DrVirgo
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A 50 year old presents with a six-month history of left calf pain that is brought on by walking and is relieved by rest. The patient reports no other symptoms. He has smoked cigarettes for the past 25 years, but does not drink alcohol or use illicit drugs. On physical exam, he has a BP of 158/92mmHg and a pulse of 88/min. The heart and lung exam are normal. A bruit is heard over the left femoral artery. Popliteal dorsalis pedis and posterior tibial pulses are palpable bilaterally. The electrocardiogram shows normal sinus rhythm and Q waves in II, III, and avF. Which of the following is the best next step in management?
A. Reassurance
B. Ankle-brachial pressure index measurement
C. Duplex scan of the arteries of the lower limbs
D. Contrast arteriography
E. Endovascular stent placement
-What about exercise and ASA? 
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| peter90036
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b ... ?
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| DrVirgo
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peter90036 wrote:
b ... ?
 Right.
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| Markus2009
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ABI again!!!------>B
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| inkspot
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The first step is always B
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| GOGETA
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. Ankle-brachial pressure index measurement
what is that?
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| peter90036
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i speculate they strapon the blood pressure cuff and measure upper extremity vs lower extremity ...maybe some USCE would help relieve my speculations... ...who wanna hire me? i'm available 8-5 with 1h lunch break. i take minimum pay. i measure all the blood pressures of any dirty feet and eczematous psoriased hands you want.
Edited by peter90036 on 04/05/08 - 07:14 AM
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| DrVirgo
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-What about exercise and ASA?
Would that help this man?
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| inkspot
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GOGETA wrote:. Ankle-brachial pressure index measurement what is that?
from my UW notes:
it is the Doppler measurement of
systolic BP in dorsalis pedis (divided by) systolic BP in brachial artery.
normal : 1-1.3
< 0.9 = 50% occlusion
< 0.4 = ischemia
How to investigate such patients
1st test: ABI ( Doppler )
2nd: Arterial Duplex
3rd: Angiography ( gold standard but invasive )
Treatment:
aspirin + Exercise program
then Ca channel blockers: eg Amlodipine.
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| peter90036
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why aspirin? prevent more clot/plaque to form ?
why exercise? make colaterals? - but if its a femoral... how does that help?
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| inkspot
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The disease technical name is : Peripheral Arterial Disease
http://www.americanheart.org/presenter.jhtml?iden...
My revised treatment is as follow:
Quit smoking, Diet modification, start light exercise, aspirin, cilostazole, amlodipine if nothing works then go for surgery.
cilostazol
http://en.wikipedia.org/wiki/Cilostazol
yes aspirin will prevent clots
and yes exercise is for collateral formation.
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| peter90036
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thx, here's more
AHA PAD Practice Guidelines 2005
aspirin: reduces cardiovascular risk: MI, stroke
exercise: supervised exercise program brings most clinical improvement. (they say its not due to collaterals as believed, but to muscle metabolism and other stuff-see guidelines for more)
Edited by peter90036 on 04/05/08 - 07:53 AM
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