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# 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.

Updated Nov 12, 2026

## Key points

- Colour sequence: white (spasm), blue (cyanosis), red (reperfusion hyperemia).
- Primary Raynaud: symmetric, young women, benign; no ulcers or gangrene.
- Secondary Raynaud: older onset, asymmetric, ulcers, abnormal nailfold capillaries; systemic sclerosis, lupus, Buerger disease, atherosclerosis.
- Coronary vasospasm: angina at rest, often at night or early morning, with transient ST elevation; triggered by smoking, cocaine, cold.
- Excess catecholamines (pheochromocytoma, intense stress) can cause spasm and contraction-band injury; stress cardiomyopathy is a related condition.

## 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.

## Memory aid

White, blue, red like a flag: function alone in the young (primary), damaged vessels behind it in the older (secondary).

## 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.

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## Elsewhere in DurgiPedia

- [Local and humoral control of blood flow](https://durgical.com/en/physiology/local-and-humoral-control-of-blood-flow/)
- [Skin blood flow](https://durgical.com/en/physiology/skin-blood-flow/)

## Connections

## Related 4

- [Medium-vessel vasculitis](https://durgical.com/en/general-pathology/medium-vessel-vasculitis/)
- [Ischaemic heart disease](https://durgical.com/en/general-pathology/ischaemic-heart-disease/)
- [Dilated cardiomyopathy](https://durgical.com/en/general-pathology/dilated-cardiomyopathy/)
- [Drugs of abuse: cocaine, opioids, amphetamines, cannabis](https://durgical.com/en/general-pathology/drugs-of-abuse-cocaine-opioids-amphetamines-cannabis/)

## Related conditions 6

- [Raynaud phenomenon](https://durgical.com/en/conditions/raynaud-phenomenon/)
- [Systemic sclerosis (scleroderma, including CREST)](https://durgical.com/en/conditions/systemic-sclerosis/)
- [Vasospastic (Prinzmetal) angina](https://durgical.com/en/conditions/vasospastic-angina/)
- [Cocaine and sympathomimetic toxicity](https://durgical.com/en/conditions/cocaine-and-sympathomimetic-toxicity/)
- [Systemic lupus erythematosus](https://durgical.com/en/conditions/systemic-lupus-erythematosus/)
- [Takotsubo (stress) cardiomyopathy](https://durgical.com/en/conditions/takotsubo-cardiomyopathy/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

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](https://www.ncbi.nlm.nih.gov/books/NBK499833/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/vessel-hyperreactivity-raynaud-phenomenon-and-coronary-vasospasm/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/vessel-hyperreactivity-raynaud-phenomenon-and-coronary-vasospasm/