CARDIOVASCULAR DISEASE AND SKIN

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					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.

				
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