Peripheral Vascular System 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 with rest. This disorder results from an imbalance between supply and demand of blood flow that fails to satisfy ongoing metabolic requirements.

Question 2

What is the socrates of intermittent claudication?

Answer 2

S- Depends on the site of arterial occlusion, e.g. occlusion of the superficial femoral artery often causes pain in the calf muscles
O-Acute e.g. after acute thrombosis/ Chronic e.g. atherosclerotic stenosis/occlusion
C-Gripping, cramping, burning, tightness
R-
A- (For example, chest pain) May suggest atherosclerotic vascular disease elsewhere e.g. ischaemic heart disease, cerebrovascular disease, erectile dysfunction
T-Intermittent?
E- Exercise (“How far can you walk?”, “Does the pain limit your walking, or something else e.g. shortness of breath?”)/ Rest (“How long before the pain subsides?”) – Usually minutes
S- Pain scale

Question 3

What is socrates of rest pain?

Answer 3

S- Foot/toes
O- Usually progresses from intermittent Claudication to rest pain
C- Sharp, burning, usually severe
R-
A- (For example, chest pain) May suggest atherosclerotic vascular disease elsewhere e.g. ischaemic heart disease, cerebrovascular disease, erectile dysfunction
T- at rest
E- Elevation of leg/ relieving factors may be Lowering legs
S-

Question 4

What are the 6 signs and symptoms of acute limb ischaemia?

Answer 4

Remember the 6 P’s:
• Pain
• Pallor
• Pulselessness
• Paralysis (loss of function)
• Paraesthesia (loss of sensation)
• Perishing cold

Question 5

What is the presentation of a Abdominal Aortic Aneurysm (AAA)?

Answer 5

Asymptomatic – majority of AAA’s are identified incidentally
Symptomatic – In this situation patients may complain of back pain
Ruptured – These present as an emergency with back pain and collapse

Question 6

What are signs and symptoms of DVT?

Answer 6

Can be asymptomatic but signs and symptoms include:
• Pain, aching
• Tenderness
• Swelling
• Increased warmth to touch
• Altered skin colour

Question 7

What is Virchow’s triad of factors that predispose one to venous thrombosis?

Answer 7

• Stasis e.g. prolonged immobility, post-operative state, intra-abdominal/ pelvic mass
compressing the venous system
• Hypercoagulability e.g. high-dose oestrogens, malignancy, sepsis, thrombophilia’s
• Intimal damage – trauma

Question 8

How would you complete the HPC in Vascular history?

Answer 8

Ask specifically about:
• Previous vascular problems
• Previous vascular surgery/intervention
• Diseases caused by atheroma elsewhere e.g. coronary artery atheroma (angina and
myocardial infarction), carotid artery atheroma (stroke, transient ischaemic attack,
amaurosis fugax)

• Major Risk factors:
o Smoking
o Hypercholesterolaemia
o Diabetes mellitus
o Hypertension

Question 9

What are key drug history and allergy questions in a vascular history?

Answer 9

Drugs of relevance include anticoagulants, antiplatelet agents, lipid/cholesterol lowering
drugs, cardiac medication, anti-hypertensives, oral contraceptive.

Question 10

What are key social history questions in a vascular history?

Answer 10

Occupation, smoking (number of pack years), alcohol, diet, exercise, recent travel etc.

Question 11

What are key family history questions in a vascular history?

Answer 11

Some prothrombotic conditions are hereditary e.g. Factor V Leiden mutation
Family history is also a risk factor for atherosclerosis.