Physical Examination

Physical findings associated with ACS are generally non-specific and include pallor, anxiety, sweating, tachycardia and tachypnoea. Generally, specific physical findings are associated with other causes for chest pain (i.e. not ischaemic cardiac) or are associated with the complications of AMI (see Table 2).

Table 2

Examination finding Likelihood ratio
Ref 9 Ref 10
Increased likelihood of AMI:
Third heart sound 3.2 3.2
Hypotension (systolic BP <80 mmHg) 3.1 3.1
Pulmonary crepitations 2.1 2.1
Decreased likelihood of AMI:
Chest pain reproducible by palpation 0.3 0.2-0.4*

* In heterogenous studies, likelihood ratios are expressed as a range.

Learning Bite

The finding of a third heart sound, hypotension or pulmonary crepitations makes AMI more likely.