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Case Report
The Open Access Journal of Science and Technology
Vol. 3 (2015), Article ID 101108, 2 pages
doi:10.11131/2015/101108

What is the Sign?

Sridhar Reddy, Adil Lokhandwala, Archana Nair, and Bujji Ainapurapu

University of Arizona, USA

Received 14 August 2014; Accepted 29 August 2014

Academic Editor: Saeed Akhtar

Copyright © 2015 Sridhar Reddy et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Frank's sign is a physical exam finding that is thought to indicate premature aging with loss of dermal and vascular elastic fibers. Studies had shown an association between Frank’s sign and early onset coronary artery disease. We present a previous healthy patient who presented with this finding and was subsequently found to have advanced multi-vessel coronary artery disease.

Patient is a 60 yo male with past medical history significant only for hypertension who presented to the ED due to progressively worsening shortness of breath and dyspnea on exertion for the past 3 months. The patient was very active at baseline but he developed NYHA Class IV symptoms with shortness of breath at rest and 3 pillow orthopnea as well as PND over the course of 3 months. Patient denied any chest pain, swelling, cough, fever, chills, sick contacts, traveling, or drug use.

Patient has pertinent family history of his mother having rheumatic heart disease and a father who had a 4 vessel CABG at the age of 50 as per the patient. His father subsequently passed away at the age of 55 after a second heart attack.

Physical exam was significant only for 14 cm JVD. Patient also was noted to have bilateral Frank's sign, which is a diagonal crease in the earlobe that runs backward from the tragus at a 45-degree angle across the lobule to the rear edge of the auricle.

EKG showed LVH and Troponins were WNL. Further evaluation with 2-D Echocardiogram was performed as well as a left and right heart catheterization for new onset heart failure evaluation. The patient's 2-D Echo was significant for an LVEF of 17%, severe global hypokinesis of the left ventricle and mitral valve inflow pattern demonstrating grade 3 diastolic dysfunction (restrictive). Left Heart Catheterization showed severe calcific multi-vessel coronary artery disease. The patient was subsequently transferred to another facility for evaluation of possible CABG.

F1
Figure 1:

Frank's sign is thought to indicate premature aging and loss of dermal and vascular elastic fibers. Although it has limited sensitivity, the sign is more useful diagnostically in persons younger than 60 years of age than in older persons. The observed sensitivity of the sign for the diagnosis of CAD was 65%, the specificity 72%, the positive predictive value 42% and the negative predictive value 87% according to one study that studied the association between Frank's sign and CAD in 1,424 patients (1). This association remained statistically significant in all decades, except for patients aged > 70 years. Although debate still persists regarding the use of this physical exam finding, as with our patient it is a finding that physicians should consider utilizing for early detection and intervention in patient's with CAD.

References

  1. B. Tranchesi Jr., V. Barbosa, C. P. de Albuquerque, B. Caramelli, O. Gebara, R. D. D. S. Filho, O. Nakano, G. Bellotti, and F. Pileggi, Diagonal earlobe crease as a marker of the presence and extent of coronary atherosclerosis,, 70, no. 18, 1417–1420, (1992).
Case Report
The Open Access Journal of Science and Technology
Vol. 3 (2015), Article ID 101108, 2 pages
doi:10.11131/2015/101108

What is the Sign?

Sridhar Reddy, Adil Lokhandwala, Archana Nair, and Bujji Ainapurapu

University of Arizona, USA

Received 14 August 2014; Accepted 29 August 2014

Academic Editor: Saeed Akhtar

Copyright © 2015 Sridhar Reddy et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Frank's sign is a physical exam finding that is thought to indicate premature aging with loss of dermal and vascular elastic fibers. Studies had shown an association between Frank’s sign and early onset coronary artery disease. We present a previous healthy patient who presented with this finding and was subsequently found to have advanced multi-vessel coronary artery disease.