Can ear creases be used to diagnose myocardial ischemia in coronary heart disease? Rumor: It has little clinical value

I personally rescue hundreds of myocardial infarction patients and treat thousands of heart disease patients every year. I have never used the earlobe crease method to diagnose coronary heart disease.

Even in patients with typical coronary heart disease such as myocardial infarction and angina pectoris, we rarely see creases on their ears. We have a very practical and accurate method for diagnosing coronary heart disease, rather than looking at earlobe creases.

1. How to judge the origin of coronary heart disease by earlobe crease

I remember that last time I commented on this matter, there were many "hackers". These hackers were not real high-tech hackers, but people who hacked others for fun. They scolded me for not understanding Chinese medicine, saying that Chinese medicine can only determine whether there is coronary heart disease by looking at the earlobe.

Let me repeat again, looking at the earlobe creases is not a diagnostic method of traditional Chinese medicine, but a diagnostic method of Western medicine.

In 1973, the medical journal "New England Journal of Medicine" reported that Dr. Sanders T. Frank found that earlobe creases were related to coronary heart disease. This phenomenon was first called Frank's sign, and some people also called it "ear fold sign". Since then, some people have believed that earlobe creases are a sign of coronary heart disease. In 2014, the results of the Copenhagen Heart Study, which followed 20,000 people for 35 years, showed that 60% of patients with positive Frank's sign had coronary heart disease, which can be said to be a very important predictive factor.

What does the book say? Whether it is teaching textbooks or the various "Practical Internal Medicine" and "Cardiology" that we often use, there are very few books that record the relationship between earlobe folds and coronary heart disease. One version of "Cardiology" records the conclusion of a survey in the 1970s, that is, the conclusion of the survey by Dr. Sanders T. Frank. Most books on the heart do not have such records, which means that they are not very instructive for doctors. Some people also say that the possible mechanism of the occurrence of earlobe folds is mainly related to special sleeping postures, genetic background, premature aging, oxidative stress, collagen degradation, etc. But none of them can be clarified. In other words, the mechanism is unclear, but only possible. In addition, this kind of investigation is limited to a small range, and its authenticity needs further verification.

To be frank, I said that people with white hair have a higher incidence of coronary heart disease, which is definitely correct, because as people age, the number of people with white hair increases, and the incidence of coronary heart disease continues to rise. So can I say that white hair is a sign of coronary heart disease? Obviously not!

When we discover some rules or phenomena, especially in medical diagnosis, they must be meaningful and valuable for the clinical diagnosis of diseases. The higher the accuracy, the more meaningful they are. They are not rarely used, let alone a discovery from decades ago that is repeatedly said. Don’t you think it’s boring to say that earlobes can diagnose coronary heart disease?

2. How do cardiovascular doctors diagnose coronary heart disease?

First, let us first clarify what coronary heart disease is. Simply put, when the heart artery narrows by more than 50%, it is called coronary heart disease.

We cardiovascular doctors need to make a comprehensive assessment of whether a person has coronary heart disease based on symptoms, high-risk factors, electrocardiogram, exercise test, coronary CT or coronary angiography.

1. The most accurate method is coronary CT or coronary angiography. These two examinations can intuitively see whether the heart and blood vessels are narrowed and how much the narrowing is. If the narrowing is more than 50%, then coronary heart disease can be diagnosed.

But we cannot ask every person suspected of coronary heart disease to undergo a CT scan or angiography. On the one hand, it is expensive, on the other hand, it has side effects, and on the other hand, it is unnecessary.

2. The more high-risk factors a person has, the more likely he is to develop coronary heart disease, such as family history, smoking and drinking, obesity, sitting for long periods of time without exercise, unhealthy diet, staying up late, stress, high blood pressure, diabetes, hyperlipidemia, high homocysteine, etc. The more risk factors a person has, the more likely he is to develop coronary heart disease.

3. For patients with typical symptoms, angina pectoris may occur in patients with cardiovascular stenosis exceeding 70%. If angina pectoris can be diagnosed, coronary heart disease can be diagnosed. Angina pectoris has many manifestations, such as chest pain, precordial pain, chest tightness, headache, toothache, back pain, shoulder pain, upper abdominal pain, sweating, etc., which may be angina pectoris. It often occurs after activities, lasts for 20-15 minutes each time, and can be relieved after rest.

4. If there are symptoms of angina pectoris, we can diagnose coronary heart disease based on the typical symptoms of angina pectoris, combined with changes in the electrocardiogram, or exercise electrocardiogram test. If it is positive, then coronary heart disease can also be diagnosed. Of course, if there is a high degree of suspicion, coronary CT or angiography must be performed to further confirm the diagnosis.

In short, we will make a comprehensive judgment on whether there is coronary heart disease based on symptoms, high-risk factors, electrocardiogram, exercise test, and even coronary CT or coronary angiography. This comprehensive approach is very accurate and rarely misdiagnoses.

3. Are earlobe folds valuable?

Some people say that if you have earlobe creases and you have high risk factors for coronary heart disease or symptoms of angina pectoris, you should get a thorough check-up; if you have earlobe creases but no high risk factors for coronary heart disease and no typical symptoms of angina pectoris, there is no need to worry.

But let me ask you, is this earlobe wrinkle worth half a cent?

The above statement can also make sense if you replace the earlobe wrinkles with a dog.

If you have a dog at home and also have high risk factors for coronary heart disease or symptoms of angina pectoris, you should get it checked out; if you have a dog at home but it does not have high risk factors for coronary heart disease or typical symptoms of angina pectoris, there is no need to worry.

Those who say that earlobe creases are valuable and meaningful, please answer what value and significance do earlobe creases have in helping us diagnose coronary heart disease?

In short, we judge whether there is coronary heart disease by combining high-risk factors, symptoms, electrocardiogram, dynamic electrocardiogram, exercise test, or myocardial radionuclide, coronary CT, coronary angiography, etc. This is not only valuable and meaningful, but also accurate!