to listen over the femoral artery in the groin.
Another thing you want to do then is you want
to palpate various places. There are many
clues to vascular disease from palpation.
The first thing you want to do is feel the
temperature in the legs and particularly the
feet. If the feet are cool and higher up the
leg is warm, that suggests that we’re not
getting enough blood flow down to the feet.
Or if there’s a difference – one leg is
cooler than the other – that suggests that
there’s narrowing of the blood vessel in
the cooler leg. Is there edema – that is
swelling? And you can figure that out by pressing
slightly on the area and see if you make,
for example on the leg, do you make an indentation?
That suggest that there’s oedema there or
swelling. If the patient’s been in bed for
a long time, then the lower back is a very
good place to test for swelling. And then
there’s a test for capillary refill. That
is you put the leg up in the air or the arm
up in the air and then you bring it down.
Does the pink colour come back into the leg
or the arm within 3 seconds? If it doesn’t,
it suggests that there’s slow blood flow
into that area of skin.
Another thing on palpation is you want to
feel the pulses. Are the pulses nice and strong?
Do you feel the artery bouncing under your
fingers? Or is it very weak and hard to feel
or, in fact, is it missing?
Another thing that suggests a disease called
coarctation of the aorta, where there’s
a constriction in the aorta as you can see
from the diagram, there is a delay between
the radial and the femoral pulse. Why? Because
the blood coming out of the left ventricle
through the aortic valve is being delivered
at a normal rate to the upper-extremity arteries
but at a much slower rate to the lower-extremity
arteries because of the constriction in the
aorta. So you’ll feel the radial pulse well
before you feel the femoral pulse. And really
they should be just about simultaneously.
This delay signifies the presence of coarctation
of the aorta.
So, again, you want to palpate the carotid
arteries. You want to palpate the radial arteries.
You want to palpate the femoral artery. Sometimes
even feeling behind the knee, you can feel
the popliteal artery. And then you want to
try and feel the two foot arteries: the dorsalis
pedis artery and the posterior tibial. The
posterior tibial is lateral. The dorsalis
pedis is medial – that is inner aspect is
dorsalis pedis, outer aspect is the posterior