Further Comments on the Levine Sign

Abstract

To the Editor: Dr. Alan Leviton in the February 4 issue of the Journal adds "Another Levine Sign." This sign, Dr. Leviton writes, "is the use of a clenched fist by the patient to describe his substernal pain." This sign is almost diagnostic of acute myocardial infarction.Asher¹ in his Lettsomian Lectures, in describing other unnamed movements that enlighten the clinician, has written of "the sponge squeezing hands approaching the sternum, as they describe the pain in cardiac ischaemic. This movement is almost diagnostic of coronary disease." Dr. Byron Evans first called Dr. Richard Asher's attention to it.The sign . . .