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COMMENTS & OPINIONS
Coronary Artery Disease in Primary Care—Reply
Thomas Sequist, MD, MPH;
Thomas H. Lee, MD
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In reply
We agree that the recognition of atypical signs and symptoms of acute cardiac ischemia represents an important component of appropriate detection and treatment of myocardial infarction in the outpatient setting. Nausea and dizziness were present in 18% of the outpatients in our study who experienced an acute myocardial infarction. However, we also stress that most (76%) of the patients with eventual acute myocardial infarction presented to primary care physicians with fairly typical symptoms including chest pain and dyspnea. This highlights the importance of initial recognition of an underlying high cardiac risk profile that can lead to a more appropriate diagnostic and therapeutic plan.
Patients with acute coronary syndromes can certainly present with an initially normal ECG, although the evaluation of the high-risk symptomatic patients in our study1 should have included the performance of this key test. Among the 52 case . . . [Full Text of this Article]
AUTHOR INFORMATION
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EXTRACT
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RELATED ARTICLE
Missed Opportunities in the Primary Care Management of Early Acute Ischemic Heart Disease
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ABSTRACT
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