The concept of Raynaud's phenomenon of the lung revisited.
ABSTRACT Having observed that a cold pressor test (CPT) induces a decrease in carbon monoxide single breath diffusing capacity (DLco) in normal subjects contrary to the findings of Fahey et al (Am J Med. 1984; 76:263-269), we compared the response to CPT for the two types of Raynaud's phenomenon.
Two groups of 8 patients suffering from primary or secondary Raynaud's phenomenon were examined.
Single breath diffusing capacity, mean pulmonary artery pressure (PAP), cardiac output (CO), pulmonary capillary wedge pressure (PwP), and pulmonary vascular resistance (PVR) were measured before and 30 minutes after CPT, which consisted of immersing both hands in a water bath at 12 degrees C for 2 minutes.
Cold pressor testing induced no change in DLco or cardiovascular parameters in patients with secondary Raynaud's phenomenon. Conversely, in patients with the primary form, it induced a significant decrease in DLco (16%), PAP (20%), and PVR (27%), whereas CO and PwP remained unaltered.
The concept of pulmonary Raynaud's phenomenon had to be reconsidered, as it is also observed in normal subjects, and is due to a vasodilatation and not to a vasoconstriction of the pulmonary artery (Frans et al, J Appl Physiol. 1994; 76:750-755). In patients with primary Raynaud's phenomenon, the decrease in DLco is not only a physiological response, but a pathological response to a CPT, as it is significantly more marked in patients than in control subjects (16% versus 10% for controls, same reference). The contribution by Fahey et al remains important, however, in that it allows assessing whether a patient with Raynaud's phenomenon suffers from the primary or secondary form of the disease.
Article: Raynaud's phenomenon of the lung.[show abstract] [hide abstract]
ABSTRACT: To determine if pulmonary vessels develop vasospasm during Raynaud's phenomenon, digital vasospasm was induced by hand immersion in 15 degrees C water (cold pressor test) in 17 subjects, and pulmonary function was measured during the subsequent 120 minutes. Five healthy persons were control subjects, seven subjects had well documented systemic disorders associated with Raynaud's phenomenon (secondary Raynaud's), and five subjects had a history of Raynaud's phenomenon but no evidence of an associated disorder (primary Raynaud's). The only measure of pulmonary function that changed significantly following cold pressor testing was carbon monoxide diffusing capacity. Subjects with primary Raynaud's phenomenon had normal baseline carbon monoxide diffusing capacity (23.7 +/- 4.6 ml/minute/mm Hg) but demonstrated significant decreases (p less than 0.05) at 15 minutes (21.2 +/- 3.5 ml/minute/mm Hg), 45 minutes (19.5 +/- 3.7 ml/minute/mm Hg), and 120 minutes (17.1 +/- 2.1 ml/minute/mm Hg) after cold pressor testing. Subjects with secondary Raynaud's phenomenon had low baseline carbon monoxide diffusing capacity (71 percent predicted) and showed no significant change following cold pressor testing. These findings indicate that digital vasospasm in patients with primary Raynaud's phenomenon is part of a systemic vascular response that includes a decrease in the size of the pulmonary capillary bed.The American Journal of Medicine 03/1984; 76(2):263-9. · 4.77 Impact Factor
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ABSTRACT: In eight healthy subjects we assessed the effects of 3 mg sublingual nitroglycerin on lung distribution of ventilation and perfusion using 133Xe (sitting, supine and lateral decubitus) and on alveolo-arterial O2 and CO2 partial pressure differences [(PAo2–Pao2), (Paco2–PAco2)] and physiological dead space to tidal volume ratio (VD/VT) (sitting).In all studied positions, nitroglycerin induced a significant decrease in uppermost perfusion indices, and a significant increase in dependent perfusion indices, without changing the distribution of ventilation. Significant increases in (Paco2–PAco2) and VD/VT were observed up to 60 min after nitroglycerin. No changes in (PAo2–Pao2) occurred, except for a transient decrease due to transient hyperventilation following nitroglycerin.The redistribution of pulmonary perfusion after nitroglycerin may be attributed to the passive effects of lowered pulmonary vascular pressures, and to possible action on extra-alveolar vessels. The evolution of the indices of pulmonary gas exchange is compatible with the observed redistribution of ventilation/perfusion relationships.European Journal of Clinical Investigation 03/2008; 12(2):177 - 184. · 3.37 Impact Factor
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