PERIPHERAL VASCULAR DISEASE History

PERIPHERAL VASCULAR DISEASE

Disorder caused by acute or chronic interruption of blood supply to the limbs usually due to atherosclerosis. Males>Females.

Presentation:

General presentation is of calf pain, brought on by exercise. The pain will generally occur at the same distance walked each time, and then relieved by stopping. This is called ‘Intermittent Claudication’ and the distance walked before needing to stop the ‘Claudication Distance’. The Claudication distance is very important to elicit as it can be used to monitor progression of the diseased vessels. Other symptoms related to claudication are numbness and paraesthesia .

When does the pain start?

How far can you walk before you need to stop?

Does the pain go away when you stop?

Do you ever tried to ‘walk through the pain’?

If a patient is unsure about how far they can walk in meters, then suggest local marks to them, such as can you go as far as your front gate? Can you manage to walk to the shop? Then they will be able to quantify their claudication distance which should be noted for future comparison.

Does the pain ever occur at rest?

This may indicate progression of the disease in those with a known claudication distance or worse, a sudden onset of rest pain may indicate distal embolisation. Rest pain is a continuous pain due to Ischaemia. This pain is very severe aching type pain mainly in the forefoot, it may be relieved by the patient dangling their leg over the side of the bed. Rest pain indicates critical Ischaemia, that is, arterial insufficiency severe enough to threaten the viability of the foot or leg.

Have you noticed any change in the colour of your legs?

Patients may commonly notice their leg looking paler than the other and when they go to put their sock on they may feel it colder too, prompting them to wear two pairs!

Have you noticed any change in the skin on you legs, such as sores that wont heal?

Patient may present due to loss of tissue of their lower limb from prolonged compromise. Quite often a carer may notice a blackened toe, or multiple small areas of discolouration over the distal phalanges- ‘trash foot’, this is due to multiple microemboli from atheromatous plaques more promixmal.

Ask questions regarding the known risk factors for peripheral Vascular Disease.

Do you smoke? How many? For how long?

If the patient used to smoke, find out for how long and again how many per day, as smoking has long lasting and far reaching effects.

Do you have high blood pressure? Are you on any medication for your blood pressure? For how long? When did you last have it checked? Was it normal at that time?

Again the same questions need to be asked about hyperlipidaemia and a family history of same.

Many patients will be on a statin and not know that this is for their cholesterol so ask specifically about each medication, what it is for, and for how long they have been on it.

Are you a diabetic?

The following are essential questions to obtain from all patients with diabetes.

How long have you been a diabetic?

Do you need insulin/injections or are you on diet and exercise alone?

If on insulin/oral hypoglycaemics ask if they have ever had a hypoglycaemic episode, and if so how many.

What is your normal blood suger range, can I see you book?

What was your last HbA1C?

This test is a marker of their glycaemic control over the last 12 weeks.

Do you have any problems with your eyesight? Is this related to your diabetes?

Do you have any kidney problems? Is this related to your diabetes

As diabetes is a systemic diseae and affects all the vasculature especially the small and medium sized vessels, poor eyesight and kidney impairment are an indication of the condition of the bodies’ vasculature albeit not a very precise one!