- Peripheral Vascular History
Chief Complaint
Elicit the patient's chief complaint.
History of Presenting Illness (HPI)
- Characterize each of the patient's skin lesions or abnormalities OPQRST/OLD CARTS approach.
- Location (unilateral, bilateral, upper or lower extremities)
- Timing (onset, duration, course)
- Character
- Severity (scale of 1-10)
- Radiation
- Alleviating/aggravating factors including:
- Pain worse with exertion like walking uphill?
- How far can the patient walk without pain?
- What effect does rest have on the pain?
- Establish a baseline to compare activities preformed in the past
- Associated symptoms:
- Fatigue
- Numbness
- Changes in skin colour
- Temperature of skin
- Hair loss, i.e. anterior tibial surface
- Ulcers or gangrenous lesions
- From trauma?
- Have they spread over time?
- Signs of infection
- Slow or absent wound healing on lower extremities
- Aching/pain that limits exertion
- Intermittent claudication
- Pain with ambulation, relieved with rest
- Impotence
- Post-prandial gastrointestinal pain with recent weight loss
- Ischemia of celiac or superior/inferior mesenteric arteries
- Chest pain
- Is it exertional, pleuritic, or positional in nature?
- Shortness of breath
- Is it exertional, pleuritic, or positional in nature?
Past Medical History (PMHx)
- Diabetes
- Hypertension
Cardiovascular disease
- Congestive Heart Failure
- Coronary Artery Disease
- Previous infarcts and dates
- Stroke
- Peripheral Vascular Disease
- Dyslipidemia
- Virchow's Triad
- Immobilization (bed rest, long car rides or plane trips)
- Previous endothelial injury
- Hypercoagulable states (Factor V Leiden, prothrombin mutations)
- Pregnancy
- Cancer
Family History (FHx)
- Hypercoagulable states
- Myocardial infarctions and age at which they occurred
- Cancers
- First degree relative with abdominal aortic aneurysm (AAA)
Social History (SocHx)
- Smoking (pack-years), alcohol, illicit drug use
- Stressors
- Occupation
- Work and home environments
- Diet and exercise
- Travel history
Medications
Gather complete list, but specifically ask about:
- Aspirin
- Anticoagulants
- Antihypertensives
- Nitro patch or spray
- Clopidogrel (Plavix)
- Beta-Blockers
- Calcium channel blockers (dihydropuridines and non-dihydropuridines)
- Digoxin
- Statins
- Oral contraceptive pills
- Hormone replacement therapy
Allergies
Note allergies and ensure they concord with those listed in the EMR
Substance Use History (SubHx)
Specifically ask about:
Review of Systems
Conduct a review of systems, keeping other etiologies from your differential in mind.
References
- Bickley L, Hoekelman R. Bates’ Guide to Physical Examination and History Taking. Philadephia, Pa: Lippincott; 2009.
- Bitar R, Jugovic P, McAdam, L. Fundamental Clinical Situations: A Practical OSCE Study Guide 4th Edition. Toronto, ON, Canada: Elsevier Canada; 2004.
- Filate, W, Leung, R, Ng, D, Sinyor, M. Essentials of Clinical Examination Handbook 5th Edition. Toronto, ON, Canada: The Medical Society Faculty of Medicine University of Toronto; 2005.
- McGee S. Evidence-Based Physical Diagnosis. Philadelphia, PA: Saunders, 2001.