Levine's sign

Levine's sign is a clenched fist held over the chest to describe ischemic chest pain.[1]

Levine's sign
Differential diagnosisischemic chest pain

It is named for Samuel A. Levine (1891–1966), an influential American cardiologist, who first observed that many patients suffering from chest pain made this same sign to describe their symptoms. This clenched fist signal may be seen in patients with acute coronary syndrome (myocardial infarction and angina pectoris).

A variant of this sign which uses the entire palm instead of the clinched fist over the chest is commonly known as the Palm Sign and in Latin America, it is widely referred to as the Cossio's Sign or Cossio-Levine Sign. This sign is named after the famous Argentine Cardiologist, Pedro Alurralde Cossio (1900-1986) who described it sometime in 1934.[2]


  1. Edmondstone WM (1995). "Cardiac chest pain: does body language help the diagnosis?". BMJ. 311 (7021): 1660–1. doi:10.1136/bmj.311.7021.1660. PMC 2539106. PMID 8541748.
  2. "Pedro Cossio - NeglectedScience". www.neglectedscience.com.
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