Question

Although in his mid-70s, a man enjoyed doing the gardens of his „elderly’ neighbors, but he’d found it difficult this winter.

“ After 10 minutes of digging I get cramp in my left calf, doctor. It goes off when I stop, but comes on very quickly again when I start digging again.”
“ Do you get it when you’re walking on the flat?” asked the doctor.
“ Not really, I can go half a mile easily, if I take it steady.”
“ Have you had any cramps in the other leg and do you get any pain in the chest when you’re gardening?” asked the doctor.
“ No doctor, I’m as fit as a fiddle except for this.”
“ No dizzy do’s or black outs? You’ve never smoked have you?” asked the doctor.
“ Not since I was about 8 doctor! And I’ve never had a dizzy do in my life.”
“ I‟ll have a look at you, then I’ll tell what’s to be done” said the doctor.
• What is the underlying problem and what is this pattern of symptoms called?
• At which sites in the arterial system could the problem causing this man’s symptoms be located?
• What other tissue in his limb could be affected and how would it be manifested?
• Which arterial pulses would the doctor need to record?
• Which two metabolic anomalies could be important in this case?

Answer 1

Answer & Explanation:

Based on the symptoms described, the underlying problem and pattern of symptoms is suggestive of intermittent claudication. Intermittent claudication refers to muscle pain or cramping that occurs during physical activity, typically in the calf muscles, and subsides with rest. It is often a result of inadequate blood supply to the affected muscles.

The problem causing this man's symptoms could be located in the arterial system supplying the leg muscles. The most common site of arterial narrowing or blockage leading to intermittent claudication is the peripheral arteries, particularly the femoral and popliteal arteries in the leg.

Other tissues in his limb that could be affected include the skin and subcutaneous tissues. Reduced blood flow to these tissues can manifest as hair loss, thinning skin, coolness, and delayed wound healing.

The doctor would need to record the arterial pulses in the affected limb, specifically the dorsalis pedis pulse on the top of the foot and the posterior tibial pulse behind the medial ankle. These pulses can provide information about the adequacy of blood flow to the lower limb.

Two metabolic anomalies that could be important in this case are atherosclerosis and oxidative stress. Atherosclerosis is the gradual buildup of plaque within the arteries, narrowing the arterial lumen and restricting blood flow. Oxidative stress, caused by an imbalance between free radicals and antioxidants, can contribute to arterial damage and dysfunction. Both these factors can contribute to the development of peripheral arterial disease and intermittent claudication.

Answer 2

The underlying problem of the man's pattern of symptoms is intermittent claudication, which is characterized by muscle cramping and pain due to lack of blood flow. This pattern of symptoms is called peripheral arterial disease (PAD).

Arterial sites where the problem causing this man's symptoms could be located include peripheral arteries, particularly in the lower extremities.

Other tissue in his limb that could be affected includes skeletal muscle, which may experience pain and weakness due to reduced oxygen supply.

The doctor would need to record the femoral, popliteal, posterior tibial, and dorsalis pedis arterial pulses.

Two metabolic anomalies that could be important in this case are hyperglycemia, as diabetes is a risk factor for PAD, and hyperlipidemia, as high levels of cholesterol can lead to atherosclerosis and narrowing of the arteries.