Peripheral Vascular Disease : History

                                                                PVD: History

1.       Chief Complaint

·         Pain in lower limb (intermittent claudication/rest pain)

·         Ulceration

·         Black discoloration of toes/foot

§  Features of acute ischemia (6 Ps) (Norman Browse)

Ø  Pain

Ø  Paraesthesiae (‘pins and needles’ sensation)

Ø  Paralysis

Ø  Pallor

Ø  Pulselessness

Ø  Perishingly(cold to the touch)

2.       History of Present Illness

·         Pain

§  Site, character and radiation of pain

§  History of intermittent claudication or not

§  Site of pain—foot/calf/thigh

§  Claudication distance

§  Claudication time

§  Progress of claudication

Ø  Claudication distance same from the onset or reduced

§  Rest pain or not

Ø  Continuous & aching, cry of dying nerves

Ø  worst at night,

Ø  aggravated by elevating leg above heart level &

Ø  relieved hanging leg below heart level

§  Relieving factor

Ø  Usually keeping the leg hanging below the bed or by application of warmth

·         Boyd’s classification

§  I –continues to walk & pain disappears

§  II –has to walk with effort

§  III –has to take rest

§  IV – rest pain

·         Ulceration or the gangrene

§  Duration and onset

§  any history of trauma

§  Progress of ulceration or the gangrene

§  any discharge

§  any pain over the site, and adjacent area

3.       Any history of superficial phlebitis: any pain, swelling or discoloration along the course of superficial veins

4.       Any history of Raynaud's phenomenon

−        pain, pallor on exposure to cold

−        afterwards any bluish discoloration of toes or fingers

−        followed by dusky red congestion in the feet and hand

−        any burning pain in the local site

−        gangrene at finger/toe tips has been preceded by such attack or not

5.       Chest pain and its relation with exercise (Suggesting anginal pain)

6.       History of blackout or loss of consciousness (suggesting any cerebrovascular disease)

7.       History of abdominal pain or other gastrointestinal symptoms

8.       Tingling, numbness or weakness of any of the limbs

9.       History of impotence (may suggest aorto-iliac disease)

10.   Past History

·         Similar illness in any other limb in the past

·         history of hypertension or other cardiac disease

·         history of collagen disease

11.   Personal History

·         Detail history of smoking:

§  Start of smoking/ Total duration

§  Number of cigarette/bidi per day (Calculate pack year)

§  Smoking or given up, any relief after cessation

12.   Family History

·         History of peripheral vascular disease particularly atherosclerotic disease in the family