Vessel hyperreactivity: Raynaud phenomenon and coronary vasospasm
- Mechanism
Some arteries clamp down too hard in response to cold, stress or drugs. Fingers turn white and blue; coronary spasm causes chest pain at rest.
What it is
Raynaud phenomenon is an exaggerated vasoconstriction of small arteries and arterioles of the fingers and toes in response to cold or emotion. Primary Raynaud (formerly Raynaud disease) is common in young women and has no structural vessel damage. Secondary Raynaud accompanies diseases that damage vessels, especially systemic sclerosis and lupus. In the heart, excessive constriction of epicardial coronary arteries causes vasospastic (Prinzmetal) angina; cocaine, catecholamines and other agents can trigger it and even cause infarction.
Structure
- Primary Raynaud: arteries normal early; late changes only intimal thickening.
- Secondary Raynaud in systemic sclerosis: intimal proliferation of small digital arteries with luminal narrowing.
Primary versus secondary Raynaud phenomenon
| Feature | Primary Raynaud | Secondary Raynaud |
|---|---|---|
| Cause and course | Functional exaggerated vasoconstriction; young women; stable and benign | Structural vessel disease (systemic sclerosis, lupus, Buerger, atherosclerosis); later onset; can progress |
| Findings | Symmetric attacks, no ulcers, normal nailfold capillaries | Often asymmetric, digital ulcers or gangrene, abnormal nailfold capillaries, autoantibodies |
Clinical notes
- New Raynaud after age 30 to 40 or with ulcers calls for a search for connective tissue disease.
- Coronary spasm can cause arrhythmias and sudden death even without fixed stenosis.
Test yourself
Think of the answer, then tap the question to see it.
What are the three colour phases of Raynaud phenomenon, and what causes each?
White from arterial spasm, blue from deoxygenated blood (cyanosis), and red from reactive hyperemia when flow returns.
Which connective tissue disease most often causes secondary Raynaud?
Systemic sclerosis (scleroderma).
What ECG change occurs during vasospastic angina?
Transient ST-segment elevation during the episode of chest pain at rest.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Raynaud Disease (StatPearls (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.