Cardiovascular System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S3_F1.jpg"}},{"insert":"\n\n"},{"insert":"It has been a tiring day. Glad that your shift is over, you make your way towards the car park.\n\nAs you open your car door, you notice an elderly gentleman walking up the slope, towards the hospital entrance.\n\nHis gait catches your eye. He walks for a bit and then stops as if in pain. After a short rest, he attempts to walk again, but only manages a few more steps before having to stop once more.\n\nThe face seems familiar, but you are too tired to walk up and talk .....\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S3_F2.jpg"}},{"insert":"\n\n"},{"insert":"As you drive home, you receive a call from the duty nurse.\n\nShe informs you that a patient has just arrived at the hospital, and that he insists on seeing you.\n\nFeeling mildly irritated, you ask her to let the patient know that you are on your way back.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S3_F3.jpg"}},{"insert":"\n\n"},{"insert":"Back in your office, you are surprised to see the same gentleman whom you saw just a few minutes ago.\n\nHe introduces himself as Mr. Lewis, an old friend of your father. Apparently, your father recommended that he consult you.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S3_F4.jpg"}},{"insert":"\n\n"},{"insert":"Mr. Lewis is 65 years old, and has been having symptoms suggestive of intermittent claudication for around 2 years now.\n\nHe complains of a cramping pain along the back of both thighs and buttocks, which occurs when he walks, and which is completely relieved by rest.\n\nThe claudication distance has reduced over time.\n\nFor the last several days, he has been experiencing pain in his right foot, even while at rest. This was what prompted him to consult you today.\n\nYou delicately inquire whether he has erectile dysfunction. He reluctantly nods \u0027yes\u0027.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S3_F5.jpg"}},{"insert":"\n\n"},{"insert":"On examination, you notice the presence of locomotor brachialis.\n\nBoth lower limbs are comparatively colder than the upper body. All lower limb pulses from the femorals downwards are impalpable.\n\nThe upper limb pulses are normal.\n\nThe ankle-brachial index (ABI) is 0.4.\n\nA left sided carotid bruit is also noted.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S3_F6.jpg"}},{"insert":"\n\n"},{"insert":"You are now fairly certain that Mr. Lewis is suffering from Peripheral Artery Disease (PAD) with critical limb ischemia of Fontaine stage III and very likely, Leriche syndrome.\n\nYou explain the likely diagnosis, and mention that you need to run a few tests for confirmation and to decide on his further management.\n"}]}