What is the Levine sign?

• A. Clenched fist placed over the heart in the setting of chest pain
• B. Hands clasped over the abdomen during chest pain
• C. Finger tapping at the chest wall during pain
• D. Arm flexion to relieve chest pain

Answer: (A)

In chest pain, a classic nonverbal cue is Levine sign: the patient clenches a fist and places it over the sternum to indicate the location and severity of the pain. This gesture is strongly associated with anginal-type ischemia and helps clinicians identify cardiac chest pain when a verbal description is limited or uncertain. The clenched fist over the chest is the description that fits this sign precisely.

The other options don’t match this well-established cue. Clasping the hands over the abdomen suggests abdominal or GI causes of pain, finger tapping at the chest wall isn’t a recognized signal for chest pain, and flexing the arm to relieve pain isn’t a standard sign for cardiac chest pain. Remember, Levine sign supports the clinical picture of myocardial ischemia but isn’t diagnostic on its own.