PAD is a condition where arteries supplying the limbs (mainly legs) get narrowed due to atherosclerosis, leading to reduced blood flow and ischemia.
Mnemonic: "PAD = Poor Arterial Distribution"
CAUSES & RISK FACTORS OF PAD
- Atherosclerosis (Most Common Cause).
- Smoking (Major Risk Factor).
- Diabetes Mellitus.
- Hypertension (High BP).
- High Cholesterol (Hyperlipidemia).
- Age >50 years.
Mnemonic: "S.D.H.C.A." (Smoking, Diabetes, Hypertension, Cholesterol, Age)
TYPES OF PAD
1. Intermittent
Claudication (IC) → Mild to Moderate PAD.
- Pain in Legs While Walking, Relieved by Rest.
- Calf Pain (Common), Thigh Pain (If Iliac Artery Involved).
2. Critical
Limb Ischemia (CLI) → Severe PAD.
- Rest Pain (Especially at Night).
- Non-Healing Ulcers, Gangrene.
Mnemonic: "I.C.C." (Intermittent Claudication, Critical Ischemia, Complications – Ulcers, Gangrene)
SYMPTOMS OF PAD
- Pain in Legs (On Walking – Intermittent Claudication).
- Cold & Pale Feet.
- Shiny Skin, Hair Loss Over Legs.
- Non-Healing Wounds, Ulcers.
- Weak/Absent Pulses in Feet.
Mnemonic: "P.C.S.U.W." (Pain, Cold Feet, Shiny Skin, Ulcers, Weak Pulses)
DIAGNOSIS OF PAD
- Ankle-Brachial Index (ABI) – Best Initial Test.
- Normal ABI >1.0
- PAD: ABI <0.9 (Mild), <0.5 (Severe).
- Doppler Ultrasound – To Assess Blood Flow.
- Angiography (Gold Standard) – For Severe Cases.
Mnemonic: "A.D.A." (ABI, Doppler, Angiography – Best Test)
TREATMENT OF PAD
1. LIFESTYLE MODIFICATIONS
- Stop Smoking (Most Important).
- Exercise (Improves Collateral Circulation).
- Diet Control (Reduce Cholesterol, Diabetes, BP).
Mnemonic: "S.E.D." (Stop Smoking, Exercise, Diet Control)
2. MEDICAL TREATMENT
- Antiplatelets (Aspirin, Clopidogrel – Prevent Clots).
- Statins (Reduce Cholesterol & Prevent Plaque Growth).
- Cilostazol (Vasodilator – Improves Walking Distance in IC).
Mnemonic: "A.S.C." (Antiplatelets, Statins, Cilostazol)
3. SURGICAL TREATMENT (For Severe PAD)
- Angioplasty + Stenting (For Short Blockages).
- Bypass Surgery (For Long Blockages).
- Amputation (Last Resort in Non-Salvageable Limb).
Mnemonic: "A.B.A." (Angioplasty, Bypass, Amputation in Severe Cases)
COMPLICATIONS OF PAD
- Non-Healing Ulcers (Diabetic Foot).
- Gangrene (May Require Amputation).
- Stroke (If Atherosclerosis Affects Carotid Arteries).
- Heart Attack (Due to Generalized Atherosclerosis).
Mnemonic: "N.G.S.H." (Non-Healing Ulcers, Gangrene, Stroke, Heart Attack)
SPECIAL CONDITIONS RELATED TO PAD
1. Buerger’s Disease (Thromboangiitis Obliterans)
- Inflammatory Disease of Small Arteries & Veins.
- Affects Young Male Smokers.
- Leads to Gangrene in Fingers & Toes.
- Strongly Associated with Smoking.
- Treatment: Smoking Cessation, Vasodilators, Surgery (If Needed).
Mnemonic: "Buerger = Burns (Tobacco), Blocks Small Arteries"
2. Raynaud’s Disease (Vasospasm of Peripheral Arteries)
- Trigger: Cold or Emotional Stress.
- Classic Color Change (White → Blue → Red).
- Common in Young Women.
- Treatment: Avoid Cold, Vasodilators (Nifedipine).
Mnemonic: "W.B.R. = White-Blue-Red (Raynaud’s Triphasic Change)"
3. Acute Limb Ischemia (Sudden Arterial Blockage – Emergency!)
"6 P’s" of Acute Ischemia:
- Pain (Severe).
- Pallor (White, Cold Limb).
- Pulselessness.
- Paresthesia (Numbness, Tingling).
- Paralysis (Loss of Movement).
- Poikilothermia (Cold Temperature).
Mnemonic: "6 P’s = Pain, Pallor, Pulseless, Paresthesia, Paralysis, Poikilothermia"
Treatment: Emergency Thrombolysis or Surgery (If Delayed → Amputation).
HOMOEOPATHIC MANAGEMENT OF PAD
- For Atherosclerosis & Arterial Weakness:
- Baryta carb, Tabacum, Cactus, Aurum met, Adrenalin.
- For Leg Pain & Cramping:
- Aesculus, Arnica, Secale, Sulphur, Lachesis.
- For Gangrene & Non-Healing Ulcers:
- Arsenicum album, Carbo veg, Silicea.
Mnemonic: "B.A.S.L." (Baryta, Aesculus, Secale, Lachesis – Key Remedies for PAD)
FINAL REVISION WITH MNEMONICS
- Definition = "PAD = Poor Arterial Distribution"
- Causes = "S.D.H.C.A." (Smoking, Diabetes, Hypertension, Cholesterol, Age)
- Types = "I.C.C." (Intermittent Claudication, Critical Ischemia, Complications – Ulcers, Gangrene)
- Symptoms = "P.C.S.U.W." (Pain, Cold Feet, Shiny Skin, Ulcers, Weak Pulses)
- Diagnosis = "A.D.A." (ABI, Doppler, Angiography – Best Test)
- Treatment = "S.E.D." (Stop Smoking, Exercise, Diet) & "A.S.C." (Antiplatelets, Statins, Cilostazol)
- Surgical Treatment = "A.B.A." (Angioplasty, Bypass, Amputation in Severe Cases)
- Complications = "N.G.S.H." (Non-Healing Ulcers, Gangrene, Stroke, Heart Attack)
- Acute Limb Ischemia = "6 P’s" (Pain, Pallor, Pulseless, Paresthesia, Paralysis, Poikilothermia)
- Buerger’s Disease = "Buerger = Burns (Tobacco), Blocks Small Arteries"
- Raynaud’s Disease = "W.B.R. = White-Blue-Red (Raynaud’s Triphasic Change)"
- Homoeopathic Remedies = "B.A.S.L." (Baryta, Aesculus, Secale, Lachesis – Key Remedies for PAD)
