Common Symptoms Table 2–4.

Table 2–4. Likelihood ratios (LRs) for clinical features associated with acute myocardial infarction.

                                                       Clinical Feature                                  LR+ (95% CI)                        
History
                                   Chest pain that radiates to the left arm                     2.3 (1.7–3.1)                     
                                   Chest pain that radiates to the right shoulder           2.9 (1.4–3.0)
                                   Chest pain that radiates to both arms                       7.1 (3.6–14.2)
                                    Pleuritic chest pain                                                  0.2 (0.2–0.3)
                                   Sharp or stabbing chest pain                                    0.3 (0.2–0.5)
                                    Positional chest pain                                                0.3 (0.2–0.4)
                                   Chest pain reproduced by palpation                          0.2–0.41
                                   Nausea or vomiting                                                   1.9 (1.7–2.3)
                                   Diaphoresis                                                               2.0 (1.9–2.2)

Physical examination
                                   Systolic blood pressure ≤ 80 mm Hg                        3.1 (1.8–5.2)
                                   Pulmonary crackles                                                   2.1 (1.4–3.1)
                                   Third heart sound                                                      3.2 (1.6–6.5)

Electrocardiogram
                                   Any ST segment elevation (≥ 1 mm)                       11.2 (7.1–17.8)
                                   Any ST segment depression                                       3.2 (2.5–4.1)
                                   Any Q wave                                                                3.9 (2.7–7.7)
                                   Any conduction defect                                                2.7 (1.4–5.4)
                                   New ST segment elevation (≥ 1 mm)                         5.7–53.91
                                   New ST segment depression                                       3.0–5.21
                                   New Q wave                                                                5.3–24.81
                                   New conduction defect                                                6.3 (2.5–15.7)
Heterogenous studies do not allow for calculation of a point estimate.
Adapted, with permission, from Panju AA et al. The rational clinical examination. Is this patient having a myocardial infarction? JAMA. 1998 Oct 14;280(14):1256–63.