Fast Five Quiz: Refresh Your Knowledge of Key Aspects of Peripheral Artery Disease

Yasmine S. Ali, MD, MSCI

Disclosures

July 05, 2018

Symptoms of PAD include:

  • Numbness or weakness in extremities

  • Coldness in a leg or foot compared with the other leg or foot

  • Sores that have difficulty healing

  • Cramping in hip, thigh, or calf after exercise or movement (claudication)

  • A change in leg color

  • Hair loss or slowed hair growth on extremities

  • Slowed toenail growth

  • Shiny skin on legs

  • Weak pulse or no pulse in feet or legs

  • Erectile dysfunction

A healthy person has no pressure drop from the heart to the ankle. In fact, pressure at the ankle may be 10 to 20 mm Hg higher because of the augmentation of the pressure wave with travel distally. In a patient with claudication, however, the measured pressure at the ankle will be diminished to some extent, depending on the severity of PAD.

Ischemic rest pain refers to pain in the extremity and may occur as PAD progresses. Ischemic rest pain is often exacerbated by poor cardiac output. The condition is often partially or fully relieved by placing the extremity in a dependent position, so that perfusion is enhanced by the effects of gravity.

Patients who report intermittent claudication and have palpable pulses can present a clinical dilemma. If the history is consistent with typical claudication symptoms, the clinician can have the patient walk around the office (or perform toe raises) until the symptoms are reproduced and then palpate for pulses. The exercise should cause the atherosclerotic lesion to become significant and should diminish the strength of the pulses distal to the lesion.

For more on PAD, read here.

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