Page 16 - Clinical Pearls in Cardiology

4 Clinical Pearls in Cardiology

coronary blood flow fails to meet this excessive demand,
the person will develop angina (i.e demand–supply
mismatch). The last three conditions are associated with
reduced myocardial oxygen supply.
8. What is Levine’s sign?
Levine’s sign is a clenched fist held over the central area
of the anterior chest wall to describe ischemic cardiac
chest pain. The referred pain associated with cardiac
ischemia often radiates to the left arm. So the unaffected
right hand is usually used to produce the gesture as
shown in the Figure 2.

Fig. 2: Levine’s sign
9. What are the general characteristics of ischemic
cardiac pain?
Cardiac chest pain can be described as being typical or
atypical. The term ‘typical’ referring to whether the pain
has majority of the features of chest pain that is usually
associated with myocardial ischemia. Ischemic type of