Peripheral Vascular History Flashcards
What is intermittent claudication?
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
What are the main presenting complaints you ask about?
Intermittent claudication, acute ischaemia, AAA, DVT
Why do you ask about the site of intermittent claudication?
Is depends on the site of arterial occlusion
Where does occlusion of the superficial femoral artery often cause pain?
In the calf muscles
Why do you ask about the onset of intermittent claudication?
It can be acute (after arterial embolism) or chronic (atherosclerotic)
Give examples of character options of intermittent claudication?
Gripping, cramping, burning
Why do you ask about associated symptoms?
It may suggest atherosclerotic vascular disease elsewhere
What associated symptoms do you ask about?
IHD, cerebrovascular disease, erectile dysfunction
What do you ask about the timing?
Intermittent? At rest? Continual? Nocturnal? Is the frequency increasing?
What exacerbating factors can you ask about?
Exercise? Elevation of the limb? Rest?
What questions can you ask about exercise?
How far can you walk? Does the pain limit your walking?
When asking about rest what do you ask?
How long before the pain subsides?
How do you ask about the severity ?
Pain scale 1-10
What are the 6 P’s of acute ischaemia?
Pain, pallor, pulselessness, paralysis, paraesthesia, perishing cold
Where is the most common site of an AAA?
Usually epigastric but can occur anywhere
Why do you ask about the onset of an AAA?
It can be acute (mycotic) or chronic (often symptom free, diagnosed as an incidental finding)
What are the options of an AAA character?
Pulsating feeling, tenderness, nagging ache
Where to AAA’s radiate?
To the back
What are the signs and symptoms of a DVT?
May be asymptomatic but may include: pain, aching, tenderness, swelling, warm, altered skin colour, prominence of superficial veins
What are the factors predisposing to venous thrombosis?
Virchow’s triad
What are the three points that make up Virchow’s triad?
Stasis, hypercoagulability and intimal change
What causes stasis?
Prolonged immobility, post-operative state, intra-abdominal rumour with pelvic venous compression
What causes hypercoagulability?
High-dose oestrogens, malignancy, sepsis
What past medical history is relevant?
Previous vascular problems and surgery. Angina and MI, stroke, TIA, amaurosis fugax.
What are the risk factors to ask about for peripheral vascular ?
Smoking, hypercholesterolaemia, family history, Diabetes, hypertension
What drug histories should you ask about?
Anticoagulants, antiplatelet agents, lipid/chlolesterol lowering drugs, cardiac medication, anti-hypertensives, oral contraceptives
What social history should you ask about?
Occupation, smoking, alcohol, diet, exercise, recent travel
What family history should you ask about?
Some prothrombotic conditions are hereditary e.g. Factor V Leiden mutation. Also a risk factor for atherosclerosis
