Frank's Sign as a clinical marker of cardiovascular disease

This distinct bilateral diagonal ear lobe crease (Figures 1 and2) was noticed in an 85-year-old gentleman who presented to the ambulance service with chest tightness and shortness of breath at rest. He told the ambulance crew that he had previously had problems with his breathing and his heart. He received pre-hospital treatment from the paramedic crew with 300 mg oral aspirin, 400 mcg sublingual glyceryl trinitrate and 5 mg of intravenous morphine sulphate. After serial 12-lead electrocardiograms and repeat serum troponin levels, he was diagnosed with a non-ST-elevation myocardial infarction (NSTEMI); the cause for his chest tightness and shortness of breath. He received medical management of his NSTEMI on the High Dependency Unit, and was discharged home a month later.

In the out-of-hospital environment, the availability of a comprehensive past medical history may be limited and the range of investigations available to the healthcare provider is restricted. As a result, pre-hospital care providers must ensure that their history taking and physical examination skills are highly developed. In this case, the patient presented with a history suggestive of either respiratory or cardiovascular pathology. In cases where there is a lack of detailed medical history, and biochemical testing is not readily available, any further information to aid a diagnosis, risk stratification and subsequent management plan is vital to the clinician.