Raynaud Syndrome 4


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Raynaud Syndrome 4

  1. 1. Raynaud Syndrome
  2. 2. Definition <ul><li>A kind of vasospastic disease </li></ul><ul><li>Episodic vasoconstriction of the fingers most commonly but of the toes occasionally </li></ul><ul><li>The affected digits may go through a classic sequence of color changes including pallor,cyanosis and rubor </li></ul><ul><li>Usually initiated by cold exposure or emotional stimuli </li></ul><ul><li>Mainly affect women </li></ul>
  3. 4. History <ul><li>1862,Maurice Raynaud reports Raynaud’s disease </li></ul><ul><li>1901,Hutchinson report Raunaud’s phenomenon </li></ul><ul><li>1932,Allen and Brown define the difference between Raynaud’s disease and Raynaud’s phenomenon </li></ul><ul><li>After 1970s, authorities believe Raynaud Syndrome is an exact definition </li></ul>
  4. 5. Associated disease <ul><li>Immunologic and connective tissue disorder </li></ul><ul><ul><li>Scleroderma, Rheumatoid arthritis , systemic lupus erythematosus </li></ul></ul><ul><li>Nonimmune obstructive arterial disease </li></ul><ul><ul><li>Diabetic mellitus, thromboaniitis obliterans </li></ul></ul><ul><li>Nerve injury </li></ul>
  5. 6. Classic sequence of color changes <ul><li>Pallor </li></ul><ul><ul><li>due to severe vasospasm in the dermal vessels </li></ul></ul><ul><li>Cyanosis </li></ul><ul><ul><li>Because of sluggish blood flown and resultant marked blood desaturation </li></ul></ul><ul><li>Rubor </li></ul><ul><ul><li>Owing to the reactive hyperemia </li></ul></ul>
  6. 7. Other presentation <ul><li>Pain, numb discomfort ,coldness,and occasionlly ulceration or gangrene </li></ul><ul><li>Usually localized in the fingers </li></ul>
  7. 9. Diagnosis <ul><li>Classic symptom </li></ul><ul><ul><li>with/without history of systemic disease </li></ul></ul><ul><li>Doppler examination </li></ul><ul><ul><li>To measure arm and wrist blood pressure </li></ul></ul><ul><li>Digital plethysmorgraphy </li></ul><ul><ul><li>To study the digital arteries.if they are diminished and unresponsive to temperature change,the arteries are occluded;if warming reverse the changes,vasospasm is more likely </li></ul></ul><ul><li>Cryodynamic angiography </li></ul>
  8. 10. Cryodynamic angiography <ul><li>Angiography is performed before and after cold stimulation. </li></ul><ul><li>During angiogrphy ,if there exist vasospasm ,a vasodilator may be injected intra-arterially and the dye injection repeated. </li></ul><ul><li>Demonstration of increased blood flow and vasodilation is strong support for the prensence of vasospastic disease . </li></ul>
  9. 11. Management
  10. 12. Generic management <ul><li>Cold should be avoided </li></ul><ul><li>Be off the habit of tobacco smoking </li></ul><ul><li>Control the emotional problems </li></ul>
  11. 13. Medication <ul><li>α-Adrenergic retarder </li></ul><ul><ul><li>phenoxy benzamine, Tolazoline, Indoramine, Prazosin </li></ul></ul><ul><li>Calcium channel blocker </li></ul><ul><ul><li>Nifedipinum, Diltiazem </li></ul></ul><ul><li>Vasodilator </li></ul><ul><ul><li>Papaverinum </li></ul></ul><ul><li>Adrenergic nerve retarder </li></ul><ul><ul><li>Reserpine </li></ul></ul>
  12. 14. Thoracic Sympathectomy <ul><li>Rarely recommended in those patients who have vascular occlusion of the digital vessels </li></ul><ul><li>Reserved for patients with disabling symptoms who are refractory to medical therapy and whose digital vessels are spastic and not occluded </li></ul>
  13. 15. Distal digital Sympathectomy <ul><li>Removal of the sympathetic nerve fibre and external membrane of digital arterioles </li></ul><ul><li>Reduce recrudescence </li></ul>