Hearing and Heart Disease (Frank's Sign)
A recent review of the literature by Friedlander et al 2011 concluded Frank's Sign to be a valuable physical sign able to distinguish some patients at risk of atheroma of the coronary arteries. Some of the studies reviewed made strong correlations with cardiac events with one prospective study showing 10.4 events per hundred patient years in cases with DELC but no heart issues across 6-8 years compared to only 1.4 for those without the sign.
Over the years numerous follow up studies have been undertaken with the majority concurring with Frank’s original observation and a minority finding no such correlation. More recent studies have found that DELC is “a valuable extravascular physical sign able to distinguish some patients at risk from succumbing to atherosclerosis of the coronary arteries” (Friedlander et al 2011). Other studies using ultrasound have associated DELC with atherosclerosis of the carotid arteries a known risk factor for stroke.
There exists an interesting historic connection with Emperor Hadrian and Frank’s sign. Apparently early Greek sculpture was renowned for its anatomical accuracy with Hadrian’s bust exhibiting a clear Frank’s sign. Given that Hadrian was considered to have expired from congestive heart failure we are somewhat indebted to those masterful Greek sculptors for giving us a look back in time to wonder if Frank’s sign has indeed been with us for millennia.