Mohammadian Mahsa, Shah Dhaval, Santana Melvin, Elkattawy Sherif, Jesani Shruti
Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA.
Cardiology, St. Joseph's University Hospital, Paterson, USA.
Cureus. 2022 May 10;14(5):e24893. doi: 10.7759/cureus.24893. eCollection 2022 May.
Levine's sign is a universal sign of ischemic chest pain, defined as an individual holding a clenched fist over the chest that has a low sensitivity but is relatively specific for ischemia. Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic and a very unusual cause of acute myocardial infarction.In literature,it has been more common in young women, postpartum, or with fibromuscular dysplasia. Strenuous exercise is a rare cause of SCAD. We describe a case of a healthy 46-year-old Hispanic male who presented to ER after his morning gym session. The initial EKG was unremarkable. However, due to Levine's sign, a repeat EKG was done and showed hyperacute T waves with J-point elevation in the anterior leads. An immediate coronary angiogram revealed a spontaneous coronary artery dissection in the mid-left anterior descending artery (LAD) segment. Given the resolution of the chest pain and thrombolysis in myocardial infarction (TIMI) 3 flow, no intervention was done. The patient was managed medically with an uneventful recovery. In the current times, with the advent of high sensitivity troponin along with other rapid multimodality imaging techniques, the importance of physical signs and symptoms like Levine's sign has diminished. Yet, they still remain a vital part of patient evaluation. Additionally, SCAD is uncommon in males. However, this patient was consuming energy booster powder that may have predisposed him to the SCAD. In our opinion, Levine's sign still has high clinical value in the right context. We also postulate that energy booster supplements may have serious deleterious cardiovascular effects, and large studies are necessary to understand their full effects on the cardiovascular system.
Levine征是缺血性胸痛的一个普遍体征，定义为个体将紧握的拳头放在胸前，其敏感性较低，但对缺血相对具有特异性。自发性冠状动脉夹层（SCAD）是急性心肌梗死的一种非动脉粥样硬化且非常罕见的病因。在文献中，它在年轻女性、产后女性或患有纤维肌发育异常的患者中更为常见。剧烈运动是SCAD的罕见病因。我们描述了一例健康的46岁西班牙裔男性病例，他在晨练后前往急诊室。最初的心电图无异常。然而，由于出现了Levine征，再次进行心电图检查，结果显示前壁导联出现超急性T波伴J点抬高。立即进行的冠状动脉造影显示左前降支（LAD）中段存在自发性冠状动脉夹层。鉴于胸痛缓解且心肌梗死溶栓（TIMI）血流为3级，未进行干预。该患者接受药物治疗，恢复过程顺利。在当前，随着高敏肌钙蛋白以及其他快速多模态成像技术的出现，像Levine征这样的体征和症状的重要性有所降低。然而，它们仍然是患者评估的重要组成部分。此外，SCAD在男性中并不常见。不过，该患者正在服用能量增强粉，这可能使他易患SCAD。我们认为，在合适的情况下，Levine征仍具有较高的临床价值。我们还推测，能量增强补充剂可能对心血管系统有严重的有害影响，需要进行大规模研究以了解它们对心血管系统的全面影响。
