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Frank's Sign

Frank's Sign - The diagonal earlobe crease as a predictor of heart disease and stroke.

by Nurse Eric

This article is intended for educational purposes only.


Since starting my career as a nurse in 2012 I've been intrigued by the bedside physical assessment signs that point to inward disease because I believe that a nurse who can identify problems before they become deadly can save lives. 

Here's a link to a video I made telling the story of how I learned about Frank's Sign.

Take a look at this comment I received on this video about Frank's Sign. I think it's incredible that someone followed through to get a CT scan because of what they saw in their earlobes. Look at what it said. It's good he followed through.

Frank's sign is one of those outward signs that can point to some big problems. Think of it like the canary in the coal mine. Poor canaries! 

Coronary Artery Disease and Risk for Stroke are both associated with the Frank's Sign (Auricular Earlobe Crease). 


Click on the photos below for a closeup view of the earlobe crease.

Alan Thicke died of a heart attack and has the diagonal earlobe crease.

J Edgar Hoover died of a heart attack and has the diagonal earlobe crease.

Orson Welles died of a heart attack and has the diagonal earlobe crease.

(Stroke) In this article, I will explore the literature, anatomy, and physiology behind the diagonal earlobe crease and it's known correlation with specific diseases.

Click on the photo below for a closeup view of the earlobe crease.

Luke Perry had the diagonal earlobe crease and suffered an early death related
to a cerebral vascular accident (stroke) at age 52.

So why does the earlobe crease occur anyway? I wondered that myself so I looked up the anatomy of the ear and found the arteries give us a clue. The earlobe itself is actually supplied by two arteries one from the top and one from the bottom. Look at these pictures that show the earlobe is perfused by both the anterior and posterior arteries. The crease shows up right in the middle of where these two arteries perfuse the earlobe. Could lack of blood flow related to narrowing of those arteries leads to tissue atrophy?

I think that's a plausible explanation don't you

There are two ways to describe or classify the diagonal earlobe crease.

The first way is by description

  • Unilateral incomplete – least severe
  • Unilateral complete
  • Bilateral complete – most severe

The second way is to classify by grade

  • Grade 1 – a small amount of wrinkling on the earlobe

  • Grade 2a – superficial crease (floor of sulcus visible) across the earlobe

  • Grade 2b – crease more than 50% across the earlobe

  • Grade 3 – deep cleft across whole  of the eralobe (floor of sulcus not visible)

These classifications have been used in studies 

Metabolic Syndrome

Metabolic syndrome is associated with various individual conditions as seen in the info-graphic below but are thought to have a similar cause. It is very important to consider that most of the conditions below, including heart attack and stroke are potentially avoidable or delayed with adjustments in nutrition and daily activity that is more consistent with what is optimal for humans. Genetic factors are also involved so it is important to make diet and lifestyle adjustments where possible and to seek state of the art medical advice for those factors that are genetically related.

Using the Earlobe Crease in Practice

There are two opportunities when knowing this information could be the most helpful. 

1. First responders who are faced with a scenario where the cause of the problem could be cardiac or pulmonary related would have a bit of evidence pointing towards cardiac. 
2. Primary care providers could use this information as an indicator to look further into the patients history or to order more diagnostics to look at the patients risk profile for coronary artery disease and stroke.

Coronary  Artery Calcium Scan

So, what should you do if you have a positive Frank's Sign? First things first is that you need make an appointment to see a cardiologist to be evaluated for other risk factors of coronary artery disease. They may recommend a coronary artery calcium scan (CAC). This scan is non-invasive and has a 98% specificity. More details about the CAC can be found at this link.

 Infographic retrieved from:

This article is a work in progress like all of my blog posts. Subscribe to my blog to stay up to date on my work if you find it of interest. You can also follow me on Twitter and Instagram @nurseericyeah To your health... Cheers!


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