All are true about intermittent claudication except:
Ans: B (Pain is positional) Intermittent Claudication# It refers to pain or fatigue in muscles of the lower extremity caused by walking and relieved by rest# Claudication is derived from the Latin word for "limping, lame"; strictly speaking, the term should be used only for symptoms in the lower extremities. The pain is a deep- seated ache usually in the calf muscle, which gradually progresses until the patient is compelled to stop walking.# Patients occasionally describe "cramping" or "tiredness" in the muscle. Typically, symptoms are completely relieved after 2-5 minutes of inactivity.# Claudication is distinguished from other types of pain in the extremities in that some exertion is always required before it appears; it is reproducible; it does not occur at rest; and it is relieved by cessation of walking.# Relief of symptoms Is not dependent upon sitting or other positional change. The distance a patient can walk varies with the rate of walking, the level of incline, and the degree of arterial obstruction.# The average patient with involvement of a single arterial segment can walk 90-180 meters on a level terrain at a moderate pace before pain appears.# Regardless of which arterial segment is involved, claudication most commonly involves the calf muscles due to their high workload with normal walking.# The correct diagnosis should be easily established by determining the location of pain (calf), the quality of the pain, the length of time required for relief of symptoms, the reproducibility of symptoms, the distance walked before symptoms begin (initial claudication distance), and the type of rest or position required for symptom relief.# Although most patients with this disorder do not develop gangrene or require amputations, adverse outcomes of systemic atherosclerosis, including death, are common# There is increasing interest in the use of the ankle-brachial index (ABI). Normal is more than 1. Claudicants are in the 0.6 to 0.9 range, with rest pain and gangrene occurring at less than 0.3.# Indications for surgery include disabling claudication (severely limiting wrork or lifestyle), rest pain, limb- threatening ischemia, and microembolization of the toes in which no other source is identified.# The claudication distance will vary from day to day and will be altered by walking up hill, the speed of walking or against the wind.# Characteristically this pain is worse at nightand is worsened by elevation of the extremity, whereas it is somewhat relieved by hanging the foot out of the bed or by sleeping in a chair. This rest pain is mainly due to ischaemic changes in the somatic nerves, so it is the cry of the dying nerves.
Most common in calf muscle
Pain is positional
Atherosclerosis is important predisposing factor
Relieved by rest