Course 03: Cardiovascular, Vascular and Hematology
Lesson 8 of 12. Read the diagnostic framework and case, then complete the 10-question practice set. All material is original educational content; high-risk presentations require emergency referral.
Peripheral arterial disease
- Claudication is reproducible exertional muscle discomfort relieved by rest; pulses, skin changes and ankle-brachial index guide assessment.
- ABI at or below 0.90 supports PAD; ABI above 1.40 suggests noncompressible vessels and may require toe-brachial index evaluation.
- Manage global cardiovascular risk with smoking cessation, statins, antithrombotic strategies when appropriate, diabetes/BP care and structured exercise.
- Rest pain, nonhealing ulcer or gangrene suggests chronic limb-threatening ischemia and warrants expedited vascular referral.
Acute limb ischemia and aortic disease
- Acute limb ischemia presents with pain, pallor, pulse deficit, paresthesia, paralysis and poikilothermia; urgent vascular emergency care is essential.
- Sudden tearing chest/back pain, pulse or BP asymmetry, neuro deficits or shock raises suspicion for aortic dissection; emergency imaging and transfer are needed.
- Abdominal aortic aneurysm risk increases with age and smoking; rupture may cause abdominal/back pain, hypotension or collapse.
- A known aneurysm with new pain warrants immediate emergency assessment.
TIA and acute stroke
- Sudden facial asymmetry, arm weakness, speech change or visual loss requires emergency stroke activation, even if symptoms resolve.
- Establish last-known-well time, glucose, anticoagulant exposure and focal deficits; imaging is required to distinguish ischemia from hemorrhage.
- Thrombolysis eligibility and mechanical thrombectomy windows are determined by trained stroke teams and imaging; do not delay transport.
- Transient symptoms still require urgent evaluation and secondary prevention; do not assume a TIA is harmless.
Venous disease and edema
- Chronic venous insufficiency causes dependent edema, varicosities, hyperpigmentation and sometimes ulceration.
- Differentiate chronic bilateral edema from new unilateral swelling suggestive of DVT, and evaluate for systemic HF, renal or hepatic disease.
- Compression may benefit venous disease but requires appropriate arterial assessment when PAD is suspected.
- Consider lymphedema, cellulitis and medication-related edema in the differential.
Long-term prevention
- Atherosclerotic PAD increases the risk of MI, stroke and limb events; address the entire cardiovascular risk profile.
- Foot inspection, ulcer care, exercise adaptation and smoking cessation are key long-term components.
- Discuss urgent signs: acute neurological deficit, cold painful limb, sudden tearing chest/back pain or syncope.
Applied clinical case
A 66-year-old smoker has calf pain after 100 metres relieved by rest. ABI 0.72 and pedal pulses are diminished.
Show model clinical reasoning and disposition
Findings support PAD: initiate comprehensive cardiovascular risk assessment and guideline-based prevention, structured exercise and vascular follow-up as indicated.
Clinical self-check
- Which ABI values suggest PAD?
- What would indicate acute limb ischemia?
- Why must transient speech loss prompt emergency care?
Guidelines and further learning
- AHA/ACC — 2024 Peripheral Artery Disease Guideline (external)
- Canadian Stroke Best Practices — Acute Ischemic Stroke Treatment (external)
- Canadian Cardiovascular Society — Guidelines Library (external)