The Utility of Gestures in Patients with Chest Discomfort

準備CV前隨意看到的，似乎可以用來幫忙Differential diagnosis用

The Levine Sign has a poor sensitivity for chest pain related to myocardial ischemia or infarction.

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A patient pointing to a specific point on the chest likely does not have discomfort due to cardiac ischemia or myocardial infarction.

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Larger areas of chest discomfort correlate with a greater likelihood of cardiac ischemia or myocardial infarction.

1. The “Levine Sign” was defined as a clenched fist of either hand brought to the chest wall with the thumb aspect of the fist positioned towards the chest or superiorly . 
2. The “Palm Sign” was defined as an extended palm of either hand touching the chest.
3. The “Arm Sign” was defined as deliberately touching the left arm with the right hand.
4. the “Pointing Sign” was defined as pointing to a single specific point with 1 or 2 fingers.
5. The Levine, Palm, and Arm Signs were each prospectively specified as indicative of chest pain or discomfort due to cardiac ischemia. The Pointing Sign was prospectively specified as indicative of nonischemic chest pain.

不過這篇論文最後的結論是:

"Contrary to traditional clinical teaching, direct examination of these gestures fails to demonstrate clinical utility." However, the clinical value of the gestures may be related to a communication of the size of the chest discomfort, with larger diameters more indicative of cardiac ischemia

文章來源:

Gregory M. Marcus, Joshua Cohen, Paul D. Varosy, Joshua Vessey, Emily Rose, Barry M. Massie, Kanu Chatterjee, David Waters, The Utility of Gestures in Patients with Chest Discomfort, The American Journal of Medicine, Volume 120, Issue 1, January 2007, Pages 83-89, ISSN 0002-9343