Lecture 28 Functional Vascular Disorders
There are many causes this; some involve cold reacting Ab’s and cold reacting globulins. People
who go outside in the cold weather will get Raynaud’s and cyanosis in the nose and ears (that
comes and goes away); so, it is due to IgM cold agglutinin dz or cryoglobinemia in old man with
However, we have other dz’s that are collagen vascular dz and first manifestation is Raynaud’s;
this involves a digital vasculitis and eventually a fibrosis – progressive systemic sclerosis (aka
scleroderma), and its counterpart CREST syndrome.
Vasculitis of fingers and leads to fibrosis – will eventually auto-amputate finger (like Berger’s).
CREST syndrome – Calcinosis (dystrophic calcification) and Centromere Ab (specific for crest
syndrome), Raynaud’s, Esophageal dysmotility, Sclerodactyly (finger that is very narrow),
Telangiectasia (very similar to the pin point hemorrhages – also seen in Osler Weber
Other causes due to vasoconstriction – common in pts that take drugs for migraine – drugs for
migraines cause vasoconstriction of vessels. So, Raynaud’s can occur after taking Ergot
derivatives; Buerger dz, too.
Therefore, general causes of Raynaud’s: vasoconstriction, vasculitis of the digits (ie CREST and
scleroderma), and cold reacting Ab’s and globulins .
MCC death with HTN = MI (2 = stroke, 3 = renal failure)
Essential HTN= MC
Multifactorial Inheritance: What racial group has highest incidence of HTN? Blacks. Why?
Multifactorial inheritance (aka polygenic inheritance; other dz’s include: gout, CAD, Type II
diabetes, affective disorders, congenital pyloric stenosis, essential HTN). This means that you
have a tendency to FOR the dz, but don’t necessarily get the dz. Why? B/c it’s MULTIfactorial!
Example: I am black, what should I do to prevent from getting it? I cannot get rid of genetics,
and my genetics are that I cannot get rid of salt in my urine - retaining too much salt (which is
the basic mechanism of essential HTN in blacks and elderly). So, cannot control genetics, but I
can control 3 things: (1) weight has a direct correlation with HTN; (2) reduce salt intake; and (3)
exercise. Example: family hx of gout, what can I do so I avoid gout? Avoid red meet, no alcohol
(which will decrease purine metabolism). Example: If you had a family hx of DM type II – be
skinny (lean and mean)– as you lose