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 the identification of angioedema, the technique of the lumbar puncture, and the description of what is now known as idiopathic intracranial hypertension.[4]

Quincke’s sign, similar to the other signs of chronic severe aortic insufficiency, is a result of 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 any 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]

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]

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 care to the patient.

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.