Emphasizing Chest Pain as a Symptom of Heart Attack

To the Editor.  —Drs Kerber, Paraskos, and Montgomery miss the point of Dr Baird's letter¹ when they state that it would be unrealistic to think that emphasis on risk-factor identification and modification will entirely prevent myocardial infarctions (MIs) and cardiac arrests. Hence, they quickly skip on to guidelines for managing the cardiac emergencies that will inevitably occur. They get off the hook by saying that the American Heart Association (AHA) is ready to review new scientific data and change its recommendations.Lost in this rhetoric is the fact that awareness of chest pain and chest discomfort is not emphasized to the same degree as are the traditional risk factors.² It is true that chest pain is mentioned in the guidelines for cardiopulmonary resuscitation and emergency cardiac care—the emphasis is just not there.This is a major blunder. Identifying chest pain and chest discomfort as acute risk factors for