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June 2007

Signs of a “Broken Heart”: Suspected Muehrcke Lines After Cardiac Surgery

Arch Dermatol. 2007;143(6):799-816. doi:10.1001/archderm.143.6.815-b

Muehrcke lines are double white transverse bands of the nail bed. They were first described by their namesake in 19561 as a manifestation of severe hypoalbuminemia. This hypoalbuminemia is thought to cause localized edema of the nail beds with compression and constriction of subungual vasculature. The transverse bands are parallel to the lunula and do not correspond to bony prominences of the underlying phalanges. This nail change is not permanent, and with normalization of albumin levels, the lines resolve.2 Application of pressure to the fingertip is classically reported to cause blanching of the nail bed and disappearance of the lines, confirming their location in the nail bed.3 A case of Muehrcke lines after placement of left ventricular assist device (LVAD) and subsequent orthotopic cardiac transplantation is described herein.

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