A Handful of Clues to Uncover Cardiovascular Disease

Clues revealed during physical examination can inform physicians and other health care providers about potential heart related concerns.  In this regard, examination of the hands can be quite revealing, especially if the patient had been unaware that any such issue existed.  Shown below are some hand-related clues that we’ve encountered in our medical center.

1. Yellowish-orange discoloration in palm creases: Yellowish-orange discoloration in palm creases of the hand may be seen in a rare medical condition (familial dysbetalipoproteinemia) associated with high triglycerides and increased risk of heart disease.
2. Little Bumps on the back of the hands: Cholesterol deposits on tendons (known as xanthomas) may appear as little bumps resembling knuckles on the back of the hand.  They are due to very high levels of LDL cholesterol found in a rare medical condition (familial hypercholesterolemia) and associated with an increased risk of cardiovascular disease.
3. Bony swellings in the thumb and fingers: These swellings occur in the base of the thumb, fingertip joint and the middle joint of the fingers due to “wear-and-tear” or osteoarthritis. Inflammation results in painful hands and increased risk of heart disease.
4. Blue clubbed fingernails. First described by Hippocrates, clubbing or enlargement of the fingertips and downward sloping of the nails occurs when blood levels of oxygen are low over time and is associated with certain types of congenital heart disease.
5. Raised red circular nodules. “Osler’s nodes” are raised reddish appearing nodules that are tender to touch and found on fingers and fleshy area of the hand (thenar eminence). They consist of small clots (micro-emboli) due to endocarditis (bacterial/fungal infection of the heart).
6. White spots on the fingernails. White spots on the fingernails may be a sign of calcium or zinc deficiency. Severe calcium deficiency adversely affects the heart’s conduction system and may cause a dangerous heart rhythm (Torsade de Pointes).
7. Discoloration of the Fingers. Raynaud’s disease includes discoloration of the fingers/toes (red/white/blue) in response to cold temperatures or emotional stress and is associated with reduced blood flow to heart muscle and increased risk of cardiovascular death.

 

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  For additional clues to protect your heart, check out Dr. Miller’s latest book, “Heal Your Heart“.