Peripheral Vascular History

Question 1

What is intermittent claudication?

Answer 1

A reproducible discomfort of a defined group of muscles that is induced by exercise and relieved by rest. This disorder results from an imbalance between supply and demand of blood flow that fails to satisfy ongoing metabolic requirements

Question 2

What are the main presenting complaints you ask about?

Answer 2

Intermittent claudication, acute ischaemia, AAA, DVT

Question 3

Why do you ask about the site of intermittent claudication?

Answer 3

Is depends on the site of arterial occlusion

Question 4

Where does occlusion of the superficial femoral artery often cause pain?

Answer 4

In the calf muscles

Question 5

Why do you ask about the onset of intermittent claudication?

Answer 5

It can be acute (after arterial embolism) or chronic (atherosclerotic)

Question 6

Give examples of character options of intermittent claudication?

Answer 6

Gripping, cramping, burning

Question 7

Why do you ask about associated symptoms?

Answer 7

It may suggest atherosclerotic vascular disease elsewhere

Question 8

What associated symptoms do you ask about?

Answer 8

IHD, cerebrovascular disease, erectile dysfunction

Question 9

What do you ask about the timing?

Answer 9

Intermittent? At rest? Continual? Nocturnal? Is the frequency increasing?

Question 10

What exacerbating factors can you ask about?

Answer 10

Exercise? Elevation of the limb? Rest?

Question 11

What questions can you ask about exercise?

Answer 11

How far can you walk? Does the pain limit your walking?

Question 12

When asking about rest what do you ask?

Answer 12

How long before the pain subsides?

Question 13

How do you ask about the severity ?

Answer 13

Pain scale 1-10

Question 14

What are the 6 P’s of acute ischaemia?

Answer 14

Pain, pallor, pulselessness, paralysis, paraesthesia, perishing cold

Question 15

Where is the most common site of an AAA?

Answer 15

Usually epigastric but can occur anywhere

Question 16

Why do you ask about the onset of an AAA?

Answer 16

It can be acute (mycotic) or chronic (often symptom free, diagnosed as an incidental finding)

Question 17

What are the options of an AAA character?

Answer 17

Pulsating feeling, tenderness, nagging ache

Question 18

Where to AAA’s radiate?

Answer 18

To the back

Question 19

What are the signs and symptoms of a DVT?

Answer 19

May be asymptomatic but may include: pain, aching, tenderness, swelling, warm, altered skin colour, prominence of superficial veins

Question 20

What are the factors predisposing to venous thrombosis?

Answer 20

Virchow’s triad

Question 21

What are the three points that make up Virchow’s triad?

Answer 21

Stasis, hypercoagulability and intimal change

Question 22

What causes stasis?

Answer 22

Prolonged immobility, post-operative state, intra-abdominal rumour with pelvic venous compression

Question 23

What causes hypercoagulability?

Answer 23

High-dose oestrogens, malignancy, sepsis

Question 24

What past medical history is relevant?

Answer 24

Previous vascular problems and surgery. Angina and MI, stroke, TIA, amaurosis fugax.

Question 25

What are the risk factors to ask about for peripheral vascular ?

Answer 25

Smoking, hypercholesterolaemia, family history, Diabetes, hypertension

Question 26

What drug histories should you ask about?

Answer 26

Anticoagulants, antiplatelet agents, lipid/chlolesterol lowering drugs, cardiac medication, anti-hypertensives, oral contraceptives

Question 27

What social history should you ask about?

Answer 27

Occupation, smoking, alcohol, diet, exercise, recent travel

Question 28

What family history should you ask about?

Answer 28

Some prothrombotic conditions are hereditary e.g. Factor V Leiden mutation. Also a risk factor for atherosclerosis