He had to be euthenized, I was devastated–his heart had been ok a year before at his physical, no problems. It came hard and fast–the only symptom he showed (which we didn’t know was connected) was a twitching left foreleg when he was resting.

Look at Merck Manual–it’s on line and can be viewed here.

http://www.merck.com/mmpe/index.html

Hands with Raynaud’s phenomenon
ICD-10 I73.0
ICD-9 443.0
DiseasesDB 25933
eMedicine med/1993
MeSH D011928
Raynaud’s phenomenon (pronounced /reɪˈnoʊz/) (rāy-NŌZ), in medicine, is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other extremities. This condition can also cause nails to become brittle with longitudinal ridges. Named for French physician Maurice Raynaud (1834 – 1881), the cause of the phenomenon is believed to be the result of vasospasms that decrease blood supply to the respective regions. Emotional stress and cold are classic triggers of the phenomenon, and the discoloration follows a characteristic pattern in time: white, blue and red.

It comprises both Raynaud’s disease (primary Raynaud’s), where the phenomenon is idiopathic,[1] and Raynaud’s syndrome (secondary Raynaud’s), where it is caused by some other instigating factor. Measurement of hand-temperature gradients is one tool used to distinguish between the primary and secondary forms.[2]

It is possible for the primary form to progress to the secondary form.[3]

Contents [hide]
1 Prevalence
2 Epidemiology
3 Symptoms
3.1 Investigations
4 Pathophysiology
5 Treatment
5.1 General measures
5.2 Emergency measures
5.3 Drug therapy
5.4 Surgical intervention
5.5 Alternative and research approaches
6 See also
7 References
8 External links

[edit] Prevalence
The phenomenon is more common in women than men, with the Framingham Study finding that 5.8% of men and 9.6% of women suffered from it.

[edit] Epidemiology
There is a familial component to primary Raynaud’s, and presentation is typically before two. Smoking worsens frequency and intensity of attacks, and there is a hormonal component. Sufferers are more likely to have migraine and angina than controls.

Secondary Raynaud’s has a number of associations:

Connective tissue disorders:
scleroderma[4]
systemic lupus erythematosus
rheumatoid arthritis
Sjögren’s syndrome
dermatomyositis
polymyositis
Eating disorders
Anorexia Nervosa
Obstructive disorders
atherosclerosis
Buerger’s disease
subclavian aneurysms
thoracic outlet syndrome
Drugs
Beta-blockers
cytotoxic drugs – particularly chemotherapeutics and most especially bleomycin
cyclosporin
ergotamine
sulfasalazine
Occupation
jobs involving vibration, particularly drilling
exposure to vinyl chloride, mercury
exposure to the cold (e.g. by working packing frozen food)
Others
hypothyroidism
cryoglobulinemia
malignancy
reflex sympathetic dystrophy
It is important to realise that Raynaud’s can herald these diseases by periods of more than 20 years in some cases, making it effectively their first presenting symptom. This can be the case in the CREST syndrome, of which Raynaud’s is a part.

[edit] Symptoms
The condition causes painful, pale, cold extremities. This can often be distressing to those who are not diagnosed, and sometimes it can be obstructive. If someone with Raynaud’s is placed in too cold a climate, it could potentially become dangerous.

Unilateral Raynaud’s, or that which is present only in the hands or feet, is almost certainly secondary, as primary Raynaud’s is a systemic condition. However, a patient’s feet may be affected without him or her realizing it.

In pregnancy, this sign normally disappears due to increased surface blood flow.

[edit] Investigations
A careful history will often reveal whether the condition is primary or secondary. Once this has been established, investigations are largely to identify or exclude possible secondary causes.

Digital artery pressure: pressures are measured in the digital arteries before and after cooling the hands. A drop of 15mmHg or more is diagnostic.
Doppler ultrasound: to assess flow
Full blood count: this can reveal a normocytic anaemia suggesting the anaemia of chronic disease or renal failure
Urea & Electrolytes: this can reveal renal impairment
Thyroid function tests: this can reveal hypothyroidism
An autoantibody screen, tests for rheumatoid factor, Erythrocyte sedimentation rate and C-reactive protein, which may reveal specific causative illnesses or a generalised inflammatory process
Nail fold vasculature: this can be examined under the microscope

[edit] Pathophysiology
Primary Raynaud phenomenon, stemming from Raynaud disease, is an exaggeration of vasomotor responses to cold or emotional stress. More specifically, it is a hyperactivation of the sympathetic system causing extreme vasoconstriction of the periphera

http://www.drsegal.com/medstud/ecg/ventricu.htm