During the examination of a patient the following physical signs and abnormalities may be observed:
• The patient may appear anxious, apprehensive, and sweaty, and clammy.
• The location of chest pain may be indicated with a clenched fist held over the area of the chest wall.
• In patients with infarction of the inferior wall the heart rate is bradycardic at less than 60 beats per minute. This is found in more than 66% of patients. The blood pressure may have fallen 20–40 mmHg lower than the normal baseline for the given individual. In some individuals it may be 110 mmHg systolic or as low as 80 mmHg from cardiogenic shock. Some patients with anterior myocardial infarction may reveal tachycardia with a rate greater than 110 beats per minute and an increase in blood pressure. If the area of infarction is extensive the pressure usually falls, and in some patients cardiogenic shock or heart failure supervenes.
• In more than 25% of patients admitted to the hospital shortness of breath is caused by heart failure and physical abnormalities that include an increase in jugular venous pressure and crepitations and rales are heard with the stethoscope over the lower lung fields.
• Extra heart sounds such as a third or fourth heart sound maybe present.

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