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The ST segment
Published in Andrew R Houghton, Making Sense of the ECG, 2019
Although the combination of chest pain and ST segment elevation often suggests STEMI, vasospastic angina is distinguished by the transient nature of the ST segment elevation. Unlike STEMI, the ECG changes of vasospastic angina resolve entirely when the episode of chest pain settles. Ask the patient about prior episodes of chest pain, which typically occur at rest and particularly overnight in vasospastic angina. Patients may also have a history of other vasospastic disorders, such as Raynaud phenomenon.
Peripheral Autonomic Neuropathies
Published in David Robertson, Italo Biaggioni, Disorders of the Autonomic Nervous System, 2019
Some patients develop swelling of the legs, oedema and severe pain on movement after a considerable interval following back surgery. The oedema is often responsive to diuretics and there may be no trophic changes in the affected limb. On occasion, Raynaud phenomenon develops in the hands. The exact mechanism of this has not been determined, but it could result from an abnormal firing of the whole of the postganglionic sympathetic nervous system induced by the initial trauma to the back. Lumbar sympathectomy in such patients is also effective in removing the symptoms if carried out soon after the onset.
Sjögren syndrome and mixed connective tissue disease
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Common cutaneous features include Raynaud phenomenon, periungual telangiectasias, acrosclerosis or sclerodactyly, swollen inflamed digits (“sausage fingers”), and symmetrically swollen hands (“puffy hands”). Raynaud phenomenon is the earliest skin manifestation and is present in almost all patients. Patients can develop painful digital ulcers, and even digital infarcts/gangrene in severe cases. Acute lupus-like features such as photosensitivity and malar rash can develop during disease flares [33–38]. Patients with MCTD often develop glandular features of Sjögren syndrome such as dry eyes and dry mouth (sicca complex) [39]. There may be well-defined sclerodermoid (unlike the diffuse binding down of skin in systemic sclerosis) or poikilodermatous (areas of mottled or reticulate dyspigmentation, telangiectasias, atrophy) lesions on the upper trunk and proximal limbs; however, other dermatomyositis-specific changes are usually absent. Oral ulcers and nasal septal perforation have also been described.
Angiotensin II receptor blockers in dermatology: a narrative review
Published in Journal of Dermatological Treatment, 2022
Raynaud phenomenon (RP) is characterized by decreased blood flow to the digits because of cold-induced vasoconstriction (27). CCBs constitute the first-line treatment option for RP (28), and phosphodiesterase-5 inhibitors and prostanoid derivatives are possible treatment choices. ACEIs and ARBs have been administered for RP treatment due to their vasodilation properties. Several ACEIs have been used in randomized double-blind trials for RP treatment (29,30), including captopril and enalapril. However, the results reported from such trials are inconsistent, and evidence supporting ACEI use for RP is limited (31). Regarding ARBs, one randomized controlled trial compared the efficacy of losartan and nifedipine in primary and secondary RP treatment (32), and treatment with 50 mg losartan daily or 40 mg nifedipine daily was provided over a period of 12 weeks. Notably, in terms of the reduction of RP severity and episode frequency, losartan demonstrated superior efficacy to nifedipine during the study period (32). Furthermore, another study revealed losartan exhibited superior efficacy to picotamide in primary RP (33). Although evidence regarding the efficacy of ARBs for RP treatment is limited, the role of ARBs in the treatment of RP warrants additional studies.
The shadow zone of capillaroscopy in the classification of the Raynaud’s phenomenon
Published in Current Medical Research and Opinion, 2022
Maria Maddalena Sirufo, Lina Maria Magnanimi, Lia Ginaldi, Massimo De Martinis
The evaluation of RP requires careful clinical and laboratory assessment5. A significant number of signs and symptoms define RP in practice and help in the differential diagnosis. Strong and symmetrical peripheral pulses, attacks of acral pallor or cyanosis which are entirely reversible, normal nailfold capillaries, no evidence of digital pitting, ulceration or gangrene, a normal erythrocyte sedimentation rate and a negative antinuclear antibody (ANA) (titre < 1/100) are established criteria for pRP6,7. Nailfold videocapillaroscopy is the gold standard method for distinguishing between primary and secondary Raynaud phenomenon, through the identification of a “scleroderma” pattern, and for quantifying differences in microvascular morphology8.
Concurrent onset of acute lupus myocarditis, pulmonary arterial hypertension and digital gangrene in a lupus patient: a possible role of vasculitis to the rare disorders
Published in Modern Rheumatology Case Reports, 2020
Takayasu Ando, Yoshioki Yamasaki, Yukiko Takakuwa, Harunobu Iida, Yusa Asari, Kanako Suzuki, Marina Uchida, Nozomi Kotoku, Yasuhiro Tanabe, Motohiro Chosokabe, Masahide Takahashi, Kengo Suzuki, Yoshihiro J. Akashi, Hidehiro Yamada, Kimito Kawahata
A 41-year-old woman experienced Raynaud phenomenon in X-1 month and visited her local clinic. Since her blood tests were positive for anti-nuclear antibody (ANA) and anti-RNP antibodies, mixed connective tissue disease (MCTD) was suspected. Upon routine screening for infections, she was found to be a carrier of the Hepatitis B virus. Entecavir was started 3 weeks (X-3 weeks) prior to the administration of 10 mg of PSL (X-1 day). The day after PSL administration (X), she visited her local clinic because she developed acute and progressive dyspnoea. Additionally, she developed ischaemic changes in all her fingers, which resulted in digital gangrene. She was transferred to our hospital on X and was admitted for more intensive management.