Earlier this week saw the sudden death of the union boss Bob Crow. The headline from the Evening Standard screamed: "Tube Union boss Dies of Heart Attack." He was just 52 years old.
Despite advances in treatment of acute heart attacks with primary angioplasty many patients still die suddenly within minutes of the onset of chest pain. The problem with coronary disease is that sometimes the first symptom to alert the patient that something's wrong is when a lethal heart attack strikes. Many patients have not experienced symptoms before that to alter them that there might be a problem.
Coronary heart disease does not really have any outward physical signs and so detecting people who may have developed the condition but who have no symptoms is difficult. We recognise various risk factors for heart disease such as age, male sex, high blood pressure, diabetes, cigarette smoking, cholesterol and family history but many people have risk factors and do not develop coronary disease. What would be helpful is an outward physical sign, easily detected, which could alter doctors and patients alike that they might not just be at risk of heart disease but more importantly that they might already have diseased arteries. Over 40 years ago in Dr Sanders Frank reported just such a sign which is today has been forgotten by many doctors and is virtually unknown to patients.
In a brief letter published in the New England Journal of Medicine Dr Frank reported his observations of a prominent crease in the ear lobe which was usually present in patients he had seen with coronary artery disease. Initially he reported findings in just 20 patients but since then many studies have been completed confirming his findings. One study of over 1000 unselected patients looked at the presence of a diagonal ear lobe crease and coronary artery disease and found a high degree of correlation independent of age. In this study 112 consecutive patients had coronary angiography and an ear lobe creases was the best predictor of narrowed coronary arteries. Other studies followed which confirmed that ear crease was much more common in patients hospitalized after a heart attack compared to age-matched control subjects with no evidence of cardiac disease. These findings have also been repeated more recently using CT scans to detect coronary artery disease.
The presence of an ear lobe crease should alert doctors and patients to the possible presence of coronary heart disease. I don't know anything about Bob Crow's medical history but the picture above a close up of his ear with the ear lobe crease clearly visible. So my advice is clear - look at your ears and if your are under 60 years old and see this change mention it to your doctor.
Dr Richard Bogle
The opinions expressed in this blog are strictly those of the author and should not be construed as the opinion or policy of my employers nor recommendations for your care or anyone else's. Always seek professional guidance instead.