PULSES, UNEQUAL

Ask the Following Questions:

1. Is it acute? Acute reduction of the pulse of an extremity may be due to an arterial embolism, dissecting aneurysm, or fracture of the limb.
2. Does it involve the upper extremities only? The upper extremities are involved selectively in the subclavian steal syndrome, Takayasu's disease, a few cases of coarctation of the aorta, congenital anomalies, thoracic outlet syndrome, aneurysm of the arch of the aorta, and supravalvular aortic stenosis.
3. Is there a history of transient ischemic attacks? The presence of transient ischemic attacks should suggest subclavian steal syndrome and Takayasu's disease.
4. Is there hypertension? The presence of hypertension should suggest coarctation of the aorta.
5. Does it involve the lower extremities only? Involvement of the lower extremities only would suggest peripheral arteriosclerosis, Buerger's disease, arteriovenous fistula, and Leriche's syndrome.
6. Are both the proximal and distal pulses in the lower extremities diminished? These findings would suggest a Leriche's syndrome.
7. Does it involve the upper and lower extremities? Involvement of both the upper and lower extremities would suggest coarctation of the aorta and dissecting aneurysm.

DIAGNOSTIC WORKUP

If the onset is acute, angiography must be done without delay. With a history of trauma, plain films of the involved extremity are essential to rule out fracture. If the onset is gradual, then Doppler studies may be done before angiography. However, angiography will ultimately be necessary in most cases. It is wise to consult a cardiovascular surgeon at the outset. If an arterial embolism is suspected, the source for the embolism must be sought. Serial EKGs and serial cardiac enzymes may disclose an acute myocardial infarction with a mural thrombus. An EKG may disclose auricular fibrillation. Blood cultures may disclose subacute bacterial endocarditis.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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