Raynaud’s phenomenon (RP) is a disorder resulting in vasospasm.

Definition

Raynaud’s phenomenon (RP) is a disorder resulting in vasospasm, a particular series of discolorations of the fingers and/or the toes after exposure to changes in temperature (cold or hot) or emotional events.

Most people with RP have sensitivity to cold. Skin discoloration occurs because an abnormal spasm of the blood vessels causes diminished blood flow to the local tissues. Initially, the digit(s) involved turning white because of the diminished blood flow.

The digit(s) then turn blue (cyanosis) because of a prolonged lack of oxygen. Finally, the blood vessels reopen, causing a local “flushing” phenomenon, which turns the digit(s) red. This three-phase color sequence (white to blue to red), most often upon exposure to cold temperature, is characteristic of RP.

Raynaud’s phenomenon most frequently affects women, especially in the second, third, or fourth decades of life. People can have Raynaud’s phenomenon alone or as a part of other rheumatic diseases.

Raynaud’s phenomenon in children is essentially identical to Raynaud’s phenomenon in adults. When it occurs alone, it is referred to as “Raynaud’s disease” or primary Raynaud’s phenomenon. When it accompanies other diseases, it is called secondary Raynaud’s phenomenon.

Types of Raynaud’s Phenomenon

Primary Raynaud’s

This is often a mild condition and there are ways to help manage the symptoms. People with primary Raynaud’s usually have no other related complications, and will rarely go on to develop an additional problem. If you have primary Raynaud’s, it is important to see your GP if you are worried about the symptoms or any other health issues.

Secondary Raynaud’s

This means that Raynaud’s is caused by another condition, usually an autoimmune disease like scleroderma or lupus. Secondary Raynaud’s needs more investigation and more careful monitoring for complications like ulceration or sores.

Risk factors of Raynaud’s Phenomenon

As many as one in 10 people may have some form of Raynaud’s, with most of those having the primary form. About one person in 100, or fewer, will have secondary Raynaud’s.

Women are up to nine times more likely to get it than men are.

All ages people can get Raynaud’s, but it usually starts showing up between ages 15 and 25.

People with secondary Raynaud’s tend to get it after 35.

Illnesses like rheumatoid arthritis, scleroderma, and lupus are more likely to get secondary Reynaud’s.

People who use some medicines to treat cancer, migraines, or high blood pressure may be more likely to get Raynaud’s.

Also, people who have carpal tunnel syndrome or use vibrating tools like jackhammers may be more likely to get Raynaud’s.

Raynaud’s Phenomenon Causes

For children with primary Raynaud’s, we don’t yet know what causes their blood vessels to react in such a vigorous way to cold and emotional stress.

However, there are concrete causes for secondary Raynaud’s, and in children it’s most often an underlying autoimmune disease. Here at Children’s Hospital Boston, the illnesses we tend to see with secondary Raynaud’s are:

Scleroderma, which leads to the hardening and scarring of the skin and other body tissues (about 90 percent of those with scleroderma also have Raynaud’s)

Systemic lupus erythematosus (SLE, or simply lupus), which can cause inflammation and damage in many parts of the body, especially the heart, lungs, kidneys and brain (about a third of those with lupus also have Raynaud’s)

Mixed connective tissue disease, an “overlap” disease that has features of scleroderma, lupus, polymyositis and sometimes rheumatoid arthritis

Vasculitis, which causes inflammation of the blood vessels

Diseases like arteriosclerosis and hypertension can also damage the blood vessels and cause secondary Raynaud’s, though almost always in adults. Other potential causes of secondary Raynaud’s include:

Medications: Certain kinds of drugs have been linked to Raynaud’s, such as beta blockers (used to treat high blood pressure), migraine prescriptions with ergotamine, medications with estrogen, drugs containing caffeine (such as Excedrin), medications used for ADHD (like Ritalin) and some over-the-counter decongestants.

Injury to the hands and feet: Frostbite is a notable culprit in this category, but things like repetitive trauma seen mainly in adults who work with vibrating tools, like drills can also trigger Raynaud’s.

Symptoms of Raynaud’s Phenomenon

The symptoms of Raynaud’s disease can include:

Extreme sensitivity to cold: Your body also may react to emotional stress as if it were reacting to cold.

Skin colour changes: Fingers, toes, and sometimes the ears, lips and nose turn white due to lack of blood flow. The blood that’s left in the tissues loses its oxygen and the affected area turns blue. As fresh oxygen-rich blood returns to the area, it often turns bright red.

Coldness, pain and numbness: These are triggered by a lack of oxygenated blood in the fingers. The numbness is the same as when your hand or fingers have “fallen asleep”.

Warmth, tingling and throbbing: The quick return of blood to the fingers triggers these feelings.

Skin ulcers and gangrene: For people with severe undiagnosed Raynaud’s and attacks that last a long time, painful, slow-healing sores may occur in the finger tips. In rare cases, a long-term lack of oxygen to the tissues can result in gangrene (when a body part loses its blood supply).

Raynaud’s Phenomenon complications         

In most cases, Raynaud’s phenomenon is harmless and has no lasting effects. However, in severe cases loss of blood flow can permanently damage the tissue.

Complications of severe Raynaud’s phenomenon include:

Impaired healing of cuts and abrasions

Increased susceptibility to infection

Ulceration

Tissue loss

Scarring

Gangrene

Talk with your doctor if you notice any of these problems or if you notice other changes to your symptoms.

Diagnosis and test

There are various tests your doctor can carry out if they suspect you have Raynaud’s phenomenon.

Blood tests can show how many white and red blood cells you have, as well as other information that will help a doctor decide if you have Raynaud’s. Blood tests can also help to show if you have primary or secondary Raynaud’s.

An x-ray can look for an extra rib at the base of the neck, called a cervical rib. This can cause Raynaud’s phenomenon by putting pressure on the blood vessels that supply blood to your arms.

Nailfold microscopy or Capillaroscopy: This test that involves looking at the tissue from a fingernail under a microscope. It will help doctors look closely at the small blood vessels in your fingers..

A cold stress test, or thermography, is used in some hospitals to find out how you react to cold. It involves using cold water and recording how long it takes for part of the feet or hands to return to their normal temperature.

If you have scleroderma, it’s likely that you’ll get Raynaud’s symptoms at some stage. However, having Raynaud’s doesn’t mean that you’ll go on to develop scleroderma or another connective tissue disease.

Treatment and medications

Dressing for the cold in layers and wearing gloves or heavy socks usually are effective in dealing with mild symptoms of Raynaud’s. Medications are available to treat more-severe forms of the condition. The goals of treatment are to:

Reduce the number and severity of attacks

Prevent tissue damage

Treat the underlying disease or condition

Medications

Depending on the cause of your symptoms, medications might help. To widen (dilate) blood vessels and promote circulation, your doctor might prescribe:

Calcium channel blockers: These drugs relax and open small blood vessels in your hands and feet, decreasing the frequency and severity of attacks in most people with Raynaud’s. These drugs can also help heal skin ulcers on your fingers or toes. Examples include nifedipine (Afeditab CR, Procardia, others), amlodipine (Norvasc), felodipine and isradipine.

Vasodilators: These drugs, which relax blood vessels, include nitroglycerin cream applied to the base of your fingers to help heal skin ulcers. Other vasodilators include the high blood pressure drug losartan (Cozaar), the erectile dysfunction medication sildenafil (Viagra, Revatio), the antidepressant fluoxetine (Prozac, Sarafem, others) and a class of medications called prostaglandins.

Surgeries and medical procedures

For some cases of severe Raynaud’s, procedures that might be treatment options include:

Nerve surgery: Sympathetic nerves in your hands and feet control the opening and narrowing of blood vessels in your skin. Cutting these nerves interrupts their exaggerated responses. Through small incisions in the affected hands or feet, a doctor strips these tiny nerves around the blood vessels. This surgery (sympathectomy), if successful, might reduce the frequency and duration of attacks.

Chemical injection: Doctors can inject chemicals such as local anesthetics or onabotulinumtoxin type A (Botox) to block sympathetic nerves in affected hands or feet. You might need to have the procedure repeated if symptoms return or persist.

Prevention of Raynaud’s Phenomenon

Be aware of workplace hazards that cause Raynaud’s phenomenon, and take the precautions needed to prevent vibration and cold exposure.

General Precautions

Protect the hands from damage and extreme temperatures.

Keep warm at work – wear gloves and warm clothing when working in the cold.

Massage and exercise your fingers during your breaks.

If tingling, numbness or signs of white finger develop, promptly consult a physician.

Precautions with Vibrating Tools

Anti-vibration tools, anti-vibration gloves, and anti-vibration shields may help reduce exposure to vibration.

In general, grinding, machining, and vibrating processes should be as fully automated as possible. Workers should use vibrating tools only when necessary.

There are several ways to reduce the amount of vibration that passes from the tool to the hands.

Use only well-maintained and properly operating tools.

Hold vibrating tools as lightly as possible, consistent with safe work practices. Let the tool do the work.

Rest vibrating tools on a support or work piece as much as possible.

Store tools so that they do not have cold handles when next used.

Use proper job design with scheduled breaks to reduce exposure to vibration.

It is important for workers to recognize if early symptoms of Raynaud’s phenomenon have occurred, and then get appropriate advice to reduce further exposure to vibration.

Atrial fibrillation is an irregular and often rapid heart rate that can increase your risk of strokes.

Description – Atrial Fibrillation

Atrial fibrillation is an irregular and often rapid heart rate that can increase your risk of strokes, heart failure, and other heart-related complications.

During atrial fibrillation, the heart’s two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart. Atrial fibrillation symptoms often include heart palpitations, shortness of breath and weakness.

Episodes of atrial fibrillation may come and go, or you may develop atrial fibrillation that doesn’t go away and may require treatment. Although atrial fibrillation itself usually isn’t life-threatening, it is a serious medical condition that sometimes requires emergency treatment.

A major concern with atrial fibrillation is the potential to develop blood clots within the upper chambers of the heart. These blood clots forming in the heart may circulate to other organs and lead to blocked blood flow (ischemia).

Pathophysiology

The pathogenesis of AF can be broadly divided into the categories of triggers, substrate, and sustaining mechanisms. Since the late 1990s, it has been recognized that the initiation of AF can occur because of premature atrial contractions triggered by beats that arise from the pulmonary veins (PVs), usually from muscular tissue sleeves near the junction with the left atrium. These triggers may also fire repetitively and contribute to the maintenance of AF, essentially becoming drivers of AF. Focal triggers outside the PV including posterior left atrial, ligament of Marshall, coronary sinus, venae cavae, septum, and left atrial appendage to contribute to the disease process. Focal triggers, especially the PVs, are felt to be very important early in the disease process and, in particular, among patients with paroxysmal AF.

Over time, myocardial fibrosis develops within the atrial tissue in association with AF to support its maintenance by shortening affected tissue refractory periods. Myocardial fibrosis of the atrium seems to be the common feature of the progression of AF disease state.

This has led to the adage that AF begets AF. Once AF is initiated by focal triggers, several theories have been postulated to explain the maintenance of AF. They include the multiple wavelet model, AF rotors and the role of the autonomic nervous system. The multiple wavelet model has suggested that AF is sustained by multiple simultaneous wavelets meandering throughout the atria.

Atrial tissue with abnormal electrical propagation recorded by mapping catheters has been referred to as complex fractionated electrograms. Expression of specific connecting protein channels at the cellular level is also felt to be an important contributor to the disease substrate and sustaining mechanisms.

Contemporary understanding of the AF substrate and sustaining mechanisms now also includes the role of the autonomic nervous system and, more recently, the discovery and evaluation of the concept of AF rotors.

What causes atrial fibrillation?

It’s not known exactly what causes AF, but it’s more common in people with other heart conditions or risk factors like:

It can also be associated with other health conditions including:

Asthma

Lung cancer

Pulmonary embolism.

Many people won’t have any pre-existing conditions or risk factors but will still develop AF.

When no cause can be identified, it’s known as lone atrial fibrillation.

Some people with atrial fibrillation also have an atrial flutter. If this is the case, you may experience periods of atrial flutter followed by periods of atrial fibrillation.

What are the risk factors for AFib?

The risk for AFib increases with age. High blood pressure, the risk for which also increases with advancing age, accounts for about 1 in 5 cases of AFib.

Risk factors for AFib include

Advancing age

High blood pressure

Obesity

European ancestry

Diabetes

Heart failure

Ischemic heart disease

Hyperthyroidism

Chronic kidney disease

Moderate to heavy alcohol use

Smoking

Enlargement of the chambers on the left side of the heart

Atrial fibrillation symptoms

You might not experience any symptoms if you have atrial fibrillation.

Those who do experience symptoms may notice:

Heart palpitations (feeling like your heart is skipping a beat, beating too fast or hard, or fluttering)

Chest pain

Fatigue

Shortness of breath

Weakness

Lightheadedness

Dizziness

Fainting

Confusion

Intolerance to exercise

These symptoms can come and go based on the severity of your condition.

For example, paroxysmal AFib is a type of atrial fibrillation that resolves on its own without medical intervention. But you may need to take medication to prevent future episodes and potential complications.

Overall, you might experience symptoms of AFib for several minutes or hours at a time. Symptoms that continue over several days could indicate chronic AFib.

Complications

A-fib can cause potentially life-threatening health issues.

Blood clots

Blood can pool in the atria if the heart is not beating regularly. Blood clots can form in the pools.

A segment of a clot, called an embolus, might break off and travel to different parts of the body through the bloodstream and cause blockages.

An embolus can restrict blood flow to the kidneys, intestine, spleen, brain, or lungs. A blood clot can be fatal.

Stroke

A stroke occurs when an embolus blocks an artery in the brain and reduces or stops blood flow to part of the brain.

The symptoms of a stroke vary depending on the part of the brain in which it occurs. They can include weakness on one side of the body, confusion, and vision problems, as well as speech and movement difficulties.

Stroke is a key cause of disability in the U.S. and the fifth most common cause of death, according to the CDC.

Heart failure

A-fib can lead to heart failure, especially when the heart rate is high. When the heart rate is irregular, the amount of blood flowing from the atria to the ventricles varies for each heartbeat.

The ventricles may therefore not fill up before a heartbeat. The heart fails to pump enough blood to the body, and the amount of blood waiting to circulate the body instead builds up in the lungs and other areas.

A-fib can also worsen the symptoms of any underlying heart failure.

Cognitive problems

A study in the Journal of the American Heart Association showed people with A-fib have a higher long-term risk of cognitive difficulties and dementia that have no link to reduced blood flow in the brain.

How is atrial fibrillation diagnosed?

Atrial fibrillation can be chronic and sustained, or brief and intermittent (paroxysmal). Paroxysmal atrial fibrillation refers to intermittent episodes of AF lasting, for example, minutes to hours. The rate reverts to normal between episodes. In chronic, sustained atrial fibrillation, the atria fibrillate all of the time. Chronic, sustained atrial fibrillation is not difficult to diagnose. Doctors can hear the rapid and irregular heartbeats using a stethoscope. Abnormal heartbeats also can be felt by taking a patient’s pulse and by a doctor’s diagnosis.

Tests to diagnose atrial fibrillation

EKG (electrocardiogram): An electrocardiogram (EKG or ECG) is a brief recording of the heart’s electrical discharges. The irregular EKG tracings of AF are easy to recognize provided AF occurs during the EKG.

Echocardiography: Echocardiography uses ultrasound waves to produce images of the chambers and valves and the lining around the heart (pericardium). Conditions that may accompany AF such as mitral valve prolapse, rheumatic valve diseases, and pericarditis (inflammation of the “sack” surrounding the heart) can be detected with echocardiography. Echocardiography also is useful in measuring the size of the atrial chambers. Atrial size is an important factor in determining how a patient responds to treatment for the disease. For instance, it is more difficult to achieve and maintain a normal rhythm in patients with enlarged atria.

Transesophageal echocardiography (TEE): Transesophageal echocardiography (TEE) is a special echocardiographic technique that involves taking pictures of the atria using sound waves. A special probe that generates sound waves is placed in the esophagus (the food pipe connecting the mouth to the stomach). The probe is located at the end of a long flexible tube that is inserted through the mouth into the esophagus. This technique brings the probe very close to the heart (which lies just in front of the esophagus). Sound waves generated by the probe are bounced off the structures within the heart, and the reflected sound waves are used to form a picture of the heart. TEE is very accurate for detecting blood clots in the atria as well as for measuring the size of the atria.

Holter monitor: If episodes of the disease occur intermittently, a standard EKG performed at the time of a visit to the doctor’s office may not show AF. Therefore, a Holter monitor, a continuous recording of the heart’s rhythm for 24 hours, often is used to diagnose intermittent episodes of AF.

Patient-activated event recorder: If the episodes of atrial fibrillation are infrequent, a 24-hour Holter recording may not capture these sporadic episodes. In this situation, the patient can wear a patient-activated event recorder for 1 to 4 weeks. The patient presses a button to start the recording when he or she senses the onset of irregular heartbeats or symptoms possibly caused by AF. The doctor then analyzes the recordings later.

Other tests: High blood pressure and signs of heart failure can be ascertained (determined) during a physical examination of the patient. Blood tests are performed to detect abnormalities in blood oxygen and carbon dioxide levels, electrolytes, and thyroid hormone levels. Chest X-rays reveal enlargement of the heart, heart failure, and other diseases of the lung. Exercise treadmill testing (a continuous recording of the EKG during exercise) is a useful screening study for detecting severe coronary disease in a doctor’s office or hospital.

Treatments

Treatments for atrial fibrillation include medicines to control heart rate and reduce the risk of stroke, and procedures such as cardioversion to restore normal heart rhythm.

It may be possible for you to be treated by a GP, or you may be referred to a heart specialist (a cardiologist).

Some cardiologists, known as electrophysiologists, specialize in the management of abnormalities of heart rhythm.

You’ll have a treatment plan and work closely with your healthcare team to decide the most suitable and appropriate treatment for you.

Factors that will be taken into consideration include:

Your age

Your overall health

The type of atrial fibrillation you have

Your symptoms

Whether you have an underlying cause that needs to be treated

The first step is to try to find the cause of the atrial fibrillation. If a cause can be identified, you may only need treatment for this.

For example, if you have an overactive thyroid gland (hyperthyroidism), medicine to treat it may also cure atrial fibrillation.

If no underlying cause can be found, the treatment options are:

Medicines to reduce the risk of a stroke

Medicines to control atrial fibrillation

cardioversion (electric shock treatment)

Catheter ablation

Having a pacemaker fitted

You’ll be promptly referred to your specialist treatment team if 1 type of treatment fails to control your symptoms of atrial fibrillation and more specialized management is needed.

Medicines to control atrial fibrillation

Medicines called anti-arrhythmic can control atrial fibrillation by:

Restoring a normal heart rhythm

Controlling the rate at which the heartbeats

The choice of anti-arrhythmic medicine depends on the type of atrial fibrillation, any other medical conditions you have, side effects of the medicine chosen, and how well the atrial fibrillation responds.

Some people with atrial fibrillation may need more than 1 anti-arrhythmic medicine to control it.

Restoring a normal heart rhythm

A variety of medicines are available to restore normal heart rhythm, including:

Flecainide

Beta-blockers, particularly sotalol

An alternative medicine may be recommended if a particular medicine does not work or the side effects are troublesome.

Newer medicines are in development, but are not widely available yet.

Controlling the rate of the heartbeat

The aim is to reduce the resting heart rate to under 90 beats per minute, although in some people the target is under 110 beats per minute.

A beta-blocker, such as bisoprolol or atenolol, or a calcium channel blocker, such as verapamil or diltiazem, will be prescribed.

A medicine called digoxin may be added to help control the heart rate further.

Normally, only 1 medicine will be tried before catheter ablation is considered.

Reduce your risk of stroke

Most people need a type of blood-thinner medication (such as warfarin, apixaban, rivaroxaban or dabigatran) to reduce the risk of clotting. With warfarin, frequent blood checks are needed to monitor effectiveness and dose, but this is not required for the newer blood thinners, says Calkins. Medication decisions are based on the assessment of your stroke risk. Most patients with AF who are over age 65 require a blood thinner, Calkins says.

Prevention and Risk Reduction

Although no one is able to absolutely guarantee that a stroke or a clot can be preventable, there are ways to reduce risks for developing these problems.

After a patient is diagnosed with atrial fibrillation, the ideal goals may include:

Restoring the heart to a normal rhythm (called rhythm control)

Reducing an overly high heart rate (called rate control)

Preventing blood clots (called prevention of thromboembolism such as stroke)

Managing risk factors for stroke

Preventing additional heart rhythm problems

Preventing heart failure

Plot to remove Vladimir Putin from office is already underway says General Kyrylo.

A Ukrainian spy chief, Major General Kyrylo Budanov, has alleged that a turning point in the conflict between Russia and Ukraine will come later in August because a plot to remove Vladimir Putin from office is already underway.

According to Daily Mail, Budanav made the statement yesterday during an exclusive interview with Sky News.

Budanov said it is expected that most of the Russian combat will die in Ukraine before the end of this year and this will precipitate the removal of Putin from office.

He stated that a change of leadership in the Russian Federation is imminent as Putin refused to withdraw his troops from Ukraine. General Budanov is also convinced that the loss for Russia will lead to Putin being removed from power.

General Budanov had earlier correctly predicted when the Russian invasion would happen when others in his government were publicly sceptical and now says he is confident about predicting its conclusion.

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Youth and police clash in Imo State.

According to Mr. Chima Uzoigwe, a resident of the community, told Homepage that.

The Amakpaka community in Mbaise LGA of Imo state has been deserted following a reported clash between police officers and some youths.

The clash was said to have started in the early hours of Friday when officers reportedly stormed the community to arrest one Agu Ugochukwu. 

According to sources, Ugochukwu was accused of assaulting one Nick Akobundu, a retired police officer and the chief security officer (CSO) of the Umuawada autonomous community. 

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EU provide military aide worth €500 million to Ukraine.

The European Union (EU) has provided fresh military aid, to the tune of 500 million euro, to Ukraine to support its ongoing pushback against Russian invasion of its territory.

The EU foreign policy chief Josep Borrell disclosed this on Friday.

Mr Borell said the aid will support the Ukrainian side with military support and standard weapons.

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