Question

Document the subjective and objective finding and identify 3 actual or potential risk factors for a 61-yr old African American patient is in the clinic and complains of right leg pain for > 8 months. Intermittent tingling in right foot and buttock and thigh pain with walking that is rated at 5/10. Can walk 50 ft before leg symptoms begin. No angina, but previous bypass and valve replacement, and EF of 35%. HTN history, diabetes, former smoker, family history of CAD, dyslipidemia. Takes a large amount of medication but states that the list is at home.

Answer 1

The probable diagnosis is Peripheral artery disease.

Peripheral Artery Disease
A form of atherosclerosis
Similar risk factors
Associated with diabetes, HTN, smoking,
hyperlipidemia
Cause of serious disability
Increases with age
Less common in women (before menopause)
Affects 12% of population 20% of older population.

Signs and Symptoms
Exercise-induced muscle aching or cramping (intermittent claudication) caused by muscle ischemia
Early in disease, pain occurs only with walking
Late in disease, pain occurs at rest
Advanced stages: ulceration, gangrene and amputation of toes or legs.

Risk Factors: same as CAD
Established
Family history
Hypercholesterolemia
Hypertension
Current cigarette
smoking
Impaired fasting glucose
Obesity
Physical inactivity
Aging

Risk Factors
New / Emerging
Inflammatory markers (CRP)
Homocysteine
Lipoprotein (a)
Fibrinolytic factors
Clotting factors
Acute post-prandial hypertriglyceridema
Infectious agents
Metabolic syndrome Estrogen deficiency/
post-menopausal
status
Genetic factors
Psychosocial stress Others.

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