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Vascular Conditions

  • Vascular Conditions

    • Raynaud’s Disease

    Raynaud’s disease is typically signified by fingers and toes losing color and feeling numb and cold. It occurs due to the narrowing of smaller arteries that supply blood to your skin, which limits circulation to affected areas. Also referred to as Raynaud’s phenomenon or syndrome, this condition is most often a response to cold temperatures or stress, and more likely to occur in women than men, as well as those living in cold climates.

    While not particularly disabling, Raynaud’s disease can negatively impact quality of life. Treatment depends on the severity of the condition and whether there are other health conditions present.

    Symptoms

    Signs of Raynaud’s vary depending on the frequency, duration, and severity of the blood vessel spasms that underlie the condition. Symptoms can include:

    • Coldness in toes or fingers
    • Color change in skin due to stress or cold temperatures
    • Numbness, prickly sensation, or stinging pain upon stress relief or warming.

    Affected areas of skin typically turn white first, then often turn blue and feel numb and cold. With warmth, circulation improves, and skin may turn red, tingle, throb, or swell. The color changes may not always occur in the same order for everyone, and not all patients experience every color.

    Although most commonly seen in fingers and toes, Raynaud’s can also affect other areas of your body, such as your lips, nose, ears and even nipples. After warming, it may take as long as 15 minutes for blood flow to return to normal.

    Causes

    Although the exact cause of Raynaud’s is unknown, it appears the blood vessels in hands and feet overreact in response to stress or cold temperatures. When exposed to cold or in times of emotional stress, arteries go into vasospasm, narrowing blood vessels and temporarily inhibiting blood supply. These small arteries may even thicken over time, further limiting circulation.

    There are two main types of this condition:

    • Primary. Also referred to as Raynaud’s disease, this is the most common form of the condition, and is not associated with an underlying medical issue that could cause vasospasm.
    • Secondary. Sometimes called Raynaud’s phenomenon, this type is due to an underlying problem, which tends to be more serious. Symptoms of secondary Raynaud’s typically appear around age 40.

    Secondary Raynaud’s can result from:

    • Connective tissue diseases. Those with diseases or autoimmune disorders such as scleroderma, lupus, rheumatoid arthritis, and Sjogren’s syndrome have an increased risk of Raynaud’s.
    • Diseases of the arteries. Raynaud’s phenomenon can be associated with various diseases that affect arteries, including atherosclerosis which is the buildup of plaque in blood vessels that lead to the heart. It can also be caused by inflamed blood vessels in the hands and feet due to Buerger’s disease, or primary pulmonary hypertension, which is high blood pressure affecting the arteries of the lungs.
    • Carpal tunnel syndrome. With this condition, pressure is placed on the median nerve in your hand causing pain and numbness and making the affected hand more susceptible to Raynaud’s.
    • Repetitive action or vibration. Repetitive actions and similar movements over extended periods of time, such as in the case of typing or playing piano, increases your risk of developing Raynaud’s. Constant vibration such as using tools like jackhammers can make you prone to the problem as well.
    • Smoking. Because smoking constricts blood vessels, it can lead to Raynaud’s.
    • Injuries. Injuries such as wrist fractures or frostbite, and surgery of the hands or feet, can increase your risk of Raynaud’s phenomenon.
    • Certain medications. Some drugs, including those used to treat high blood pressure, migraines, attention-deficit/hyperactivity disorder, cancer, and even certain over-the-counter cold medications can cause blood vessels to narrow and are linked to Raynaud’s.

    Diagnosis

    After reviewing medical history and symptoms, tests will be conducted to rule out any other possible conditions, such as a pinched nerve, that have similar signs and symptoms.

    Is it primary or secondary Raynaud’s?

    To distinguish between the two types of Raynaud’s, you may need to undergo an in-office test called nail fold capillaroscopy. This entails an examination of the skin at the base of your fingernail under a microscope. An underlying disease can be indicated by enlarged or deformed blood vessels (capillaries), found near the nail fold. However, not all secondary diseases can be detected by this test. If there is suspicion, of an underlying condition, such as a connective tissue or autoimmune disease, blood tests will be done to confirm the diagnosis. These may include:

    • Antinuclear antibodies test. This reveals the presence of certain antibodies produced by your immune system which can indicate a connective tissue disease or other autoimmune disorder.
    • Erythrocyte sedimentation rate. This determines the rate at which your red blood cells settle to the bottom of a tube — a faster than normal rate is a sign of an underlying inflammatory or autoimmune disease.

    Since no single blood test can diagnose Raynaud’s, other tests may be performed to help pinpoint any other condition associated with Raynaud’s.

    Treatment

    Dressing appropriately for cold temperatures is sometimes all that is needed to effectively deal with mild Raynaud’s symptoms. In more severe, cases, there are medications available, with the goal of:

    • Reducing the frequency and severity of instances
    • Preventing any tissue damage
    • Addressing the underlying condition or disease

    To promote circulation and widen, or dilate, blood vessels you may be prescribed:

    • Calcium channel blockers. These drugs help to relax and open the small blood vessels in your hands and feet, as well as help heal skin ulcers on fingers or toes.
    • Alpha blockers. These counteract the actions of norepinephrine, which is a hormone that constricts blood vessels.
    • Vasodilators. These drugs also relax blood vessels and heal ulcers, and often come in the form of cream applied to the base of your fingers. Some types of these medications that are commonly used to treat conditions like high blood pressure, erectile dysfunction, and depression, may also relieve symptoms of Raynaud’s.

    We will help you determine which works best for you.

    Because some medications can aggravate the condition, it is recommended you avoid taking:

    • Certain over-the-counter (OTC) cold drugs. Steer clear of those that contain pseudoephedrine (Chlor-Trimeton, Sudafed, and others).
    • Beta blockers. These are often used to treat heart disease and high blood pressure but contain metoprolol (Lopressor, Toprol-XL), nadolol (Corgard) and propranolol (Inderal, InnoPran XL) which can aggravate Raynaud’s symptoms.

    Surgeries and medical procedures

    In severe cases of Raynaud’s, other treatment options may need to be explored, including:

    • Nerve surgery. Through small incisions in the affected hands or feet, tiny nerves around the blood vessels are stripped away to help open blood vessels in your skin.
    • Chemical injection. Chemicals like local anesthetics or onabotulinumtoxin type A (Botox) are injected in the affected area to block nerves in the hands or feet. The procedure may need to be repeated if symptoms return or persist.