Let’s look at a typical patient who has
atherosclerotic or arteriosclerotic peripheral
arterial disease of the legs.
This man is 54 years old. He’s obese. He
has a long-term smoking history – still
smoking. He complains of cramps and discomfort
in his calves after walking for 10 minutes
and this discomfort goes away when he rests.
When you examine him, you find that the pulses
in both of his legs are markedly decreased.
You don’t feel them very powerful compared,
for example, to the radial pulse in the arm.
And then you want to make sure you’ve identified
all of the atherosclerotic risk factors for
Some can’t be modified. For example, the
risk of atherosclerosis goes up with age.
Nothing you can do about that. It’s more
common early on in men. It becomes quite common
in women after menopause. And also is there
a family history of atherosclerosis?
Some factors can be modified, such as whether
they’re smoking. Their high blood pressure
can be treated. Their hyperlipidaemia – or
high blood lipid levels – can be treated
with drugs. They can reduce weight and get
out of the obese situation. They can start
exercising. If their diabetes has been poorly
controlled, that can be controlled much better,
often with medical therapy and also diet and
exercise. And finally life stresses: are there
some ways to avoid some of the life stresses
that contribute to the atherosclerotic process?
So we’ve done the history. Let’s talk
about the physical exam.
The physical exam often reveals clues also
to the diagnosis. So what should the physical
Well, first of all, you want to just look at the
patient – inspection. Then you want to listen
to various parts of the patient’s anatomy.
We’re going to talk about which parts and
what you might expect to find. And finally
you want to feel parts of the anatomy. For
example, can you feel the liver? Is the liver
enlarged? So let’s talk about the physical