title: The utility of gestures in patients with chest discomfort.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Cardiology, University of California, San Francisco, San Francisco, Calif 94143, USA. marcusg@medicine.ucsf.edu
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Marcus
authors.forename: Joshua
authors.initials: J
authors.lastname: Cohen
authors.forename: Paul D
authors.initials: PD
authors.lastname: Varosy
authors.forename: Joshua
authors.initials: J
authors.lastname: Vessey
authors.forename: Emily
authors.initials: E
authors.lastname: Rose
authors.forename: Barry M
authors.initials: BM
authors.lastname: Massie
authors.forename: Kanu
authors.initials: K
authors.lastname: Chatterjee
authors.forename: David
authors.initials: D
authors.lastname: Waters
mesh_terms: D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000175:diagnosis*; D003952:Diagnostic Imaging; D005260:Female; D005868:Gestures; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I