Quincke Sign


Definition/Introduction

Quincke’s sign, also known as Quincke’s pulse, represents the visualization of capillary pulsations upon light compression applied to the tip of the fingernail bed. It is an eponym associated with chronic severe aortic insufficiency.[1] A patient exhibiting this sign will have alternating reddening and blanching of the nailbed with each pulsation.[2] This sign can be further enhanced with the use of illumination.[3]

Quincke’s sign was named after Dr. Heinrich Quincke, who first coined the term in 1868.[4] He was a German physician who contributed numerous medical discoveries, including identifying angioedema, the technique of the lumbar puncture, and the description of what is now known as idiopathic intracranial hypertension.[4]

Issues of Concern

Quincke’s sign, similar to the other signs of chronic severe aortic insufficiency, results from a widened pulse pressure, with an increased systolic stroke volume and rapid decrease in arterial pressure.[5] While this sign is most prominently demonstrable in patients with chronic severe aortic insufficiency, it can also occur in asymptomatic patients without valvular heart disease. Therefore, the sensitivity and specificity for screening and establishing a diagnosis with this isolated sign are poor.[6] “Pseudo-Quincke’s pulse” has been characterized in a case report describing a patient with keratoderma whose manifestations were from sclerodactylous compression of the nailbed.[7] Any physical exam finding can be suggestive of a condition; however, it requires supporting objective confirmation before proceeding with further management.[8]

Clinical Significance

Quincke’s sign is one of several signs exhibited in patients with chronic severe aortic insufficiency.[5] The quintessential finding for aortic insufficiency is an early diastolic, decrescendo murmur, which is best auscultated at the sternal border.[9] Some other associated physical exam findings include Becker’s sign, Corrigan’s (water-hammer) pulse, de Musset’s sign, Duroziez’s sign, Hill's sign, Müller’s sign, and Traube’s sign.[10] An observant clinician can quickly identify concerning signs of cardiac valvular disease on physical exam, which is confirmable with the use of transthoracic echocardiography.[11]

Nursing, Allied Health, and Interprofessional Team Interventions

Quincke’s sign is an infrequently encountered physical exam finding. When this sign appears in a patient, the healthcare provider must complete a thorough physical examination with detailed attention paid to the cardiovascular exam. Proper documentation when describing physical exam findings in an electronic medical record is necessary for interprofessional communication. Signs and symptoms of valvular heart disease must then have further support with a transthoracic echocardiogram. Coordinated patient-centered care is required between the primary physician, nursing staff, cardiologist, and cardiothoracic surgeon to provide the best possible patient care.

Nursing, Allied Health, and Interprofessional Team Monitoring

Of the healthcare providers, the nursing staff has the most prolonged interaction with the patients. At times, they can be the first to encounter any new symptoms or physical exam findings. The nursing staff must communicate any abnormalities to the physicians. Integrated patient-centered care between healthcare providers is essential in achieving improved patient outcomes.


Article Details

Article Author

Aqsa Z. Sorathia

Article Editor:

Michael P. Soos

Updated:

2/17/2022 11:06:59 PM

PubMed Link:

Quincke Sign

References

[1]

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[2]

Michelena HI,Enriquez-Sarano M, Corrigan's Pulse and Quincke's Pulse. The New England journal of medicine. 2018 Aug 2;     [PubMed PMID: 30067925]

[3]

Mizuno A,Niwa K, Pocket flashlight-elicited Quincke pulse for aortic dissection diagnosis. The Korean journal of internal medicine. 2013 Sep;     [PubMed PMID: 24009465]

[4]

Heinrich Ireanaeus Quincke (1842-1922--clinician of Kiel. JAMA. 1966 Jun 27;     [PubMed PMID: 5327866]

[5]

Akinseye OA,Pathak A,Ibebuogu UN, Aortic Valve Regurgitation: A Comprehensive Review. Current problems in cardiology. 2018 Aug;     [PubMed PMID: 29174586]

[6]

Sapira JD, Quincke, de Musset, Duroziez, and Hill: some aortic regurgitations. Southern medical journal. 1981 Apr;     [PubMed PMID: 7013091]

[7]

Norton SA, Keratoderma with pseudo-Quincke's pulse. Cutis. 1998 Sep;     [PubMed PMID: 9770128]

[8]

Babu AN,Kymes SM,Carpenter Fryer SM, Eponyms and the diagnosis of aortic regurgitation: what says the evidence? Annals of internal medicine. 2003 May 6;     [PubMed PMID: 12729428]

[9]

Otto CM, Heartbeat: Improving diagnosis and management of aortic valve disease. Heart (British Cardiac Society). 2018 Nov;     [PubMed PMID: 30366931]

[10]

Ashrafian H, Pulsatile pseudo-proptosis, aortic regurgitation and 31 eponyms. International journal of cardiology. 2006 Mar 8;     [PubMed PMID: 16503268]

[11]

Capoulade R,Pibarot P, Assessment of Aortic Valve Disease: Role of Imaging Modalities. Current treatment options in cardiovascular medicine. 2015 Nov;     [PubMed PMID: 26391799]