He rolled over in bed, and said 'I love you'.....

'Local Bloke' by Tolouse-Lautrec

It is usually fairly straightforward to diagnose a heart attack (Coronary Thrombosis, Myocardial Infarction). The classical presentation is a 'crushing' chest pain, going into the neck or left arm, severe, and associated with nausea, sweating and shortness of breath.

The ECG (EKG in the States) shows typical changes (S-T wave elevation), and there is a blood test called Troponin that should be elevated above a specific figure.

Actually, many heart attacks do not present classically. Some occur without any symptoms at all (the so-called 'silent' Myocardial Infarction).

In the area I work, some of the patients are very stoic, and will put up with a lot. I remember one chap I saw on a monday morning in my surgery. He said that he got some chest pain at 3 o'clock in the morning on the saturday (around 36 hours before coming to see me). He said the pain was not too bad, but then said

'Actually, doc, the pain was so bad that I rolled over in bed and told the wife I loved her"

This is most uncharacteristic for Mr Local Bloke, and that was a clincher. I was sure he'd had a heart attack. Tests afterwards confirmed that. He's never said it since...

So this is the Jobbing Doctor's sign...... The "I love you" sign.