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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify risk factors for peripheral artery disease (PAD).

  • Describe the symptoms and diagnosis of PAD.

  • Recommend appropriate nonpharmacologic treatment strategies for PAD, including risk factor modification, exercise, and revascularization.

  • Design an appropriate pharmacologic treatment plan for a patient with PAD.

  • Provide appropriate education to a patient with PAD.

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PATIENT PRESENTATION

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Chief Complaint

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“I am having pain in both legs and in my left foot.”

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HPI

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Angie Belden is a 47-year-old woman with a history of hypertension, diabetes, stroke, hypothyroidism, dyslipidemia, and a history of bilateral leg weakness for the previous year. She reports to her primary care provider today with increased numbness and weakness when she walks. She reports that it is painful to walk even for 4–5 minutes and that her legs are often weak and “give out.” She is concerned because she lives alone and is responsible for walking her beloved Labrador retriever, Jules. Her symptoms tend to get better when she is able to rest and prop her feet up. She would also like a “checkup” on her other chronic conditions as well.

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PMH

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  • HTN

  • Diabetes

  • Stroke

  • Hypothyroidism

  • Dyslipidemia

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FH

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Mother died of a stroke at the age of 67; father died of pneumonia at the age of 62

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SH

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Works as a biller in a dentist’s office; has one child; lives alone; smokes 1 ppd × 25 years; denies ETOH and illicit drug use; has one dog at home

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Meds

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  • Atenolol 50 mg PO daily

  • Clopidogrel 75 mg PO daily

  • Gabapentin 600 mg PO TID

  • Hydrocodone/acetaminophen 7.5/500 mg q 6 hours PRN pain

  • Levothyroxine 75 mcg PO daily

  • Metformin 1000 mg PO BID

  • Simvastatin 20 mg PO daily

  • Hydrochlorothiazide 25 mg PO daily

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All

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NKDA

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ROS

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Complains of dyspnea on exertion, lower extremity muscle aches, and muscle weakness. Denies chest pains, palpitations, syncope, and orthopnea. Denies nausea, vomiting, diarrhea, constipation, change in bowel habits, abdominal pain, or melena. Denies transient paralysis, seizures, syncope, and tremors.

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Physical Examination

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Gen
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The patient is a Caucasian woman in NAD. She appears older than her stated age

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VS
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BP 149/87, P 73, RR 17, T 98.2°F; Wt 85 kg, Ht 5′4″

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Skin
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Distal to midshin with shiny-appearing skin, skin atrophy, and lack of hair growth. No evidence of skin breakdown or ulceration

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HEENT
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PERRLA; conjunctivae and lids normal; TM intact; normal dentition, no gingival inflammation, ...

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