Which physical findings are characteristic of acute coronary syndrome (ACS)?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Physical examination results are frequently normal. If chest pain is ongoing, the patient will usually lie quietly in bed and may appear anxious, diaphoretic, and pale. Physical findings can vary from normal to any of the following:

  • Hypotension - Indicates ventricular dysfunction due to myocardial ischemia, infarction, or acute valvular dysfunction

  • Hypertension - May precipitate angina or reflect elevated catecholamine levels due to anxiety or to exogenous sympathomimetic stimulation

  • Diaphoresis

  • Pulmonary edema and other signs of left heart failure

  • Extracardiac vascular disease

  • Jugular venous distention

  • Cool, clammy skin and diaphoresis in patients with cardiogenic shock

In addition, a third heart sound (S3) may be present, and frequently, a fourth heart sound (S4) exists. The latter is especially prevalent in patients with inferior-wall ischemia and may be heard in patients with ischemia or systolic murmur secondary to mitral regurgitation

A systolic murmur related to dynamic obstruction of the left ventricular (LV) outflow tract may also occur. It is caused by hyperdynamic motion of the basal left ventricular myocardium and may be heard in patients with an apical infarct.

A new murmur may reflect papillary muscle dysfunction. Rales on pulmonary examination may suggest LV dysfunction or mitral regurgitation.

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