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The utility of gestures in patients with chest discomfort.

Publication ,  Journal Article
Marcus, GM; Cohen, J; Varosy, PD; Vessey, J; Rose, E; Massie, BM; Chatterjee, K; Waters, D
Published in: Am J Med
January 2007

PURPOSE: Patient gestures are thought to be useful in determining the etiology of chest discomfort. We sought to determine the utility of certain patient gestures in the diagnosis of ischemic chest discomfort or myocardial infarction. METHODS: We performed a prospective observational study of 202 patients admitted with chest discomfort. Patients were observed for the Levine Sign (clenched fist to the chest), the Palm Sign (palm of the hand to the chest), the Arm Sign (touching the left arm), and, as an indicator of nonischemic chest discomfort, the Pointing Sign (pointing with 1 finger). RESULTS: Prevalences of the Levine, Palm, Arm, and Pointing Signs were 11%, 35%, 16%, and 4%, respectively. Using troponin levels and results of functional studies and coronary angiograms as reference standards, none of the sensitivities of the signs exceeded 38%. Specificities of the Levine and Arm Signs ranged between 78% and 86%, but the positive predictive values did not exceed 55%. The Pointing Sign had a specificity of 98% for evidence of nonischemic chest discomfort, and the positive predictive value of a negative troponin was 88%. The diameter of discomfort significantly correlated with certain gestures. Larger chest pain diameters were associated with evidence of myocardial ischemia. CONCLUSIONS: Although certain gestures are exhibited by patients presenting with chest discomfort, they generally have poor test characteristics. The Pointing Sign has a high specificity for nonischemic chest discomfort, but a low prevalence. The gestures may communicate the size of the chest discomfort, with larger areas suggestive of ischemia.

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Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

January 2007

Volume

120

Issue

1

Start / End Page

83 / 89

Location

United States

Related Subject Headings

  • Troponin I
  • Sensitivity and Specificity
  • Prospective Studies
  • Predictive Value of Tests
  • Observation
  • Middle Aged
  • Male
  • Humans
  • Gestures
  • General & Internal Medicine
 

Citation

APA
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ICMJE
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Marcus, G. M., Cohen, J., Varosy, P. D., Vessey, J., Rose, E., Massie, B. M., … Waters, D. (2007). The utility of gestures in patients with chest discomfort. Am J Med, 120(1), 83–89. https://doi.org/10.1016/j.amjmed.2006.05.045
Marcus, Gregory M., Joshua Cohen, Paul D. Varosy, Joshua Vessey, Emily Rose, Barry M. Massie, Kanu Chatterjee, and David Waters. “The utility of gestures in patients with chest discomfort.Am J Med 120, no. 1 (January 2007): 83–89. https://doi.org/10.1016/j.amjmed.2006.05.045.
Marcus GM, Cohen J, Varosy PD, Vessey J, Rose E, Massie BM, et al. The utility of gestures in patients with chest discomfort. Am J Med. 2007 Jan;120(1):83–9.
Marcus, Gregory M., et al. “The utility of gestures in patients with chest discomfort.Am J Med, vol. 120, no. 1, Jan. 2007, pp. 83–89. Pubmed, doi:10.1016/j.amjmed.2006.05.045.
Marcus GM, Cohen J, Varosy PD, Vessey J, Rose E, Massie BM, Chatterjee K, Waters D. The utility of gestures in patients with chest discomfort. Am J Med. 2007 Jan;120(1):83–89.
Journal cover image

Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

January 2007

Volume

120

Issue

1

Start / End Page

83 / 89

Location

United States

Related Subject Headings

  • Troponin I
  • Sensitivity and Specificity
  • Prospective Studies
  • Predictive Value of Tests
  • Observation
  • Middle Aged
  • Male
  • Humans
  • Gestures
  • General & Internal Medicine