Cardiac chest pain: does body language help the diagnosis?

The pain of cardiac ischaemia is characteristically crushing, gripping, or tight in nature. When describing their chest pain many patients will use movements of the hands to illustrate their symptoms. A clenched fist to the centre of the sternum conveys the gripping quality of the pain (Levine's sign; fig 1) while a flat hand describes the sensation of crushing heaviness (fig 2).1 Tight band-like chest pain may be represented by a movement of the palmar surfaces of both hands laterally from the centre of the chest (fig 3). Patients with non-cardiac pain may use other actions to illustrate their pain, such as movement of the fingertips up and down the sternum (oesophageal pain) or pointing to one spot (chest wall pain).