0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1
Raynaud’s Syndrome 1267➣Benign condition; presence of ulcers suggest vasculitis
➣Cosmetic problem that requires no treatment
■Acrocyanosis
➣Painless blue discoloration of fingertips, hands and feet
➣Associated with increased sweating
➣Cosmetic problem that requires no treatment
■Upper extremity atherosclerosis
➣Usually in large vessels of the arm – decreased pulses at wrist
➣Older patients with risk factors for atherosclerosis
➣Emboli are common with painful ulceration and gangrene of
fingertips
➣Digit pressures are decreased
➣Angiogram shows proximal lesion (usually subclavian) and
embolic obstructions of hand
➣Emboli can be from non-palpable subclavian aneurysm
management
General Measures
■Conservative therapy
■Avoidance of cold (whole body)
■Mittens and hand warmers (chemical and electrical)
■Discontinuation of smoking
■Severe disease (ulceration, gangrene)
■Define and aggressively treat associated large vessel disease and col-
lagen vascular disease
specific therapy
Indications
■Raynaud’s that interferes with daily activity
Treatment Options
■Calcium channel blockers (Nifedipine)
■Treatment of choice for most patients
■Proven in placebo controlled studies
➣Side Effects
Headache
Ankle edema
Light-headedness
Flushing
Dyspepsia
Palpitation
Gingival hyperplasia