What should you know about Levine sign angina?

Someone may place a clenched fist over the breastbone when trying to describe pressure, squeezing or tightness. This gesture can occur with angina, which is chest discomfort caused by reduced blood flow to heart muscle, but people describe symptoms in many ways. A gesture cannot confirm angina or distinguish it from a heart attack, lung problem, reflux or a muscle strain.

A clinician considers when the discomfort occurs, whether it follows exertion, where it spreads and whether breathlessness, sweating, nausea or faintness accompany it. Hypertension can add cardiovascular strain. An ECG and other assessment may be needed, even when the chest sensation has settled.

Stop exertion and sit upright if chest discomfort begins. Follow the personal action plan and prescribed medicines you have been given; do not take someone else’s treatment. Arrange medical assessment for new, recurring or changing chest symptoms, and keep a note of triggers, duration and associated symptoms. Do not rely on the Levine sign, or its absence, to decide that symptoms are harmless.

Call emergency services immediately for chest pressure or tightness that is severe, lasts several minutes, returns, or occurs with breathlessness, sweating, nausea, fainting or pain spreading to the arm, jaw, back or shoulder. Treat sudden chest symptoms as urgent regardless of the gesture used to describe them. Do not drive yourself if you may be having a heart emergency.

Ask whether your symptoms fit angina, whether an ECG or other tests are needed, and what your personal emergency plan should be. Discuss blood pressure control, statin therapy and how to use any prescribed chest-pain medicine.