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.
Sequist T, Lee TH. Coronary Artery Disease in Primary Care—Reply. Arch Intern Med. 2007;167(9):971. doi:10.1001/archinte.167.9.971-a