Question

Patient with Peripheral Arterial Disease also known as Peripheral Vascular Disease

M.S is a 65-year-old African American retired schoolteacher. She complains of left calf pain when walking a couple of blocks. She states the pain goes away after she rests for 5 minutes. M.S is requesting pain medication for her headache that she rates a 8 on a 1-10 pain scale. Her primary history includes: NSTEMI 20 months ago, carotid bruit, hypertension, type 2 diabetes, hyperlipidemia, and former smoker. She has a family history of diabetes and cardiovascular disease.

The current physical examination reveals BP: 142/92, HR: 80, RR: 28, height: 5’4”, weight: 180 lbs., left femoral bruit, carotid bruit, and bilateral reduced pedal pulses.

Current medications: ASA 81 mg/day; Ramipril 10 mg/day; Metformin 500 mg TID; Lovastatin 20 mg/day; Metoprolol 25 mg BID. M.S tells you she has not taken her blood pressure meds for several weeks because she can not afford them right now.

Current laboratory findings: A1C: 7.5%; Lipids at desired values; Complete blood count within normal limits; ECG normal.

1. What data stands out as relevant? (USLO 1)
2. What is your suspected diagnosis? Explain. (USLO 1)
3. What are the risk factors for PAD? (USLO 1, 2)
4. How would you manage this patient’s claudication and overall vascular risk? (USLO 1, 2, 6)
5. What teaching do you need to provide? (USLO 1, 6)

Answer 1

●The data which stands as relevant are

• Calf pain
• Pain settles after rest
• Carotid bruit

●The suspected diagnosis is peripheral vascular disease or peripheral arterial disease

●The risk factors for PAD are

• Smoking
• Diabetes
• Hyperlipidemia
• Hypertension
• NSTEMI
• Obesity

●Encourage the patient to strictly avoid smoking as this can affect the arteries

Encouraging to do walking atleast 30 to 60 minutes with rest in between to improve circulation

Maintaining blood pressure, blood glucose,lipid levels under control

Dietary modifications

Medication to relice pain

Angioplasty or vascular surgery as per order

●The following teaching has to provided

• Regular exercise
• Dietary modifications
• Quit smoking
• Diabetes under control ideally A1C at lower than 7 %
• Weight management to decrease excess weight