An evaluation of facial expression displayed by patients with chest pain

Objective: To determine whether patterns of facial expressions of patients complaining of chest pain can aid in the diagnosis of myocardial infarctions. Design: Exploratory. Setting: Southeastern university medical center emergency department (ED). Patients: Twenty-eight patients in the ED who presented with chest pain. Age range was 40 to 84 years, with a mean of 65.4 years. Outcome Measures: Common patterns of facial expressions among patients diagnosed with myocardial infarction. Intervention: On admission to the ED, patients were videotaped during physical examination. Videotapes were reviewed to code the facial action units exhibited by the patients. The presence or absence of creatine kinase (CK) enzymes was determined; these results were blinded to the coders until after all facial actions were coded. Results: With use of the Facial Action Coding System, 4 facial expressions were found to be associated with true myocardial infarction: lowering the brow, pressing the lips, parting the lips, and turning the head left. Conclusion: Additional research with a larger sample of patients presenting with chest pain is needed to validate the findings of this study. However, if these findings are supported, instruction regarding assessment of specific facial expressions in clinical settings may be warranted. (Heart Lung ® 1999;28:168-74)