Question

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 relevant data are

• Calf pain while walking and settling down when rests
• Headache
• Carotid bruit
• Femoral bruit
• Reduced pedal pulae
• K /C/O Hypertension, Hyperlipidemia
• Family history of cardiovascular disease

●The suspected diagnosis from the chief complaints is peripheral artery disease.

●The risk factors for PAD are

• Age usually abovec 50 or older population
• Family history of cardiovascular issues
• Diabetes
• Hypertension
• Hyperlipidemia

●The patient claudication and overall vascular risk can be reduced by administration of blood thinners which can improve the circulation in the lower limb and reduce pain,analgesics to reduce pain, lipid lowering drugs,antihypertensive drugs.Vascular surgery if very severe

●The following teaching has to be provided

• Medication adherence
• Daily Exercise
• Low fat diet
• Diabetes to be kept under control
• Managing weight steadily
• Heat application