“Checklist for history,examination & presentation of long case of peripheral vascular disease”
Checklist for history;
-Character of the pain, severity aggravating & relieving factors.
-Claudication distance.
-H/o of sudden onset or gradual onset.
-H/o smoking.
-H/o diabetes mellitus/ cardiac illness/TIA/CVA.
-H/o dyslipidemias.
-H/o superficial phlebitis.
-H/o fainting, blurred vision,
abdominal pain.
-H/o impotence.
-Family H/o atherosclerosis.
Checklist for examination;
-Always examine the heart because vascular diseases are part of the cardiovascular system.
-Listen for aortic, renal, celiac and iliac bruits.
-Look for signs of congestive cardiac failure raised VP, edema, basal creps, pleural effusion,ascites.
-Take blood pressure in both arms.
-Look for palpable thrill over the vessels
-Examine all peripheral pulses carotid arteries and their bifurcation,facial & superficial temporal vessels.
-Assess the mental status and speech abnormalities
-Look for visual defects
-Examine for evidence of motor and sensory disorders (hemiplegia of contralateral leg,arm and face).
-Look for speech problems like aphasia lpsilateral temporary visual loss (Atheromatous fragments in retinal vessels).
-Look for nutritional changes (trophic changes)of toes, foot,fingertips and hands-thin & atrophic skin, loss of pulp, brittle and deformed nails, with loss of hair, wasting of muscles.painful cracks appear across the heel.
-Look for ulceration in the pressure points & bony prominences-the heel, malleoli, tips of toes, 5th metatarsal head region, and ball of the foot.
"Checklist before presenting case or decision regarding Rx"
-Find out the level of occlusion clinically and include it in the diagnosis?
-Look for bruit in all arterial diseases over vessels even if they are palpable–carotids, subclavian, aorta, renal, celiac axis, and femoral.
-Find out nature of obstruction? Thrombosis/
embolism.
-Decide whether patient needs invasive investigations?
Invasive investigations are done only if patient is suitable for surgery?
-Assess the comorbid conditions?