“The Moustache Sign”: A Common Morphological Characteristic in Cardiovascular Disease Treatment

Vineet Bhatia*, Parneesh Arora, Anunay Gupta, Suman Bhandari and Upendra Kaul

“The Moustache Sign”: A Common Morphological Characteristic in Cardiovascular Disease Treatment.

There are multiple eponymous medical signs in the field of cardiology. These “signs” refer to significant physical findings or observations made by the cardiologist while evaluating the patient.
We hereby describe and summarize all the conditions in which “moustache sign”, a commonly occurring observation, is seen in the field of cardiology. The importance of signs like these is that
they help in earlier recognition of the disease pathophysiology and in the management of patients.

The first example is identification of the left anterior descending artery (LAD) on coronary angiography. The LAD bifurcates at the apex akin to a moustache or the bifid tail of a whale
(Figure 1) and is variously described as “whale tail sign”, “pitchfork sign” or “Moustache sign”.1
This feature helps us to identify this coronary artery in case of any anatomical confusion (may help
identify Dual LAD morphology) and is also used as the distal landmark while calculating the thrombolysis in myocardial infarction (TIMI) frame count.

A second one is digitalis effect, the morphology of the QRS complex/ST segment in patients who have achieved therapeutic levels of digitalis in their circulation. Another observation is the stag’s “antler sign” which refers to the upper lobe pulmonary venous diversion in pulmonary venous hypertension or pulmonary edema as seen on frontal chest radiograph. This prominence of upper lobe pulmonary veins, resemble a stag’s antlers. It is the earliest sign of pulmonary venous hypertension (grade 1 pulmonary edema). This sign is also known as “hands-up sign” or “inverted moustache sign”.

Heart Res Open J. 2019; 6(1): 1-3. doi: 10.17140/HROJ-6-148