Page 31 - Clinical Pearls in Cardiology

History and General Examination 19

However, embolic splinter hemorrhages that occur in
infective endocarditis are subungual and they usually do
not extend to the distal nail edge. Fresh red hemorrhages,
especially at the base of nail, are more important than
brown linear streaks near the tip of the fingers (Fig. 5).
30. How is koilonychia related to heart disease?
Koilonychia or spoon-shaped nails is a feature of iron
deficiency anemia. Anemia can worsen myocardial
ischemia and left ventricular dysfunction by causing
hyperdynamic circulatory state. Hence it is very
important to examine the nails carefully in a person with
cardiac disease (Fig. 6).

Fig. 6: Nail in koilonychia

31. Which kind of corneal arcus is associated with
hypercholesterolemia?
The corneal arcus associated with hypercholesterolemia
is a thick yellowish band that begins inferiorly and
it does not extend to the rim or limbus of the iris
(Fig. 7). This allows a thin rim of iris pigment to be seen