Page 44 - Clinical Pearls in Cardiology

32 Clinical Pearls in Cardiology

5. What are the common causes of unequal peripheral
pulses?
Carotid, radial, brachial, femoral, posterior tibial, and
dorsalis pedis pulses should be routinely examined
bilaterally to ascertain any differences in the pulse
amplitude. Inequality in the amplitude of peripheral
pulses can occur in many diseases. Some of the important
causes for unequal peripheral pulse are the following:
• Obstructive arterial diseases (commonly due to
atherosclerosis)
• Diseases of the aorta like dissection, aneurysm or
coarctation
• Vasculitic disorders like Takayasu disease
• Leriche’s syndrome characterized by aorto-iliac
occlusion
• Supravalvular aortic stenosis in which the carotid,
brachial and radial pulses on the right side are larger
in amplitude than those on the left side. This is
because of the preferential streaming of the jet of
blood from the left ventricle towards the right
innominate artery (Coanda effect).
6. How will you differentiate between vascular and
neurogenic claudication?
Claudication is defined as fatigue, discomfort or pain that
occurs in specific group of limb muscles during effort
due to exercise-induced ischemia. It commonly occurs
in the calf muscles because the gastrocnemius muscle
has the highest oxygen consumption among the muscle
groups in the leg during walking. Claudication symptoms
are usually relieved with rest. Claudication may be of
vascular or neurological etiology (Table 1).