Raynaud’s Phenomenon

描述

Digital blanching, cyanosis, rubor following cold exposure

3 phase:
Vasospasm – blanching (ischemic phase)
Deoxygenated RBC - cyanosis (ischemic phase)
Reactive hyperemia – rubor (rewarming phase)

Reflex sympathetic vasoconstriction
Idiopathic (Raynaud’s disease) vs secondary 

鑑別診斷

Buerger’s disease
 Male, > 40 y/o, smoking

Clinical triad: Claudication, Raynaud’ phenomenon, Migratory superficial vein thrombophlebitis

Acute Arterial Occlusion 

femoral artery

5P – pulseless, paralysis, pallor, pain, paresthesia

Emboli from 

Heart – Af, AMI, IE, myxoma, ventricular aneurysm, cardiomyopathy
Vessel – atherosclerosis/aneurysm of large artery

Raynaud’s Disease 

20-40 F

Idiopathic, Exclude secondary cause 

Fingers more frequently
PE: normal

Secondary causes:

Arterial occlusive disease
Collagen vascular disease (scleroderma…)
Pulmonary hypertension
Neurologic disorders
Blood dyscrasia (cold agglutinin…)
Trauma (vibration inj…)
Drugs (beta-blockers, ergot, chemotherapy)