Clinical Health Updates

Typical hand gestures not useful for chest pain diagnosis

Clinical Question:
Are typical hand gestures made by patients with acute chest pain useful for ruling in or ruling out ischemia?

Bottom Line:
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.

Reference:
Marcus GM, Cohen J, Varosy PD, et al. The utility of gestures in patients with chest discomfort. Am J Med 2007;120:83-89.

Study Design:
Cohort (prospective)

Synopsis:
Patient gestures are thought to be useful in determining the etiology of chest discomfort. The authors sought to determine the utility of certain patient gestures in the diagnosis of ischemic chest discomfort or myocardial infarction. They 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). 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.