the free gifts you receive with your purchase, they are yours to keep as a thank you for giving this natural, Chest pain update: Retrosternal chest pain, chest pain that comes and goes, anxiety chest pain, http://healthncare.info/substernal-chest-pain-diagnosis-symptoms-treatment/, http://firstaidkelowna.ca/substernal-chest-pain/, Costochondritis: Common cause of chest pain, can mimic a heart attack and other heart conditions. It may extend to the neck, left arm or the back. With the help of a medical professional, you can find the reasons behind your particular case of substernal pain, helping you address potential harmful medical conditions as soon as possible. specifications following safe manufacturing practices. They will need imaging studies such as an MRI or CT scan to confirm and begin treatment. Common and important causes of retrosternal chest pain for doctors and medical students. How to Diagnose and Treat Functional Chest Pain. Julie continues to monitor Amanda closely now that her injuries have been confirmed. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease. Substernal chest pain is quite painful that usually feels below or behind the sternum bone. Cancer that causes retrosternal chest pain includes: Retrosternal chest pain can be a symptom of a condition causing a benign (noncancerous) or malignant (cancerous) tumor in the area behind the sternum. What is the Difference Between SIRS & Sepsis? Typical treatment for pulmonary embolism includes anticoagulation medication like: Often referred to as AFib, atrial fibrillation is an irregular heart rate that can heighten your risk of stroke and heart disease. Publicado en junio 16, 2022 por junio 16, 2022 por Retrosternal chest pain can be a symptom of a condition affecting the heart and major blood vessels such as: Angina . [1] Up to 10% of substernal goiters are located in the posterior mediastinum, and 90% of . in government-approved facilities. - Definition, Types & Symptoms, What Is Scabies? Kearon C, Akl EA, Ornelas J, et al. Infrasternal is another term meaning . INTRODUCTION. Alexandrea has taught secondary science for over six years. These are certain other significant causes of substernal pain, such as: Pneumonia: It is a lung infection that inflames air sacs in the lungs. Bel Marra products are produced Substernal Thyroid. The treatment for Substernal Chest Pain solely depends on the underlying cause of the pain. Chest tightness with radiation to the left arm, jaw, and/or back that is associated with dyspnea should be considered cardiac chest pain until proven otherwise. Substernal chest pain ICD-10 code is R07.2. Gyawali CP, Fass R. Management of Gastroesophageal Reflux Disease. The sternum is located in the middle of the chest and the ribs attach to it, creating protection for vital organs. Tracheitis is an inflammation of the trachea (windpipe). So, what's a sternum? Hypertonic Solution: Example | What is a Hypertonic Solution? thing but used less often. Substernal Chest Pain which may not be caused due to a cardiac cause but it is still imperative for the individual to undergo diagnostic studies to rule out a potentially cardiac cause of the pain, as it is difficult to differentiate Substernal Chest Pain caused due to cardiac causes or non-cardiac causes. Respiratory problems: Disorders of the respiratory tract can lead to retrosternal pain and can be quite severe. Chest pain can be caused by acute pericarditis, perhaps following a viral illness. Conditions such as acid reflux can lead to pain and are often confused with a heart problem. If substernal chest pain is found to be psychogenic in nature, as is the case in those suffering from anxiety and panic attacks, mood relaxers and antidepressants may be prescribed. Ten causes of epigastric pain. Kreuter M, Mathis G. Emergency ultrasound of the chest.. Mavroudis CD, Kucharczuk JC. For this, cardiac pathology should be evaluated deeply to treat chest pain infection. On EKG there will be evidence of ST elevation or depression, Q waves, or inverted T waves. If you notice one or more of the signs below in yourself or someone else, call 911 or your local emergency number right away. Learn more about acid reflux, a condition that occurs when stomach acids back up into the esophagus through the lower esophageal sphincter. Gastrointestinal problems: Perhaps the most common cause of retrosternal chest pain, as the esophagus lies behind the sternum. You have 30 days to try one bottle of the product. Onset over minutes to hours. liver disease. On a three-year communications program in Germany, Mohan developed a keen interest in German Medicine (Homoeopathy), and other alternative systems of medicine. Usually located substernal or in the left chest. Only after we are satisfied with the products. Patients presenting with substernal or left chest pain with radiation to the left arm had a less than 10% chance of having right coronary artery disease. Retrosternal hematoma is a complication of sternal fractures. A retrosternal hematoma occurs when the fractured sternum oozes blood that collects in the back of the sternum. Confirmed by: OGD showing inflamed mucosa. It is estimated that about 25% of people in the United States experience Substernal chest pain for one reason or another. Typical treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs). Cardiac issues will often need to be assessed in depth, as minor invasive procedures need to be done to properly treat the cause of chest pain. During CPR, the sternum is compressed onto the heart to help it pump blood. A full workup, including medical history and a physical exam, will be done to rule out potential cardiac causes. This can compromise the heart's ability to pump blood. In pericarditis, the substernal pain often radiates to the shoulder and can sometimes be . Patients with acute thoracic aortic dissection may present with chest or back pain. Page RL, Joglar JA, Caldwell MA, et al. Opioids for acute pancreatitis pain. Moreover, pleurisy has been caused by bacterial infections like pneumonia or viral infections. using current production and quality control standards. [1]. Yancy CW, Jessup M, Bozkurt B, et al. Psychological problems, including pain disorders, stress, anxiety and depression. Learn what you can do and when you should see a doctor. Heart attacks can cause substernal chest pain because the heart is deprived of oxygen, causing chest complications, as noted by Right Diagnosis. Dooling KL, Guo A, Patel M, et al. Consider urgent specialty consult and critical care unit admission. https://www.belmarrahealth.com/substernal-chest-pain-causes-symptoms-diagnosis-treatment/, https://www.medicalnewstoday.com/articles/320185, https://www.physio-pedia.com/Sternal_Pain_-_Different_Causes#, https://www.mayoclinic.org/diseases-conditions/costochondritis/symptoms-causes/syc-20371175, https://my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction, https://www.webmd.com/heartburn-gerd/guide/what-is-acid-reflux-disease, https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940, https://www.medicalnewstoday.com/articles/146619, https://www.epainassist.com/chest-pain/substernal-chest-pain. What diagnosis does the nurse expect? Sternum fracture causes severe pain during coughing and inhaling. If the pain is described as atypical, musculoskeletal, or noncardiac with no further information on the underlying cause, then . Linder H. (2018). Typical chest pain is retrosternal. Plus, get practice tests, quizzes, and personalized coaching to help you Generally, a retrosternal hematoma will resolve on its own in two to nine weeks. The following are different symptoms depending on the causes of substernal pain; The diagnosis can be initiated by taking the patients medical history and physical tests. This is a complication experienced by about 70% of sternal fracture patients. Julie is a registered nurse working in the emergency department at the hospital. Drinking too much can also cause conditions such as: gastritis, or stomach inflammation. Satoh K, Yoshino J, Akamatsu T, et al. Kaman L. Management of Esophageal Perforation in Adults. What causes chest congestion and how to get rid of it. Discuss substernal vs. retrosternal, retrosternal chest pain, and retrosternal thyroid surgery. Nontraumatic chest pain is one of the most common reasons that patients visit the emergency department; it is also frequently encountered in both the inpatient and outpatient settings. Thyroid mass: substernal goiter remains a significant consideration in the differential diagnosis of mediastinal masses, particularly those located in the anterior mediastinum. Treatment of tracheitis depends on the cause, which is typically allergic, viral, or bacteria-based. . Once this has been achieved, proper treatment can ensue. International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management. Additionally, cognitive behavioral and psychological therapy may also be implemented. Learn, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Notice an unusual lump? Chest pain may be another early symptom, characterized by a squeezing retrosternal pain radiating to the neck, jaw, arms, or back. Long B, Koyfman A, Gottlieb M. Management of Heart Failure in the Emergency Department Setting: An Evidence-Based Review of the Literature. A sternum fracture takes much longer to fully heal and can take up to six months to heal. Sternoclavicular joint attaches the upper sternum to the collarbone. The sternum consists of three parts; manubrium, body, and xiphoid process. These all are the symptoms of respiratory disease that causes substernal pain throughout normal breathing. All our products are backed by a 100% satisfaction guarantee. Severe or prolonged substernal or precordial chest pain usually indicates myocardial ischemia. This is often the first step in all serious cases of chest pain. You could be dealing with GERD. lessons in math, English, science, history, and more. Whats Causing Pain in the Left Side of My Chest? document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); We provide cardiology services in Chicago suburbs with offices in Park Ridge, Oak Brook, Niles and Schaumburg. These are certain other significant causes of substernal pain, such as: Substernal pain has been reported as agonizing, crushing, and compressing in nature. Pain, numbness, pinching, prickling, or . Their use or mentioning on this website is only for informational purposes. [1]. This bone may also be referred to as the breastbone. Create your account. Treatment for AFib can include medication, nonsurgical procedures, and surgical procedures. There is . Pleurisy treatment is based on the underlying cause of the inflammation. The incision or incisions are closed with sutures, sometimes with drainage tubes that will be removed several days post-op. The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection. Patients with red flag features suggestive of life-threatening causes (e.g., acute coronary syndrome, pulmonary embolism) and those who are hemodynamically unstable require immediate assessment. Retrosternal chest pain, therefore, is a pain that occurs inside the chest. Substernal goiters can cause compressive symptoms and can harbor a thyroid cancer. Once this has been achieved, proper treatment can ensue. Required fields are marked *. Atrial fibrillation. In: Post TW, ed. specifications following safe manufacturing practices. Angina (an-JIE-nuh or AN-juh-nuh) is a type of chest pain caused by reduced blood flow to the heart. All Copyright 2023 Bel Marra Health. This creates a cage of protection around vital organs such as your heart and lungs. Treatment often includes OTC medications such as Pepcid but your doctor might prescribe: Retrosternal chest pain can be a symptom of a condition affecting the heart and major blood vessels such as: Angina is chest discomfort triggered by a reduced flow of oxygen-rich blood to the heart. Read the, immediately life-threatening causes of chest pain, Acute management checklist for aortic dissection, Acute management checklist for cardiac tamponade, Acute management checklist for acute pericarditis, Acute management checklist for heart failure exacerbation, Acute management checklist for Takotsubo cardiomyopathy, Acute management checklist for thoracic aortic aneurysm, Acute management checklist for pulmonary embolism, Acute management checklist for tension pneumothorax, Acute management checklist for spontaneous pneumothorax, Acute management checklist for asthma exacerbation, Acute management checklist for COPD exacerbation, Acute management checklist for pleural effusion, Acute management checklist for esophageal perforation, Acute management checklist for acute pancreatitis, Acute management checklist for esophageal hypermotility disorders, Acute management checklist for Mallory-Weiss syndrome, acute management checklist for herpes zoster, Rome IV criteria for functional chest pain, Differential diagnosis of increased troponin, Differential diagnosis of ST elevations on ECG, https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/diffuse-esophageal-spasm. Mohan Garikiparithi got his degree in medicine from Osmania University (University of Health Sciences). Khalaf M, Chowdhary S, Elias PS, Castell D. Distal Esophageal Spasm: A Review. She knows that other injuries can occur with a fractured sternum. These pains can be cured with different medicines such as: Your email address will not be published. Cardiac problems: By far the most worrisome complication that medical professionals want to rule out first. It may feel like a heavy weight lying on the chest. Diagnosis and Treatment of Peptic Ulcer Disease. pancreatitis, or inflammation of the pancreas. On any matter relating to your health or well-being, please check with an appropriate health professional. Uncomfortable pressure, squeezing, fullness, burning, tightness, or pain in the center of the chest. Angina usually causes uncomfortable pressure, fullness, squeezing . Individual having symptoms of heartburn . Treatment for esophagitis is based on the underlying cause and the amount of tissue damage already sustained. Kim H-S. Endoscopic Management of Mallory-Weiss Tearing. Chest pain can be associated with symptoms such as. Furthermore, psychological therapy and cognitive behavior are also effective. Cardiac pathology will often need to be assessed in depth, as minor invasive procedures may be needed to properly treat the cause of chest pain. The generally accepted definition is that described by Candela in 2007: any goitre that descends below the plane of the thoracic inlet or grows . However, other less serious conditions can also cause chest pain. Substernal chest discomfort of characteristic quality and duration; Provoked by exertion or . Pulmonary embolism treatment options. She has a bachelors degree in Teaching Secondary Science and a Masters of Education in Instructional Design. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes. All rights reserved. Fashner J, Gitu AC. dizziness, lightheadedness, shortness of breath, stabbing or burning sensations, squeezing sensation, tightness, sharp or dull pain in chest, neck, or arms, and. Some of the most common causes of sternum and substernal pain are: costochondritis. The features that physicians rely on to diagnose it are the associated symptoms that accompany substernal chest pain. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2020 Report). Some chest pain is described as crushing or burning. An esophageal ulcer is often caused by erosion of tissue in the esophagus. Retrosternal chest pain is pain felt behind the sternum bonea flat bone located in the middle of the chest. American Gastroenterological Association Medical Position Statement on the Management of Gastroesophageal Reflux Disease. It is located in the middle of the chest and the ribs attach to it. gastrointestinal, or relating to the stomach and intestines, cardiovascular, or relating to the heart and blood vessels, respiratory, or relating to organs used for breathing, other drugs that stop or reduce stomach acid production. An error occurred trying to load this video. As a member, you'll also get unlimited access to over 88,000 copyright 2003-2023 Study.com. Bronchitis: It is an inflammation of the central airways of the lungs. Chest pain is experienced by 25% of people in the U.S. At least 1% to 2% of visits to physicians are caused by concern about chest pain. Yancy CW, Jessup M, Bozkurt B, et al. In this condition, chest pain radiates to the back, neck, or shoulders and often worsens when the patient inhales. It is comprised of three parts; the manubrium, the body, and the xiphoid process. Please always ask your doctor for personalized diagnosis, evaluation, assessment, treatment and care management plan. It improves if the patient sits upright or leans forward. During his active practice he served as the head of the Dept. adjective describing the anatomical area below, beneath or behind - Causes, Symptoms & Treatment, What is Radiation Therapy? Applicable to most patients with undifferentiated chest pain. 355 lessons. Chronic lung diseases, including diseases of the pleura, the tissue that covers your lungs. Substernal Chest Pain can be quite painful. The pain is traditionally accompanied by dyspnea and fever. Moreover, other problems are also seen in costochondritis, such as pain in the ribs, difficulty in deep breathing, or coughing. Acute aortic syndromes.. Hiratzka LF, Bakris GL, Beckman JA, et al. Karkhanis V, Joshi J. Pleural effusion: diagnosis, treatment, and management. For traumatic causes of chest pain, see Blunt chest trauma and Penetrating chest trauma., The following recommendations are consistent with the 2021 American Heart Association (AHA) chest pain guidelines. She's TESOL certified and a National Geographic Certified Educator. [ 1 , 3 ] Chest pain is responsible for 5.5 to 5.8 million . Enrolling in a course lets you earn progress by passing quizzes and exams. It is chest pain that is mainly caused by the inflammation of the cartilage that connects ribs to the sternum. Pulmonary embolism is a blockage such as a blood clot in one of the pulmonary arteries in your lungs. Top Chest Pain Treatment in Schaumburg, IL, Top Chest Pain Treatment in Oak Brook, IL, Top Chest Pain Treatment in Libertyville, IL, Chest Pain Treatment Near Libertyville, IL, Chest Pain Treatment Near Schaumburg, IL. Angina can be treated with lifestyle changes and medication. In addition, air sacs fill with pus, causing chest pain, fever, severe coughing, sweating, confusion, breathing issues, and nausea. If this were to occur, Amanda would become pale and have low blood pressure and heart rate. To unlock this lesson you must be a Study.com Member. In some cases, prescription medication and even surgery are necessary treatments for GERD. Classic angina presents with substernal chest pain that's described as "squeezing" or "pressure-like." It often radiates to the arms or jaw and is made worse by exertion or emotion and . Substernal pain may also occur on the left side of the chest, and while typical pain is normally constant, a creeping discomfort can grow severe for a few minutes. Moreover, doctors can prescribe a combination of medicines like Pepcid, Prevacid, Nexium, Aciphex, or Protonix. Chest Pain Risk Factors. Create your account, 26 chapters | (NSTEMI), or unstable angina. There is a wide range of risk factors that can increase a patient's risk of experiencing chest pain. Amsterdam EA, Wenger NK, Brindis RG, et al.. 2014 AHA/ACC Guideline for the Management of Patients With NonST-Elevation Acute Coronary Syndromes. It was an older car so there weren't any air bags, and since she didn't have her seat belt on, she hit the steering wheel of her car. Learn how your comment data is processed. with substernal chest pain that may radiate to the shoulder, jaw, or arm as well as SOB, N/V, palpitations, and diaphoresis. Location, Pain, Abscess | Gluteal fold vs Gluteal cleft, Medial Longitudinal Fasciculus Functions, Location, Lesion, Damage, Saturday Night Palsy Meaning, Definition, Symptoms, Recovery, Treatment, What is Jefferson fracture? During the surgery, the surgeon will attempt to remove the mass through the neck to avoid the potential complications of opening up the chest. Consider initiating medical therapy with one of the following. The ingredients are tested by the manufacturer for. However, it does not substitutes a physician, hospital or medical care facility. Although its likely that pain behind the breastbone relates to the organs located there, such as the heart and esophagus, sometimes the pain originates elsewhere but is felt in this area. https://www.cdc.gov/nchs/products/databriefs/db43.htm. You have 30 days to try one bottle of the product. Diagnosis. Substernal vs retrosternal chest pain. Your mediastinum contains your heart, aorta, esophagus, thymus, thyroid, trachea, lymph nodes and nerves. A sternal fracture occurs when there is a break in any of the three sternal components. Free Special Report: The Secret Fixes for Your Sleep Problems, Get this report FREE when you opt in for our FREE Health eTalk daily

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