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Intermittent claudication

Definition
  • Intermittent claudication: A symptom of peripheral arterial disease (PAD) characterised by muscle pain (often calf pain) that occurs during physical activity and is relieved by rest.
Etiology & Pathophysiology
  • Caused by reduced blood flow to the leg muscles due to atherosclerosis in the peripheral arteries.
  • Insufficient oxygen supply (ischaemia) to the muscles during activity.
Risk Factors
  • Smoking.
  • Diabetes mellitus.
  • Hyperlipidaemia.
  • Hypertension.
  • Age over 50.
  • Family history of cardiovascular diseases.
Clinical Presentation
  • Pain, cramping, or fatigue in the leg muscles (often calves) during walking or exercise.
  • Relief of symptoms with rest.
  • Decreased or absent pulses in the affected limb.
  • Atrophic skin changes, hair loss on the leg.
  • Delayed wound healing, especially on feet.
Investigations
  • Ankle-brachial index (ABI): Ratio of blood pressure at the ankle to the arm. A decreased ratio indicates PAD.
  • Doppler ultrasound: Evaluates blood flow and identifies blockages or narrowing.
  • Angiography (either magnetic resonance angiography or contrast angiography).
  • Treadmill exercise test to reproduce symptoms and measure severity.
Management
  • Conservative: Supervised exercise programmes to improve walking distance.
  • Medical: Antiplatelet agents (e.g., aspirin or clopidogrel) and statins to reduce cardiovascular risk.
  • Interventional: Angioplasty with or without stent placement, bypass grafting.
Complications
  • Progression to critical limb ischaemia.
  • Increased risk of myocardial infarction and stroke due to systemic atherosclerosis.
Prevention
  • Smoking cessation.
  • Regular exercise.
  • Control of blood sugar, cholesterol, and blood pressure.
  • Maintaining a healthy weight and diet.

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