Patient 9


80 year old male.


Painful toe – chilblain type appearance (unspecified toe)

Non-palpable foot pulses

B/popliteal pulses palpable

Vascular Audio

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Consensus Opinion

These are all different types of monophasic pulse. An ABPI is needed in the assessment of this person; you could not make a decision based on just the sound waves alone. The chilblain toe maybe microvascular disease or embolic event. It might not need vascular referral but you would be advising the GP post-ABPI and full assessment for best cardio-vascular risk management. You would want to know about pain pattern, that medications are optimised. This person needs to be observed in approximately 6 weeks and referred to vascular service if the pain and lesion are non-resolving/ non-improving. Also, you want to re-check for palpable pulses. Toe pressure index would also support your assessment.