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Peripheral Vasculature Diseases – Section 3 DISEASE CAUSING ARTERIAL SPASM

Raynaud’s Phenomenon

Clinical Presentation:

  • Color change in the fingers or toes that comes with cold temperature settings or emotional stress

  • Usually get a triphasic color response in the fingers (or toes):

Phase

Color

Phase 1

distinct white

Phase 2

blue (cyanotic)

Phase 3

reddish (ruddy)

Explanation blood flow is interrupted local accumulation of desaturated hemoglobin blood flow begins to resume

  • Color changes may be accompanied by numbness, paresthesias, or pain of the affected digits.

  • Only 16% of patients report worsening of their symptoms over an extended time, so prognosis is usually benign.

Etiology:

  • Primary Raynaud’s Phenomenon (aka Raynaud’s Disease): occurs as an isolated disorder

    • o

      Patients are majority females between 20-40 years old

      • o

        Apparently no genetic component

  • Secondary Raynaud’s Phenomenon: appears as a component of other conditions, such as…

      • o

        Connective tissue diseases: like scleroderma, SLE

      • o

        Arterial occlusive disorders: (see Section 2 study guide for Peripheral Vasculature Diseases)

      • o

        Carpal tunnel syndrome: tunnel protects the median nerve and nine tendons; pressure placed on the nerve produces the numbness, pain, and eventually hand weakness

      • o

        Thoracic outlet syndrome: compression of the neurovascular structures at the superior aperture of the thorax; the brachial plexus (95%), subclavian vein (4%), and subclavian artery (1%) are affected

      • o

        Blood dyscrasias: a general term used to describe any abnormality in blood or bone marrow's cellular components, such as low WBC count, low RBC count, or low platelet count

      • o

        Certain drugs: like…beta-blockers, ergotamine preparations (used for migraine headaches), some chemotherapy agents, and vasoconstrictor drugs (such as some OTC cold meds and narcotics)

      • o

        Thermal or vibration injury: like with workers who operate vibrating tools

Pathology:

  • Raynaud’s Phenomenon is a vasospastic disease of the digital arteries (usually of the fingers, but 40% of patients also have involvement of their toes).

  • People with this condition can experience vasospasm, an extreme vasoconstrictor response when they’re in cold temperature settings or under emotional stress.

  • Vasospam causes temporary blockage of vascular lumen, which blocks blood flow.

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