|
Headlines:
|
 |
Back to Cardiovascular Diseases
Raynaud Phenomenon
Definition
Raynaud's phenomenon (RP) is the abrupt onset of digital (fingertips)
pallor and/or cyanosis (bluish discoloration) in response to cold exposure
or stress.
Mechanism (pathophysiology)
RP is due to changes in the flow of blood to the fingertips. When the
finger is white or pale, there is very little blood in the finger. When
the fingertip is blue, there is blood present but the flow is so slow that
the oxygen has left the blood, turning the blood blue rather than red.
Classification and causes
When there is no evidence of an underlying illness, this condition is
termed "primary" RP. RP can, however, be an early symptom of an underlying
disease and, in those cases, is "secondary" RP. Any condition that
slows blood flow to the fingertips may cause RP.
Illnesses associated with RP include atherosclerosis ("artery hardening"),
abnormal proteins in the blood, a blood vessel disease caused by smoking
(Buerger’s disease), inflammation in the blood vessels (vasculitis) and
by several autoimmune connective tissue diseases.
The connective tissue diseases most likely to cause RP are scleroderma,
dermatomyositis, and systemic lupus erythematosus. Rheumatoid arthritis
can sometimes cause RP. RP is a nearly universal symptom of scleroderma
(occurs in up to 90% of the patients) and is the most common first symptom.
Several decades may pass from the time of onset of RP until the diagnosis
of scleroderma is made. In other cases, the nature of the scleroderma is
evident shortly after, or even before, the onset of the RP.
Clinical picture (symptoms and signs)
Most often Raynaud's phenomenon affects the fingers and toes. It can
also affect the ears and nose. One’s fingertips turning blue or white upon exposure to cold. The color
returns to normal on warming. The cold exposure can be in any of several
forms, including cool ambient temperatures, picking up a cool object or
drinking a cool drink. Sometimes people who experience RP notice that the
fingertip turns red after the blue or white period. RP episodes may last
minutes to hours, but are most often about 10 to 15 minutes long. People
frequently have episodes associated with driving in cold weather, opening
the food freezer, drinking cold drinks, and entering air-conditioned areas.
RP is a common trait among perfectly healthy people. Between 5 and 10%
of healthy people have RP.
|
|
|
|
Are you a doctor or a nurse?
Do you want to join the Doctors Lounge online medical community?
Participate in editorial activities (publish, peer review, edit) and
give a helping hand to the largest online community of patients.
Click on the link below to see the requirements:
Doctors Lounge Membership
Application |
|
Treatment
In patients with mild vasospastic attacks, reassurance
about the benign nature of the disease and instructions on how to prevent
attacks are often all that is needed. Mittens are better than gloves for
keeping the hands warm. Patients need to be especially careful when handling
cold objects. Hand and foot warming devices (battery operated or chemical)
may be helpful.
Patients who have infrequent attacks of Raynaud's phenomenon
may benefit from a short-acting calcium channel blocker.
When vasospasm occurs more frequently, the extended-release
preparations of nifedipine (30-90 mg daily), amlodipine (2.5-10 mg daily),
or diltiazem (120-300 mg daily) are effective. The alpha1 -adrenergic receptor
antagonists such as prasozin or terazosin can also decrease the severity,
frequency, and duration of vasospastic attacks in patients. Nitroglycerin
can be used topically in patients, whereas prostacyclin can be given intravenously.
The angiotensin-converting enzyme inhibitor captopril has shown some benefit.
When vasospasm occurs more frequently, the extended-release
preparations of nifedipine (30-90 mg daily), amlodipine (2.5-10 mg daily),
or diltiazem (120-300 mg daily) are effective. The alpha1 -adrenergic receptor
antagonists such as prasozin or terazosin can also decrease the severity,
frequency, and duration of vasospastic attacks in patients.
Nitroglycerin can be used topically in patients, whereas prostacyclin can
be given intravenously. The angiotensin-converting enzyme inhibitor captopril
has shown some benefit.
|
send
to a friend
printer
friendly version
