ABSTRACT
It is important to establish a proper history. This includes the nature of the patient’s symptoms, their duration and what makes the symptoms better or worse. In a patient presenting with pain in the legs, a systematic inquiry should be made to exclude pain in the chest on exercise (angina), funny turns and visual disturbance (transient ischaemic attacks); inquiries should be made concerning past medical problems, including operations. Specific questions about whether the patient suffers from diabetes, heart disease and kidney disease should also be made. It is important to know whether patients are taking medication, as medication can affect symptoms of arterial disease (beta blockers given for heart disease can make intermittent claudication [pain in the legs] worse). A past history of thrombotic problems, deep vein thrombosis or pulmonary embolism should also be elicited. Some patients with arterial problems have a family history, with one or both parents suffering from similar problems. This information may also be useful. Smoking may adversely affect the symptoms and it is important to determine whether a patient smokes, the number they smoke and, in particular, whether they are trying to give up smoking. When taking a history, particularly with a patient with arterial disease, their job and home circumstances may be important. For example, patients with severe arterial disease may come to amputation. If this is recognised at an early stage, arrangements can be made to provide additional services or to re-house the patient. This may prevent a significant delay in hospital discharge.
