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Warning Function of Frank's Sign in Pre-Existing Cardiac Disease Patients: A Case Report
Mingzhe Wang1,2, Yujing Zhang1,2, Jiang Huang1,2
1Department of Cardiology The First Affiliated Hospital of Nanchang University Jiangxi Medical College, Nanchang, China.
Insights
Frank's sign, a diagonal earlobe crease, may indicate coronary artery disease. This case highlights its importance in diagnosing acute coronary syndrome in younger patients, prompting early intervention.
Area of Science:
- Cardiology
- Dermatology
Background:
- Coronary artery disease (CAD) is a significant health concern.
- Frank's sign (FS), a diagonal earlobe crease, is an independent predictor of CAD.
- Younger patients with prior myocardial infarction and FS are infrequently documented.
Observation:
- A 49-year-old male with diabetes, smoking history, and prior myocardial infarction presented with acute chest pain.
- Physical examination revealed Frank's sign (FS), also termed diagonal earlobe crease (DELC).
- Electrocardiography (ECG) showed ST elevation and elevated cardiac biomarkers, suggesting acute coronary syndrome (ACS).
Findings:
- Coronary angiography revealed significant stenosis and occlusion in the right coronary artery (RCA).
- Percutaneous coronary intervention (PCI) was successfully performed, relieving chest pain.
- This case reinforces the association between FS and acute ischemic heart disease.
Implications:
- Frank's sign (FS) can serve as a simple, non-invasive screening tool for identifying individuals at risk of ischemic heart disease.
- Routine examination of FS may facilitate earlier diagnosis and treatment, particularly in younger populations.
- Integrating FS assessment into routine cardiovascular examinations could improve early detection strategies for CAD.
Abstract:
Frank's sign (FS) refers to a diagonal skin fold between the tragus and the outer edge of the earlobe. FS has been identified as an independent variable in coronary artery disease (CAD). Young patients with FS and previous myocardial infarction are still rarely reported in clinical studies. We report the case of a 49-year-old male smoker and diabetic, with a history of myocardial infarction, who presented to the emergency department due to 2 h typical cardiac chest pain. His urgent electrocardiography (ECG) showed ST elevation, and cardiac biomarkers were elevated after admission. A diagonal earlobe crease (DELC) was observed in physical tests. The preliminary diagnosis considered acute coronary syndrome (ACS). Subsequently, acute coronary artery angiography demonstrated a slit-like contrast defect in the proximal right coronary artery (RCA), with stenosis and occlusion in the distal segment. The percutaneous coronary intervention (PCI) was performed immediately. The patient's chest pain symptoms were relieved significantly after intervention. Our case indicates that FS should be highly regarded as a routine cardiovascular clinical examination, which can be effortlessly applied and be easily interpreted for screening to suspect the presence of ischemic heart disease. This may set strategies for primary screening in a younger population and prompt early diagnosis and treatment.
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