A 58 year male diabetic, hypertensive and smoker presented for executive checkup in cardiology clinic

A 58 year male diabetic, hypertensive and smoker presented for executive checkup in cardiology clinic. He is asymptomatic except for feeling fatigue enough to walk >200 m. His physical examination was normal. You ordered baseline tests including lipid profile. All labs are normal except for elevated cholesterol and LDL. His ECG was normal. Please answer following questions based on guidelines

a.      When should we expect PAD?

b.      You screened with ABI and it turn out to be 1.29. Will you stop evaluating him or proceed for another test

c.       How would you differentiate pseudoclaudication from arterial claudication?

d.      How would you classify this patient based on fontaine classification

Answers:

a.      1)All patients above 70 years of age , 2) Between 50-70years with additional factors like DM, Smoking, 3)Any age with symptom of claudication, Ischemic Ulcer/gangrene

b.      No (may be due to incompressible Vessel), Exercise ABI, Toe Brachial Index

c.       Exercise ABI (In true arterial claudication ABI will decrease <0.9 whereas in pseudoclaudication it will remain normal/borderline). Normal= 1.0 to 1.4, Borderline 0.91 to 0.99

d.      Class IIa (Pain free claudication distance >200m)

References:

1. 2013 practice guidelines (Compilation of 2005 and 2011 ACCF/ AHA guidelines) for management of PAD
2. Braunwald Heart Disease – A Textbook of Cardiovascular Medicine 10^th edition - Chapter 58 – Page 1316