Claudication, pain. Why? Insufficient, inadequate
supply to the muscles o the legs, why? Peripheral
arterial disease, why? Atherosclerosis, why?
Maybe the patient is obese, maybe the patient
has type II hyperlipoproteinemia a.k.a. hypercholesterolemia.
Claudication and pain and depends. For example, "Hey doc, walking
a few blocks and I have pain my thigh and
then I stop and the pain goes away." Claudication.
Patients with severe pain, they will develop the following.
Ischemic ulcerations of the skin and feet. Which patient
are you truly worried about? A diabetic. Why?
What is one of the first things that you would
do in a patient with long standing diabetes
who has come in perhaps for the first time
for an actual examination? You are looking
for those ubiquitous ulcers. What does that mean? You are looking
for those ulcer that is on the dependent areas
of the body and why? Why wasn't the patient
able to tell you or feel the pain
if there is skin eroding in this depending
areas? Maybe the bottom of the feet? Because
maybe with diabetes long standing, there is
diabetic neuropathy and the pain was never triggered.
Maybe the nerve has got shot. Right? So the combination. And
what do you know a diabetic? Could they have atherosclerosis?
Are you kidding me? Of course. So along with that and your
ulceration and neuropathy, quite dangerous
to the point where if the ulceration is not
properly looked for and the ulceration continues
and ischemia continues, what are you left
with? Gangrene. Next step? Amputation. Rest
pain, tissue necrosis, what does that mean?
This is severe PAD. Would you tell me what
kind of angina it is called when you are feeling
pain even at rest with severe coronary arterial
disease? That was called unstable angina, wasn't
it? What do we have here? Severe peripheral
arterial disease. We just talked about that
gangrene, worst case scenario especially in
a patient who is diabetic.