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March 30, 1979

Pain of Myocardial Infarction Reproduced by Precordial Palpation

Author Affiliations

University of Utah Medical Center Salt Lake Veterans Medical Center Salt Lake City

JAMA. 1979;241(13):1328. doi:10.1001/jama.1979.03290390016019

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To the Editor.—  Precise reproduction of a patient's chest pain by chest wall palpation is usually interpreted by physicians as a strong argument against an ischemic origin for the pain. Although this is undoubtedly generally true, a patient recently seen at our institution illustrates that it is not invariably so.

Report of a Case.—  A 48-year-old man was admitted to the Salt Lake Veterans Medical Center on Nov 23, 1978. He had been awakened that morning by severe, dull, aching anterior chest pain that radiated down both arms. He was unresponsive to eight nitroglycerin tablets. The pain persisted for five hours before being completely relieved by 16 mg of morphine sulfate administered in increments intravenously at the time of admission to the coronary care unit. Serial ECGs (Figure) and enzyme studies (Table) were interpreted to be diagnostic of an acute anterior wall myocardial infarction. When his condition was evaluated two