Inspect the Facies

Abnormalities of the heart may also be associated with peculiarities of the face and head. Supravalvular aortic stenosis, a congenital problem, occurs in association with widely set eyes, strabismus, low-set ears, an upturned nose, and hypoplasia of the mandible. Moon facies and widely spaced eyes are suggestive of pulmonic stenosis. Expressionless facies with puffy eyelids and loss of the outer third of the eyebrow is seen in hypothyroidism. Affected individuals may have a cardiomyopathy. The earlobe crease, or Lichtstein's sign, is an oblique crease, often bilateral, seen frequently in patients older than 50 years with significant CHD. This sign is shown in Figure 14-17. Although it is a useful sign, there are too many false-positive and false-negative findings for this sign to be very reliable.

Figure 14-16 Splinter hemorrhages.
Figure 14-17 Earlobe creases.

*The serum triglyceride concentration for an adult is normally lower than 200 mg/dL.

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