Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

1268 Raynaud’s Syndrome

■Alpha blocking agents (Prazosin)

➣2/3 of patients have favorable response

➣Less well-tolerated than calcium channel blockers

➣Side effects

Palpitations

Orthostatic hypotension

Dizzyness

Headache

Fatigue

Edema

Diarrhea

■Nitroglycerin

➣May be used on hands or elsewhere

➣Response less common than calcium channel blockers

➣Side effects

➣Headache

■Cervical sympathectomy

➣Not of value in Raynaud’s

➣Treatment of underlying collagen vascular disease generally does

not reduce symptoms of Raynaud’s

follow-up

During Treatment

■Individual pt’s response to a particular agent is variable

■Check for efficacy and side-effects

■Switch to other agents as needed

Routine

■Mild disease – no specific follow-up needed

complications and prognosis

Complications

■Ulceration, necrosis and finger gangrene

➣Due to associated collagen vascular disease or proximal occlu-

sion or emboli

➣Define and treat specific occlusive lesions – surgical bypass

➣Aggressive treatment of collagen vascular disease

Prognosis

■Primary Raynaud’s (10 year follow-up)

➣1/6 symptoms disappear

➣1/3 stable