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"textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the article by Montero-Pérez et al. on the diagnostic validity of nonverbal language in coronary pain, which concluded that certain hand gestures are not useful for understanding the ischemic etiology of a chest pain.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Although we agree with some of the conclusions, we would like to discuss some of the issues.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Firstly, the study sample should have been divided according to groups with a greater likelihood of atypical presentation, such as the elderly, women and patients with diabetes.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Secondly, it would have been appropriate to consider aspects such as the patient's cultural level, previous history of other chest pain episodes (of coronary origin or not) and other factors that could have affected the level of information on the chest pain, given that the patients might illustrate the pain with gestures that depend on their prior experience and education level.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Finally, if the objective was to try to associate the chest pain with the nonverbal language, future studies should delve further into other signs such as the presence or absence of vegetative symptoms, tachypnea and simply the patient's general impression.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Given the above and despite the results shown by Montero-Pérez et al., further research is needed on any clinical aspect that can contribute to improving the diagnosis of acute coronary syndrome in emergency departments, so that decisions can be made quickly on the appropriate treatment and destination.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span>"
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