Raynaud Syndrome - Clinicals, Diagnosis, and Management

Cardiovascular

Clinicals - History

Fact Explanation
Absence of causative factors for secondary Raynaud phenomenon There are associated vascular and non-vascular causes for secondary Raynaud phenomenon but it is not classified under Raynaud disease. Absence of causative factors for secondary Raynaud phenomenon
There are associated vascular and non-vascular causes for secondary Raynaud phenomenon but it is not classified under Raynaud disease.
Colour change of the extremities following an exposure to a stimulus Raynaud phenomenon or freezing finger syndrome is characterized by three phasic color change when challenged with a predisposing factor. First when the stimulus is applied, there is an immediate vasoconstriction causing the affected areas to appear blood-less or pale. The extent of vasoconstriction is easily visible separated. After that, since the blood flow is insufficient to keep the oxygenated blood running, the affected blood vessels become desaturated and the areas are cynosed, so they appear blue. Once the stimulus is withdrawn, the blood vessels dilate and the rapid blood flow established, causing the affected areas to look redder, or hyperemic. Skin color comes back to the natural color with time. The most commonly affected areas are the extremities. i.e. finger-tips, toe-tips, earlobes, lips and nipples. The symptoms are always bilateral. The color change may not be very visible in the dark skinned population. The color change is reversible and reproducible. The usual predisposing factors are cold and emotional upset. It is hypothesized that increased level of sympathetic activity is the causative factor in primary Raynaud syndrome. Colour change of the extremities following an exposure to a stimulus
Raynaud phenomenon or freezing finger syndrome is characterized by three phasic color change when challenged with a predisposing factor. First when the stimulus is applied, there is an immediate vasoconstriction causing the affected areas to appear blood-less or pale. The extent of vasoconstriction is easily visible separated. After that, since the blood flow is insufficient to keep the oxygenated blood running, the affected blood vessels become desaturated and the areas are cynosed, so they appear blue. Once the stimulus is withdrawn, the blood vessels dilate and the rapid blood flow established, causing the affected areas to look redder, or hyperemic. Skin color comes back to the natural color with time. The most commonly affected areas are the extremities. i.e. finger-tips, toe-tips, earlobes, lips and nipples. The symptoms are always bilateral. The color change may not be very visible in the dark skinned population. The color change is reversible and reproducible. The usual predisposing factors are cold and emotional upset. It is hypothesized that increased level of sympathetic activity is the causative factor in primary Raynaud syndrome.
Pain of the affected areas Due to collection of noxious metabolites in the process of ischemia. Pain of the affected areas
Due to collection of noxious metabolites in the process of ischemia.
Numbness of the affected areas Due to sensory nerve ischemia. Numbness of the affected areas
Due to sensory nerve ischemia.

Clinicals - Examination

Fact Explanation
Normal skin color if not stimulated The patients with Raynaud syndrome have a normal skin color unless provoked by a stimulus. Normal skin color if not stimulated
The patients with Raynaud syndrome have a normal skin color unless provoked by a stimulus.
Color change if presented with a recognized stimulus. There is a triphasic color change in the extremity when met with a recognized stimulus. i.e. cold. There is a sharp demarcation between the affected areas due to the color change. Color change if presented with a recognized stimulus.
There is a triphasic color change in the extremity when met with a recognized stimulus. i.e. cold. There is a sharp demarcation between the affected areas due to the color change.
Wounds and gangrenes There can be loss of tissues in the extremities due to chronic ischemia. Unlike in secondary Raynaud disease, in primary condition gangrenes and widespread tissue losses are rare. Wounds and gangrenes
There can be loss of tissues in the extremities due to chronic ischemia. Unlike in secondary Raynaud disease, in primary condition gangrenes and widespread tissue losses are rare.

Investigations - Diagnosis

Fact Explanation
Cold challenge test It is used to test the severity of Raynaud phenomenon. The test can be performed by measuring the skin blood flow of hand or foot that is cooled or the opposite limb, to test sympathetically mediated vasoconstriction. The blood flow is assessed by laser Doppler method. The cold is applied as cold water of 20'C. Cold challenge test
It is used to test the severity of Raynaud phenomenon. The test can be performed by measuring the skin blood flow of hand or foot that is cooled or the opposite limb, to test sympathetically mediated vasoconstriction. The blood flow is assessed by laser Doppler method. The cold is applied as cold water of 20'C.
Laser Doppler monitoring Superficial blood flow difference with cold exposure can be assessed with laser Doppler technique. It can be used in adjunct with other investigations such as cold challenge test. Serial monitoring helps in identifying the provocative stimuli. It is positive early in the course of the disease and Laser Doppler-recorded venoarteriolar reflex (VAR) response to hand lowering can be used to differentiate primary and secondary Raynaud phenomenon. Laser Doppler monitoring
Superficial blood flow difference with cold exposure can be assessed with laser Doppler technique. It can be used in adjunct with other investigations such as cold challenge test. Serial monitoring helps in identifying the provocative stimuli. It is positive early in the course of the disease and Laser Doppler-recorded venoarteriolar reflex (VAR) response to hand lowering can be used to differentiate primary and secondary Raynaud phenomenon.

Management - Supportive

Fact Explanation
Education of the patient and family Educating the patient and the family about the nature of the condition, provocative factors, management options and prognosis of the disease is mandatory and helps with compliance and long term outcome. Education of the patient and family
Educating the patient and the family about the nature of the condition, provocative factors, management options and prognosis of the disease is mandatory and helps with compliance and long term outcome.
Lifestyle modifications, Since there is not an underlying cause for primary Raynaud disease, lifestyle modification could be the only measure required for management. THe identified factors usually are cold/frozen drinks or food, cold air, cold water baths etc. Wearing protective socks or gloves when being exposed to such factors to prevent direct contact with them has also proved useful. Wearing body insulators is also recommended. Quitting smoking is also mandatory, since there has been strong evidence linked with smoking and Raynaud disease exacerbations. The recognized drugs that are known to cause peripheral vasoconstriction should be avoided. i.e. nicotine, antihistamines Lifestyle modifications,
Since there is not an underlying cause for primary Raynaud disease, lifestyle modification could be the only measure required for management. THe identified factors usually are cold/frozen drinks or food, cold air, cold water baths etc. Wearing protective socks or gloves when being exposed to such factors to prevent direct contact with them has also proved useful. Wearing body insulators is also recommended. Quitting smoking is also mandatory, since there has been strong evidence linked with smoking and Raynaud disease exacerbations. The recognized drugs that are known to cause peripheral vasoconstriction should be avoided. i.e. nicotine, antihistamines

Management - Specific

Fact Explanation
Topical nitroglycerin It acts as a regional vasodilator. It can also be used as a transdermal patch. Topical nitroglycerin
It acts as a regional vasodilator. It can also be used as a transdermal patch.
Calcium channel blockers It acts as a peripheral vasodilator. It also reduces the frequency of attacks. The preferred drug is nifedipine. Calcium channel blockers
It acts as a peripheral vasodilator. It also reduces the frequency of attacks. The preferred drug is nifedipine.

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