The NYTimes has an interesting photo of Obama on one of their articles. THIS PHOTO. Maybe it’s an optical illusion, but dang, his arm is long, and his fingers are long…and as a doc, it made me stare…

No problem. Probably tall and thin, like his father.

Several others in his African family have the long thin fingers PHOTO link

So no big deal. Half the basketball players in the world are like that.

But if he walked into

my office, and I saw those hands, the first thing I would think is: Arachnodactyly: Marfan Syndrome.

Photo from AllAboutArthritis, a corporate website that discusses Orthopedic problems.

What is Marfan syndrome, and should it be discussed as a health question if suspected in a Presidential candidate?

Yes and no.

Abraham Lincoln had it, so no, it doesn’t mean Obama can’t be president. But it does mean his doctors need to keep an eye on his aorta.

Political junkies can move on, because the rest of the article is about Marfan Syndrome.

Marfan Syndrome is common.(1 in 10,000 individuals). It is an inherited disorder, autosomal dominant, which means if you have it, half your kids will have it. However, it has variable expression, so that one person might have all the problems and another person have only a few symptoms or none.

It is a genetic defect where your connective tissue is weak.

Humans have all sorts of tissue, and connective tissue is what keeps everything connected. Doctor Chen has a nice article here if you want the biochemical details. But the easiest way to think of it is bad glue: that some of the stuff that keeps things together can stretch easily.

Unlike many syndromes, there is no ethnic variability, but like many genetic syndromes, some cases are probably genetic mutations, although given the fact that most cases of Marfan probably are so mild that they never get diagnosed, this is hard to prove.

Marfan Syndrome is a clinical diagnosis. That means there is no lab test. You diagnose it by old fashioned physical examination.

Many of these features are related to the bone and can include: Long face, high arched palate, long slender fingers, flat feet, spinal problems, and chest abnormalities (pectus excavatum).

Except for the last one, these problems are not medical problems.

Since your ligaments are lose, you are prone to get scoliosis (crooked back). You might be double jointed. the arm span is longer than the height of the body, and you can pull your thumb down until it hits your wrist.

And because the connective tissue holding the lens of the eye is weak, one problem is that people with Marfans are prone to get their lens dislocated. The eye is also prone to nearsightedness and iris problems.

So who cares? Why worry if someone might have Marfan Syndrome?

And the answer is: In some patients, the connective tissue of the heart valves and the Aorta are also weakened in the syndrome, and this can lead to disaster if not watched carefully.

You can be born with a weak Mitral valve, leading to the need for cardiac surgery as a child. You can develop problems with Mitral Valve prolapse.

But for adults, the danger is the aorta: The Aorta can dilate (balloon up) where it meets the heart. This messes up the Aortic valve. And the weakness of the Aorta makes it prone to develop a devastating disease called dissecting Aortic Aneurism.

A dissecting Aortic aneurism is what killed John Ritter (who did not have Marfan’s) and it is not only dangerous even when treated, it is also something that is rare and easily overlooked, since the symptoms are similar to those of an ordinary heart attack. Our First Gentleman Mike was diagnosed and treated when his started to dissect, so it is not necessarily fatal if you diagnose it in time.

So what do you do if you think you have Marfan syndrome?

Don’t panic.

Get your doctor to check you out, and have him/her listen to your heart, and maybe order a Cardiac ultrasound.

If you have Marfan syndrome, get regular checkups by your eye physician and have your doctor keep an eye on your heart with examination and with ultrasounds, or if there is a problem, with the newer MRI/MRA examinations.

High blood pressure and pregnancy can make things worse, but a lot of patients can lower their risks with medicines, including beta blockers.

If you get chest pain, let the Emergency room doc know you have Marfan syndrome.

This is only a superficial summary, so if you want more information, go to the National Marfan Foundation website.


Nancy Reyes is a retired physician living in the rural Philippines. She writes medical essays at HeyDoc Xanga Blog. 

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