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Ravi K. Bobba, MD; Edward L. Arsura, MD; Madhavi Bollu, MD; Puneet Katyal, MD

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We read with interest the article published by Sequist et al¹ regarding missed opportunities for diagnosing acute myocardial infarction in outpatient settings. This assessment can be difficult, even with increased suspicion, and the tools used by the authors should be adopted in primary care settings. One future enhancement of their study could be the review of atypical of signs and symptoms (eg, nausea or presyncope) of acute coronary syndrome that are frequently seen in women and elderly patients.²

In their article, the electrocardiograms (ECGs) were performed in 50% of cases and 20% were misinterpreted. Although an abnormal ECG should raise the suspicion of acute coronary syndrome, a normal ECG should not exclude it.³ It would be interesting to know the percentage of normal ECGs in the authors' population.

In the patients who were sent home and . . . [Full Text of this Article]

AUTHOR INFORMATION

RELATED LETTER

Coronary Artery Disease in Primary Care—Reply
Thomas Sequist and Thomas H. Lee
Arch Intern Med. 2007;167(9):971.
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Missed Opportunities in the Primary Care Management of Early Acute Ischemic Heart Disease
Thomas D. Sequist, Richard Marshall, Steven Lampert, Elizabeth J. Buechler, and Thomas H. Lee
Arch Intern Med. 2006;166(20):2237-2243.
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