Intermittent claudication diagnosis

More than 5 million (estimated range 4 to 7 million) adults age 40 years or more have PAD and 95% of individuals with PAD have at least one cardiovascular risk factor the majority of patients have multiple risk factors for CVD. Based on the PAD Awareness, Risk, and Treatment New Resources for Survival (PARTNERS) program, the prevalence of PAD in primary care practices is high, yet physician awareness of the PAD diagnosis is relatively low. In this cross-sectional study, PAD was detected in 29% of 6979 patients and 83% of the patients were aware of their diagnosis but only 49% of their patients physicians were aware. The reason for this observation is that patient self-report of symptoms and the use of questionnaires to detect PAD are not sufficiently sensitive and specific to reproducibly diagnosis PAD and the cardinal symptom of PAD, intermittent claudication, is present in the minority of patients (1 to 27%). A simple ABI measurement wiU identify a large number of patients with previously... 

Intermittent claudication is a clinical diagnosis. Usually lower extremity ischemia is caused by flow-limiting atherosclerotic plaques. Intermittent claudication is the presenting symptomatology in half of the patients with chronic lower extremity ischemia. The other one-third to half of patients with documented peripheral arterial occlusive disease are asymptomatic or silent (8). Other symptoms and physical findings indicating more severe ischemia are pain at rest, pale and cold extremity(s), ischemic ulcers, peripheral cyanosis, and gangrene (12). 

Patients with LEAD may present with symptoms of intermittent claudication (for a detailed diagnosis and differential diagnosis, see Chap-... 

A striking case of drug-induced thrombocytopenia was reported by Rennie et al. in a patient who had been taking 0.3 g of quinine at bedtime for 3 years for intermittent claudication (19 -). In this particular case a dental extraction nearly proved fatal, and it was only on the second admission to hospital that the diagnosis was made. 

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