VIEWS: 3 PAGES: 49 POSTED ON: 8/7/2012
CARDIOVASCULAR DISEASE AND SKIN MOHAMMAD JAFFERANY, MD Resident (Psych.) Hennepin County Medical Center Minneapolis, MN 55415 INTRODUCTION SKIN AS A MIRROR DIRECT EFFECTS OF CVS DISEASE ON SKIN COMMON PATHOLOGY IN SKIN AND CVS CLASSIFICATION 1. CIRCULATION 2. DEVELOPMENTAL 3. METABOLIC 4. AUTOIMMUNE 5. INFECTIONS 6. EFFECTS OF CARDIAC SURGERY 7. MISCELLANEOUS 1. CIRCULATION Chronic Venous insufficiency Atherosclerosis Cyanosis Acrocyanosis Erythromelalgia CHRONIC VENOUS INSUFFICIENCY Follows thrombophlebitis Edema and delayed superficial veins Increased freckling and hyperpigmentation ATHEROSCLEROSIS Changes most pronounced in feet Dry skin, Brittle and thick nails Corn and calluses Disappearance of lanugo hairs CYANOSIS Excessive concentration of reduced hemoglobin Deficient blood circulation Insufficient arterial oxygenation in Lungs Right to left shunting Right valvular heart disease ACROCYANOSIS Symmetric persistent dusky discoloration Peripheral arterioles react unduly to cold Smaller vessels are dilated ERYTHROMELALGIA Throbbing and burning pain in the skin of hands, due to paroxysmal vasodilatation Pathogenesis unknown, ANS neuropathy Primary or Secondary (Thrombocythemia) One Aspirin tablet - Diagnostic 2. DEVELOPMENTAL Progeria Marfan’s Syndrome Cutis laxa Ehler’s - Danlos Syndrome Fabry’s Disease Tuberous Sclerosis Neurifibromatosis Pseudoxanthoma elasticum LEOPARD Syndrome PROGERIA Markedly accelerated aging Dwarfism, Retarded development, Senile degenerative changes Skin- Dry thin wrinkled, bird like facies, hair loss CVS- Atheromatous changes, Fatal coronary thrombosis before age of 8 MARFAN’S SYNDROME Arachnodactyly, Ocular and CVS defects Mitral valve prolapse and aortic aneurysm 90% death from Cardiovascular complications CUTIS LAXA Lax pendulous skin. Loss of elastic tissue in dermis. Congenital or Acquired (Following severe inflammatory dis. from drug reaction.) Pulmonary artery stenosis and Cor Pulmonale. EHLERS - DANLOS SYNDROME Fragility of skin and blood vessels. Loss of collagen in dermis. Skin is hyperextensible and recoils quickly. CVS - Herniation of Mitral valve leaflets. FABRY’S DISEASE X-linked, Deposition of glycolipids in smaller blood vessels. Angiokeratomas, Mitral valve prolapse, conduction defects, Cardiomyopathy, CCF, MI and CVAs. TUBEROUS SCLEROSIS Multiple hamartomas in skin, brain, eye, kidney and heart. Angiofibromas, Shagreen patches, Ash-leaf macules and subungual fibromas. CVS - Hypertrophy and Rhabdomyomas. NEUROFIBROMATOSIS Classified as NF-I through NF-VII NF-I is common type ,seen in >85%. AD, Characterized by café-au-lait spots,multiple neurofibromas and Lisch nodule in the eyes. CVS - Atrial aneurysms and heart murmurs. PSEUDOXANTHOMA ELASTICUM Degeneration and fragmentation of elastic fibers with deposition of Calcium. Skin - Velvety yellow papules on intertriginous skin, loss of elasticity and skin is redundant. CVS - Early atheromatous changes, Aortic aneurysms and MI. LEOPARD SYNDROME L.E.O.P.A.R.D. Lentigines, ECG changes, Ocular hypertelorism, Pulmonary stenosis, Abnormalities of genitalia, Retardation of growth, and deafness. CVS - Hypertrophy, Atrial defects and Pulmonary valve stenosis. 3. METABOLIC Diabetes Hyperlipoproteinemias Amyloidosis Hemochromatosis DIABETES Microangiopathy of small and large blood vessels. Skin Markers: D.dermopathy, NLD, Bullous pemphigoid, D.scleroderma, Eruptive xanthoma, D.hand syndrome, D.bullae and finger pebbling. DIABETES………(CONT…) Diabetic dermopathy: Results from vascular disturbance. A useful monitor of angiopathic changes. N.Lipoidica: On legs, Necrotic and granulomatous changes often forming deep ulcers, associated with microvascular changes. DIABETES……(CONT…) Eruptive Xanthomas: Associated with hyperlipidemia. Increased risk of atherosclerotic disease. Diabetic hand syndrome: Flexion contractures and scleroderma-like changes of soft tissues. An increased risk of microvascular disease. HYPERLIPOPROTEINEMIAS Xanthelasmas, Tuberous Xanthomas, Plane Xanthomas. Qualitative and quantitative abnormalities of lipid metabolism. Increased risk of cardiovascular disease. AMYLOIDOSIS Systemic disease, with deposits of amyloid in different tissues including vascular system. Skin: Waxy skin, Purpura, Thickened enlarged tongue. CVS: Conduction disturbances, Cardiac arrythmias, CCF and Cardiomegaly. HEMOCHROMATOSIS A classic triad. Hyperpigmentation, Diabetes mellitus and Cirrhosis. Iron deposition in internal organs. CVS: Supraventricular arrhythmia and CCF. 4. AUTOIMMUNE SLE Dermatomyositis Systemic Scleroderma S. L. E Multisystem disease of autoimmune nature. Skin: Malar flush, Photosensitivity, purpura, telangiectasia etc. CVS: Lesions of Endocardium,Myocardium and Pericardium. Libman-sack endocarditis, Aortitis, LV thrombosis, LV hypertrophy and aneurysm, MI, Pericardial effusion and fibrous endocarditis. DERMATOMYOSITIS Autoimmune disorder of skin, muscle and blood vessels. Skin: Heliotrope erythema, poikiloderma, photosensitivity etc. CVS: Conduction defects, ECG changes, CCF, and Myocardial fibrosis. SYSTEMIC SCLERODERMA Hyalinization of collagen Skin: Telangiectasiasis, Calcinosis, Tapering of fingers, Tightening of skin. CVS: Myocardial fibrosis in 80% at postmortem. 5. INFECTIONS Herpes zoster Rheumatic fever S.B.E Lyme’s disease Syphilis Kawasaki’s disease Reiter’s disease Behcet’s disease HERPES ZOSTER Post-Heart transplant patients have greater chance of H.zoster. Possible viremia can cause Pericarditis and CCF. RHEUMATIC FEVER Group A beta hemolytic streptococcus Skin: Erythema marginatum and Subcutaneous nodules. CVS: Pancarditis, Mitral and Aortic valvulitis. S .B .Endocarditis Rheumatic valvular disease is a predisposing factor. Circulating immune complexes. Skin shows Petechiae on conjunctivae and mucous membrane, Splinter hemorrhages under nails, Osler nodes, and Janeway lesions. LYME’S DISEASE An Spirochete, Borrelia burgdorferi Migratory chronic erythema followed by neurologic, joint and cardiac lesion. CVS: AV blocks of varying severity. SYPHILIS Nowadays cardiac complications are rare. Aortic aneurysms. Last reported gumma of heart in 1980. KAWASAKI DISEASE Below 5 years with Fever, Cheilitis and glossitis. Acral erythema with desquamation, Polymorphous eruption. CVS: Myocarditis, Coronary artery disease and Myocardial infarction. REITER’S DISEASE Triad of Arthritis, Conjunctivitis and Urithritis. Young men, HLA-B27 Skin: Psoriasiform lesions on skin, Keratoderma blenorrhagicum, Mucosal erosions. CVS: Conduction defects, Aortic insufficiency BEHCET’S DISEASE A multisystem disease. 1937. Turk Dermatologist Hulsi Behcet. Recurrent oral ulcer, genital ulcer and iritis. Pathergy phenomenon, Arthritis, EN Thrombophlebitis, and Nervous system lesions. CVS: Endartiritis, Venous thrombosis,MI Pericarditis & Coronary artery aneurysm EFFECTS OF CARDIAC SURGERY GVH Disease A transplant patient with defective immunity from immunosuppressor drugs. Donor’s T-lymphocytes identify host antigens as foreign and reject host tissue. Skin: Maculo-papular rash, LP-like lesions, and Kaposi’s sarcoma. EFFECTS OF CARDIAC SURGERY…… (CONT…) Cholesterol emboli After cardiac catheterization and angioplasty. Skin shows palpable purpura, livedo reticularis and ulcerations. DRUG REACTIONS Thiazides Photosensitivity Procainamides Drug induced LE Warfarin Painful and purple toe Amiodarone Photosensitivity, Slate blue or grey pigmentation Minoxidil Hypertrichosis, Erythema Quinidine Petechiae, Photosensitivity Drug Reactions (Cont…) Beta blockers Drug induced LP and Psoriasis ACE inhibitors Angioedema, Pemphigus like lesions Verapramil Erythromelalgia Mexiletine Maculo-papular rash, Urticaria Ca Antagonists Photosensitivity, Erythema MISCELLANEOUS Dego’s Disease Sarcoidosis Carcinoid Syndrome Ear Lobe Crease DEGO’S DISEASE A progressive vasculitis, affecting different parts of body. Infarcts in Skin, healing with ivory colored scars. Heart lesions cause death SARCOIDOSIS Multisystem disease, non-caseating granulomas. Involves Skin, Lungs, Lymph nodes and Eyes. CVS: Conduction defects and CCF. CARCINOID SYNDROME Skin flushing, Sclerodermoid changes. CVS shows Endocardial plaques, Tricuspid insufficiency, Conduction defects, Pulmonary stenosis and Heart failure. EAR LOBE CREASE 1973, Ischaemic heart disease A diagonal deep wrinkle in the lobar portion of one or both auricle. Identifies patients at higher risk for complications of coronary heart disease. SKIN COLOR CHANGES Red Skin: Hypertension, Stroke, Alcoholics, Sunburn and Infections. Cherry Red: Carbon mono oxide poisoning. White Skin: Stroke, MI, Anemia, Fainting. Blue Skin: Asphyxia, Anoxia, Poisonings. Yellow Skin: Liver disease associated with cardiac decompensation. Black & Blue: Echymoses.
Pages to are hidden for
"CARDIOVASCULAR DISEASE AND SKIN"Please download to view full document