Heart disease: 12 warning signs that appear on your skin

Warning signs can appear on your skin and nails, which is why your dermatologist may be the first doctor to notice that you have heart disease. If you know what to look for, you can also find warning signs of heart disease on your skin and nails. The following pictures show you what to look for.

1. Swelling in your feet and lower legs

   

   What it may be telling you: Your heart isn’t working properly.
   
   Many diseases of the heart cause fluid to build up in your feet and lower legs. As the fluid builds up, you may see swelling, which can extend as far as the upper legs and groin.
   
   Medical name: Edema (medical term for swelling)

2. Blue or purple color on your skin
   
   What it may be telling you: You have a blockage in a blood vessel.

   

   When you’re extremely cold, your skin can turn blue (or purple). If an area of your skin is blue (or purple) when you’re warm, that’s can be a sign your blood isn’t getting enough oxygen. The patient in this photo has a condition known as blue toe syndrome, which happens when one or more blood vessels are blocked.
   
   Without treatment, the lack of oxygen can cause the skin and underlying tissue to eventually die.
   
   Medical name: Cyanosis (refers to the bluish color on the skin)

3. Blue or purple net-like pattern on your skin
   
   What it may be telling you: You have a blocked artery.

   

   Some people see this pattern on their skin when they feel chilly. When their skin warms up, this pattern disappears. It’s also possible to see this pattern when taking certain medications. If one of these is causing the netlike pattern, it’s usually nothing to worry about.
   
   This netlike pattern can also be a sign of a disease called cholesterol embolization syndrome, which occurs when small arteries become blocked. The blockage can lead to damaged tissues and organs, so it’s important to see a doctor to find out whether you have an undiagnosed disease.
   
   Medical name: Livedo reticularis (medical term for the net-like pattern)

4. Yellowish-orange, waxy growths on your skin
   
   What it may be telling you: You have unhealthy cholesterol levels.

   

   If you see yellowish-orange growths on your skin, you may have deposits of cholesterol under your skin. These painless deposits can appear in many areas, including the corners of your eyes, lines on your palms, or the backs of your lower legs.
   
   If you notice these growths on any area of your skin, see your doctor. You may need cholesterol testing or another medical test. Unhealthy cholesterol levels require treatment, which can prevent life-threatening heart disease. Getting your cholesterol levels under control may also help clear the growths on your skin. If the growths don’t clear, a board-certified dermatologist can treat them.
   
   Medical name: Xanthelasma (cholesterol deposits on the eyelids), Xanthoma (cholesterol deposit found elsewhere on the skin)

5. Clusters of waxy bumps that suddenly appear on your skin
   
   What it may be telling you: You have skyrocketing cholesterol levels or diabetes.

   

   The sudden appearance of these bumps can look like a rash, warts, or a contagious skin condition called molluscum contagiosum. These bumps are actually fatty deposits of cholesterol caused by extremely high levels of triglycerides (type of cholesterol) in the blood.
   
   Treatment is essential to lower the triglycerides and treat any serious medical conditions, such as heart disease caused by the high cholesterol levels.
   
   Medical name: Eruptive xanthoma (refers to the sudden appearance of many fatty deposits of cholesterol)

6. Nails curve downward and the ends of your fingers are swollen

   

   What it may be telling you: You may have a heart infection, heart disease, or lung problem. For many people, these signs are harmless. That said, if your fingers and nails look like this, it’s best to find out if you may have a medical condition, such as lung disease or a heart problem.
   
   Medical name: Clubbing (term describes the downward turned nails and swollen fingers)

7. Red or purple lines under your nails
   

   

   What it may be telling you: Most people who see these lines under their nails have injured the nail in some way. If you cannot remember injuring your nail, you may want to see your doctor. These lines can be a sign of heart disease or another condition.
   
   When it’s a sign of heart disease, people tend to have symptoms, such as high fever and a weak or irregular heartbeat.
   
   Medical name: Splinter hemorrhage (line often looks like a splinter stuck under the nail)

8. Smooth, waxy lumps on your skin
   

   

   What it may be telling you: You have protein deposits in your heart or another organ.
   
   These waxy lumps can appear anywhere on the skin. They often indicate that there’s an abnormal buildup of protein in an organ, such as your heart. If protein builds up in the heart, it’s hard for the heart to work properly.
   
   Medical name: Nodules of systemic amyloidosis (“nodule” means lump and amyloidosis refers to the type of protein that has built up)

9. Painful lumps in your fingers, toes, or both
   

   

   What it may be telling you: You have an infection in your heart or blood vessels.
   
   If you have a heart infection known as infective endocarditis, these painful lumps can develop in your fingers, toes, or both places. The lumps can last for a few hours to several days.
   
   While the lumps go away on their own, patients need treatment for the infection. Because this infection is caused by bacteria, antibiotics can often treat it. Sometimes, surgery is also necessary.
   
   Medical name: Osler nodes. A doctor named Osler discovered the connection between a patient having these lumps, which are now called Osler nodes, and a heart infection.

10. Brownish (or reddish) discoloration, usually on your sole(s) or palm(s)
    

    

    What it may be telling you: You have an infection in your heart or blood vessel.
    
    The spots that developed on the bottom of this patient’s foot are also a sign of a heart infection called infective endocarditis. Unlike Osler nodules, these spots are painless. These spots will clear without treatment, usually in a few days or weeks. The infection requires treatment.
    
    Medical name: Janeway lesions, which are named after an American doctor, Theodore Caldwell Janeway.

11. Non-itchy rash (flat spots with slightly raised edges) and fever
    

    

    What it may be telling you: You have rheumatic fever.
    
    If your child develops strep throat, treating it quickly is important. When it’s not treated quickly, other medical problems can develop. One such problem is rheumatic fever. While this seldom happens in the United States today, rheumatic fever is common in developing countries.
    
    When a child has rheumatic fever, it can lead to lifelong heart disease. Rheumatic fever is a leading cause of heart disease in children.
    
    Medical name: Erythema marginatum (name of the rash shown in this picture)

12. Rash and cracked, swollen lips that often bleed


    

    What it may be telling you: A child has Kawasaki disease.
    
    When a child has a rash, fever, and extremely dry lips that may crack and bleed, Kawasaki disease is a likely cause. This disease, which affects the blood vessels, usually develops in children between the ages of 6 months and 5 years of age.
    
    While Kawasaki disease may go away on its own within 12 days without treatment, it can lead to serious side effects, such as heart disease.
    
    Medical name: Mucocutaneous lymph node syndrome (another name for Kawasaki disease)

Other signs that appear on the skin and can be a warning sign of heart disease, include:

• A gray ring around the colored part of your eye

• Changes to your tongue, such as it swelling and turning red as a strawberry

• Discolored skin

If you notice any of these signs, make an appointment to see your primary doctor and try to stay calm. The sign could be harmless, but it’s important to get it checked out. Heart disease is easier to treat when found early.

Images
Images 1, 5, 6, 7, 8, 10: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Images 2, 3, 4, 9, 12: Used with permission of Journal of the American Academy of Dermatology:

• (2 and 9) J Am Acad Dermatol. 2009; 60(1):1-20.

• (3) J Am Acad Dermatol. 1999;41:842-4. (Fig 2)

• (4) J Am Acad Dermatol. 2017;77:728-34. (Fig 3A)

• (12) J Am Acad Dermatol. 2013;69:501.

Image 11: Used with permission of DermNet NZ. Last accessed May 11, 2018.

References
Hirschmann JV and Raugi GJ. “Blue (or purple) toe syndrome.” J Am Acad Dermatol. 2009; 60(1):1-20.

Khanna N, Roy A, et al. “Janeway lesions: an old sign revisited.” Circulation. 2013; 127(7):861.

Misin A, Di Bella S, et al. “Image of the month: ‘Diagnostic hands’: Janeway lesions.” Clin Med (Lond). 2017; 17(4):373-374.

Uliasz A and Lebwohl M. “Cutaneous manifestations of cardiovascular diseases.” Clin Dermatol. 2008; 26(3):243-54.