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Gen Med Unit 7: Cardio > Giant Cell arteritis and Reynaud's Syndrome > Flashcards

Giant Cell arteritis and Reynaud's Syndrome Flashcards

1
Q

Define giant cell/temporal arteritis

A
  1. Temporal arteritis is inflammation and damage to the blood vessels that supply blood to the head
  2. If the inflammation affects the arteries in your neck, upper body and arms, it is called giant cell arteritis. Includes temporal arteritis
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2
Q

What is the etiology of temporal arteritis?

A
  1. Etiology and pathogenesis unknown

A. Humoral and cell-mediated immunity suspected

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3
Q

What demographic group is prone to temporal arteritis?

A
  1. Common in US & Scandinavian populations
  2. F>M
  3. Mean age 70 (range 50 - 90+)
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4
Q

What comorbidities are often asst with temporal arteritis?

A
  1. Chronic vasculitis involving medium & large diameter arteries in pts > 50 yrs
    A. thoracic aorta, SC, carotids, and extracranial branches of the carotids (temporal)
    B. 50% of patients also have polymyalgia rheumatica (PMR)
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5
Q

What are the sxs of temporal arteritis that are generally acute?

A
  1. Symptoms can be acute
  2. Fever
  3. Headache (severe, throbbing)
  4. Tenderness and sensitivity on the scalp
  5. Jaw claudication (pain in jaw when chewing)
  6. Tongue claudication (pain in tongue when chewing)
  7. Reduced visual acuity
  8. Diplopia
  9. Acute tinnitus
  10. Bruits
  11. Amaurosis fugax
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6
Q

What temporal arteritis sxs are gradual over several weeks?

A
  1. Fever (usually low-grade)
  2. Fatigue
  3. Malaise
  4. Unexplained weight loss
  5. Hyperhidrosis
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7
Q

What diagnostic tests are indicated in gc/temporal arteritis?

A
  1. CBC
  2. CRP
  3. ESR
  4. Temporal artery biopsy
  5. Fundoscopic exam
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8
Q

What are the common CBC results in giant cell/temporal arteritis?

A

anemia common

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9
Q

What are the common CRP results in giant cell/temporal arteritis?

A

elevated

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10
Q

What are the common ESR (erythrocyte sediment rate) results in giant cell/temporal arteritis?

A
  1. Elevated in > 90% of pts

2. > 50 mm/hr

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11
Q

What are the common temporal artery biopsy results in giant cell/temporal arteritis?

A
  1. Confirms GCA vasculitis
  2. Inflammatory infiltrate in media & adventitia, necrotizing arteritis
  3. Lymphocytes, eosinophils, mulitnucleated giant cells
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12
Q

What are the common fundoscopic exam results in giant cell/temporal arteritis?

A
  1. May have optic neuritis
  2. May be totally normal
  3. May have copper/silver wire abnormalities
  4. May have changes in optic disc
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13
Q

Why is treatment urgent for gc/temporal pts?

A

Delayed or untreated → permanent blindness

Start tx before biopsy

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14
Q

What is the treatment for GC/temporal arteritis?

A
  1. Biopsy can be done up to 14+ days after Tx started
  2. Prednisone 60 mg/day p.o.
    A. Continue high dose prednisone x minimum 1 month before tapering
    B. May be continued up to 1-2 yrs
  3. Aspirin 81 mg qd
    A. To prevent ischemic event (unless contraindicated)
  4. Methotrexate
    A. 0.3 mg/kg/wk po
    B. Use if pt can’t tolerate steroids or recurrence as tapering off
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15
Q

What is the treatment of gc/temporal arteritis if there are visual disturbances?

A

→ IV methylprednisolone 500 to 1000 mg qd for 3 to 5 days, then switch to oral as above

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16
Q

Define Raynaud’s phenomenon

A
  1. Vasospastic disorder that produces an exaggerated response to cold temperatures or emotional stress, resulting in transient digital ischemia
  2. Affects 3% of population worldwide
17
Q

What is stage I of Reynaud’s disease?

A
  1. Pallor phase
    A. Spasm causes ↓ cutaneous blood flow
    B. Pallor, numbness, paresthesias, pain in affected digits
18
Q

What is stage II of Reynaud’s disease?

A
  1. Cutaneous cyanosis phase

A. Due to ↓ oxygenated blood in capillary bed

19
Q

What is stage III of Reynaud’s disease?

A
  1. Hyperemic phase

A. ↑ Blood flow to affected digits → skin blushing

20
Q

What demographic group is the primary form of reynaud’s common in?

A
  1. Occurs at 15-25 yr
  2. F>M
  3. More common in colder climates
21
Q

What demographic group is the secondary form of reynaud’s common in?

A
  1. Begins after 35-40 yr
  2. High incidence w/Scleroderma (90%)
  3. Common in SLE & Sjogren syndrome (30%)
  4. May be assoc. w/drugs and trauma
    A. Nicotine, caffeine, ergotamine
    B. Vibrating tools (jackhammer)
22
Q

What diagnostic tools are indicated for Reynaud’s disease?

A
  1. H & P
  2. Noninvasive vascular testing
  3. Screen for systemic disease
23
Q

How is systemic disease screened for?

A
  1. ANA: antinuclear Antibody Test
    A. If (+), specific serologic testing indicated
    -Complement testing (↓ SLE), protein electrophoresis (↓ SLE), anti-Scl-70 (scleroderma), cryoglobulins (collagen vasc. Dz, MM)
24
Q

How is Reynaud’s disease treated?

A
  1. Treat underlying auto immune disorder if (+)
  2. CCB’s effective
    A. Nifedipine (Procardia)
  3. Alpha blockers
    A. Prazosin (Minipress), doxazosin (Cardura)
  4. Nitrates
    A. Nitropaste, hydralazine (Apresoline)
  5. Avoid triggers
    A. Cold temp, stress, smoking, caffeine, antihistamines, amphetamines, cocaine, beta-blockers, Estrogen Replacement Therapy
25
Q

How is Severe ischemic Raynaud’s Phenomenon treated?

A
  1. ASA + heparin if acute ischemic event
  2. Bypass surgery if severe & assoc with PVD
  3. Sympathectomy (block sympathetic nerve that causes vessel to constrict) if refractory

Gen Med Unit 7: Cardio (13 decks)

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