The Heart & the Hand

A man's hands can tell a lot about him--the kind of work he does, his attention to personal cleanliness, the extent of his vanity. Now, in the opinion of some modern cardiologists, the hand is a valuable clue not only to a man's occupation and habits, but also, in many cases, to the condition of his heart.

Dr. Mark E. Silverman and Dr. J. Willis Hurst of Atlanta's Emory University School of Medicine presented their latest hand-and-heart findings to the American College of Cardiology last week. Although the cause and nature of a heart defect or disorder are often obscure, the doctors suggested that these may become apparent to "the cardiovascular sleuth who lingers a moment longer at the radial (wrist) pulse to inspect the hand closely."

Simian Crease. Countless babies are born with genetic heart defects and in many of these cases the genetic defect has visible, external effects as well as internal ones. The most obvious example: mongolism, technically known as Down's syndrome, in which there may be heart defects along with abnormalities of the hands--flabbiness, thickness, a short fifth finger and a "simian crease" across the palm. Several other genetic, chromosomally determined defects have comparable telltale hand signs.

More surprising was Dr. Silverman's report that heart disease acquired relatively late in life--including coronary occlusion--may be signaled by changes in the hand. Warm, moist hands with a fine tremor and occasionally clubbing* of the fingers, he said, suggest the possibility of an overactive thyroid with resulting inefficiency of the heart, and twitching of its upper chambers. A cold hand with coarse, puffy skin may be due to an underactive thyroid, and associated with fluid in the heart sac, a high blood-level of cholesterol, and even necrosis of part of the heart muscle from a coronary occlusion.

And Cancer Too. The clenched fist of a patient describing his chest pain is a vivid illustration of the discomfort at the time of an occlusion. About two weeks after an otherwise undetected occlusion, the patient may have a hand (usually only one) that is swollen, shiny, discolored and stiff. The stiffness comes from thickening of the fibrous layer just below the skin down the middle of the palm. It may pull the fingers together and sometimes also downward. Skin thickening and stiffness of this type may be the signs of a previous and hitherto-undetected coronary occlusion.

Even lung disease, including cancer, may be reflected in the hands, said Dr. Silverman. Emphysema, the currently common disease marked by inadequate oxygen intake at the lungs' surface, may produce clubbing of the fingers. The type of cancer that occurs most commonly in long-term male cigarette smokers may eventually lead to acutely painful clubbing of the fingers and equally painful enlargement of the toe joints.

Typical of rheumatoid arthritis, which may have several adverse effects upon the heart, said Silverman, is an outward turning of the fingers (with the hand viewed palm-down), along with thickening of the finger joints. In many hard-to-diagnose cases of heart disease, say the Atlanta doctors, the skilled physician's careful observation of the hands will yield valuable clues that the stethoscope and even the electrocardiograph do not disclose.

* Thickening of the fingertip tissue.

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