Intermittent claudication
Intermittent claudication
Classification & external resources
| ICD-10 |
I73.9 |
| ICD-9 |
440.21 |
Intermittent claudication is a cramping sensation in the legs that is present during exercise or walking and occurs as a result of decreased oxygen supply. This cramping usually occurs in the calf, but may also occur in the feet. When intermittent claudication is discussed it is measured by the number of "blocks" (e.g. 1 or 2 blocks) one can walk comfortably. It often indicates severe atherosclerosis. One of the hallmarks of this clinical entity is that it occurs intermittently. It disappears after a brief rest and the patient can start walking again until the pain recurs.
Intermittent claudication in and of itself is often a symptom of severe atherosclerotic disease of the peripheral vascular system. Claudication derives from the Latin verb claudicare, "to limp."
Signs
The following signs are general signs of atherosclerosis of the lower extremity arteries:
- cyanosis
- atrophic changes like loss of hair, shiny skin
- decreased temperature
- decreased pulse
- redness when limb is returned to a "dependent" position
All the "P's"
- Increase in Pallor
- Decrease in Pulses
- Perishing cold
- Pain
- Paraesthesia
- Paralysis
Treatment
In patients who smoke, smoking cessation is the most effective treatment. Exercise can improve symptoms as do medication to control the lipid profile, diabetes and hypertension. Surgery is only indicated in severe cases with limb-threatening ischemia or lifestyle-limiting claudication. The vascular surgeon will perform an endarterectomy of leg arteries or an arterial bypass. Angiotensin converting enzyme (ACE) inhibitors, beta-blockers, antiplatelet agents (ASA and clopidogrel), pentoxifylline and cilostazol (selective PDE3 inhibitor) are used for the treatment of intermittent claudication. Low molecular weight heparin (LMWH), oral anticoagulants (warfarin), vitamin E or chelation therapy is not effective.
Epidemiology
Atherosclerosis affects up to 10% of the Western population older than 65 years and for intermittent claudication this number is around 5%. Intermittent claudication most commonly manifests in men older than 50 years.
See also
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|
Circulatory system pathology (I, 390-459) |
| Hypertension |
Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension (Renovascular hypertension) |
| Ischaemic heart disease |
Angina pectoris (Prinzmetal's angina) - Myocardial infarction - Dressler's syndrome |
| Pulmonary circulation |
Pulmonary embolism - Cor pulmonale |
| Pericardium |
Pericarditis - Pericardial effusion - Cardiac tamponade |
| Endocardium/heart valves |
Endocarditis - mitral valves (regurgitation, prolapse, stenosis) - aortic valves (stenosis, insufficiency) - pulmonary valves (stenosis, insufficiency) - tricuspid valves (stenosis, insufficiency) |
| Myocardium |
Myocarditis - Cardiomyopathy (Dilated cardiomyopathy, Hypertrophic cardiomyopathy, Loeffler endocarditis, Restrictive cardiomyopathy) - Arrhythmogenic right ventricular dysplasia |
Electrical conduction system
of the heart |
Heart block: AV block (First degree, Second degree, Third degree) - Bundle branch block (Left, Right) - Bifascicular block - Trifascicular block
Pre-excitation syndrome (Wolff-Parkinson-White, Lown-Ganong-Levine) - Long QT syndrome - Adams-Stokes syndrome - Cardiac arrest - Sudden cardiac death
Arrhythmia: Paroxysmal tachycardia (Supraventricular, AV nodal reentrant, Ventricular) - Atrial flutter - Atrial fibrillation - Ventricular fibrillation - Premature contraction (Atrial, Ventricular) - Ectopic pacemaker - Sick sinus syndrome |
| Other heart conditions |
Heart failure - Cardiovascular disease - Cardiomegaly - Ventricular hypertrophy (Left, Right) |
| Cerebrovascular diseases |
Intracranial hemorrhage/cerebral hemorrhage: Extra-axial hemorrhage (Epidural hemorrhage, Subdural hemorrhage, Subarachnoid hemorrhage)
Intra-axial hematoma (Intraventricular hemorrhages, Intraparenchymal hemorrhage) - Anterior spinal artery syndrome - Binswanger's disease - Moyamoya disease |
Arteries, arterioles
and capillaries |
Atherosclerosis (Renal artery stenosis) - Aortic dissection/Aortic aneurysm (Abdominal aortic aneurysm) - Aneurysm - Raynaud's phenomenon/Raynaud's disease - Buerger's disease - Vasculitis/Arteritis (Aortitis) - Intermittent claudication - Arteriovenous fistula - Hereditary hemorrhagic telangiectasia - Spider angioma |
Veins, lymphatic vessels
and lymph nodes |
Thrombosis/Phlebitis/Thrombophlebitis (Deep vein thrombosis, May-Thurner syndrome, Portal vein thrombosis, Venous thrombosis, Budd-Chiari syndrome, Renal vein thrombosis, Paget-Schroetter disease) - Varicose veins / Portacaval anastomosis (Hemorrhoid, Esophageal varices, Varicocele, Gastric varices, Caput medusae) - Superior vena cava syndrome - Lymph (Lymphadenitis, Lymphedema, Lymphangitis) |
| Other |
Hypotension (Orthostatic hypotension) |
| See also congenital (Q20-Q28, 745-747) |
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