Ortner's Symptom

Ortner-Epstein: symptom or phenomenon?

In medical practice, sometimes there are patients whose questioning reveals a strange fact: they do not notice any pain in the heart area on the eve of myocardial infarction. Moreover, this phenomenon is accompanied by a normal neurological status. The patient complains of pain in the left arm (mainly in the forearm and wrist), loss of appetite and adynamia. Before a myocardial infarction, they note some weakness, which is explained by overwork, workload at the dacha, flight, etc. Their ECG results are contradictory, the boundaries of the heart are significantly expanded, the T and U waves are negative. However, hospitalization itself or hospitalization for an “intercurrent” infection is postponed for unknown reasons. In this case, intensive further examinations are necessary, which often include echocardiography. Echocardiography reveals significant obstruction of the anterior interventricular branch of the left coronary artery and this is an argument in favor of ST-segment elevation myocardial infarction.

According to Moskin and Rosinsky (1971), this paradoxical phenomenon is defined as “hospital paralysis” of the heart with a negative T wave, while pain caused by damage to the sarcolemma, cardiac