Patient 1

Biography
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Consensus Opinion

Biography

57 year old female.

Query intermittent claudication, bi-lateral symptoms

Chronic Obstructive Pulmonary Disease (COPD)

Smoker

Vascular Audio

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Right Dorsalis Pedis Artery

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Pod: “Monophasic, regular pulse sound. When we hear some more we will put it in to perspective.”

Nurse: “Monophasic pulse sound.”

Sonographer: “Biphasic pulse sound.”

Left Dorsalis Pedis Artery

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Pod: “Monophasic, regular pulse sound. Possibly biphasic on the 4th sound? But it does not sound a healthy biphasic signal. Right at the very end there is a ‘dum’.”

Nurse: “Monophasic, but there is a second sound at the end. The last one is biphasic.”

Sono: “Monophasic, pulsatile.”

Right Posterior Tibial Artery

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Pod: “Monophasic and regular.”

Nurse: “Monophasic, muffled. I’d query the value [of the ankle pressure]. A longer lapse of time is needed, perhaps 10 beats.”

Sono: “Dampened monophasic pulse.”

Left Posterior Tibial Artery

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Pod: “Monophasic, but that last sound seems biphasic.”

Nurse: “Monophasic, but I’m not sure on that 2nd one. I need longer, 10 beats perhaps!”

Sono: “Biphasic/ monophasic, because I see what I’m hearing I make a decision much quicker. I regularly only use 3 beats but based on the sound alone I would want longer.”

Right Peroneal Artery

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Nurse: “Monophasic pulse sound. I do not do peroneal [Doppler assessment] unless you are bypassing on to it, not as a peripheral arterial disease check.”

Pod: “Monophasic pulse sound, query a biphasic on the 2nd pulse sound? We check the peroneal pulse every time [in peripheral arterial disease assessment]. The pulse sound is regular.”

Sono: “Monophasic pulse sound, dampened.”

Left Peroneal Artery

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Pod: “Monophasic, dull pulse sound. Regular [rhythm].”

Nurse: “Monophasic pulse sound.”

Sono: “Monophasic pulse sound. Very dampened.”

Right Popliteal Artery

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Pod: “Biphasic pulse sound, regular.”

Nurse: “Biphasic pulse sound.”

Sono: “Biphasic, pulsatile.”

Left Popliteal Artery

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Pod: “It’s quiet; it sounds like it’s not really on the artery. Monophasic pulse sound.”

Nurse: “Monophasic pulse sound.”

Sono: “It’s quiet, query if it’s a monophasic pulse sound?”

Right Common Femoral Artery

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Pod: “Biphasic or triphasic pulse sound, regular. Bi/ triphasic femoral, biphasic if I have to come off the fence.”

Nurse: “Biphasic pulse sound.”

Sono: “Triphasic pulse sound.”

Left Common Femoral Artery

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Pod: “Biphasic pulse sound. Regular”

Nurse: “Biphasic pulse sound.”

Sono: “Triphasic pulse sound.”

Consensus Opinion

He has left popliteal and bi-lateral crural vessel disease, so potential left Superficial Femoral artery blockage, would assess further. The Doppler signals need to be put in to context of all the clinical findings, the next assessment should be an Ankle Brachial Pressure Index (ABPI) alongside history of symptoms to confirm if it is intermittent claudication (IC). This type of bi- lateral IC description without any symptom analysis is typical outside the vascular world, more can be done to assess for IC properly.

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Query Intermittent Claudication

“This requires clarifying. IC symptoms can be investigated with Edinburgh Claudication questionnaire. Don’t base solely on pulse sounds.”

“Claudication is dead easy to assess, it is pain only on exercise, it never happens at rest. It is worse on an incline nine times out of ten, you do not get the symptoms sat down, and you do not get the symptoms in bed.”

Further questions wanted from assess clinician:

“Is there any rest pain? And is one side worse than the other?”