Myocardaial infarction

A 55-year-old male presents to his family physician with a complaint of bilateral lower leg pain that started gradually and has persisted for the past 3 months. He notices this leg pain after walking 2-3 blocks or ascending stairs. The pain is relieved with rest. The patient admits to a 30 pack-year history of smoking and social alcohol use. Vitals are as follows: T 98.0, HR 86, BP 144/88, RR 18, O2 Sat 98% RA. His BMI is 34.4. Physical exam is significant for shiny skin and absence of hair on both lower legs. This patient is at greatest risk of experiencing which of the following?

1.Deep venous thrombosis
2.Pulmonary embolism
3.Critical limb ischemia
4.Myocardaial infarction
5.Abdominal aortic aneurysm

exp:

This patient’s symptoms of lower leg claudication and exam findings are consistent with peripheral artery disease (arterial insufficiency). Patients with peripheral artery disease (PAD) are at an extremely high risk of experiencing a myocardial infarction (MI).
Peripheral arterial disease is often a marker of underlying systemic atherosclerotic build-up. Although symptoms of lower leg claudication may be the first to manifest, coronary artery and cerebrovascular disease are often concurrent, even if they have yet to exhibit symptoms such as angina, TIA, etc. Overall prognosis is correlated with the severity of PAD present, which is quantified by ankle-brachial index (ABI). An abnormal ABI should lead the physician to pursue lower extremity doppler ultrasound and/or angiography to confirm the diagnosis.

Illustration A depicts the pathophysiology of PAD and its relation to coronary artery disease. Illustration B summarizes outcomes associated with PAD; note the extremely high risk of cardiovascular events and mortality. Illustration C lists interpretations of ABI values, with ABI < 0.9 indicative of PAD.