Vasospastic Disorders Flashcards
What is Raynauds Disease?
Uncontrollable vasoconstriction of arterioles and capillaries in the fingers in response to a cold trigger
What are the different causes?
Primary- Raynauds Phenomenon
-no underlying cause for the condition
Secondary- Raynauds Disease
- can occur due to
- autoimmune e.g. SLE, systemic sclerosis, sjogrens
- drugs- betablockers and cytotoxic
- malignancy
- atherosclerosis and thoracic outlet syndrome
What are the symptoms?
In response to cold trigger
1) pallor due to vasospasm
2) cyanosis due to deoxygenated blood accumulation
3) rubor due to influx of blood
Can get numbness, burning sensation and pain as fingers return to normal
Episodes normally last <45mins but can last hours
How can you differentiate between primary and secondary raynauds?
Primary- no further investigations needed and all will be normal if completed
Secondary
- nailfold capillorscopy will show abnormal dilated capillaries, avascular areas and small haemorrhages
- asymmetrical distribution
- raised ESR
- male
What investigations are needed?
Bloods
- FBC-polycythaemia and signs of cancer
- U&Es
- LFTs
- glucose
- TFTs
- ANA- SLE
- RF- rheumatoid arthritis
- Anti-scl70
- Anti ro and anti-la
- ESR- raised
What is the management?
Avoid cold triggers
Stop smoking
Stop offending drugs and treat underlying causes
1) Nifedipine
2) losartan, prazosin, fluoxetine
3) digital sympathectomy if severe- not always permanent
