Name
Age
Sex
Occupation
Residence
Marital status
Date of admission
C/o
Lower limb pain for 1 month
History of Presenting Illness
Local
Intermittent claudication :Onset Duration , After how much distance ,Relieving and Aggravating factors ,site of pain. Related to walking or sitting
Rest pain :Onset ,Duration, Awaking from sleep ,Holding leg below the level of the bed, Compensation ,Relieving and aggravating factors
. Change in the color of the limb :black red in color site level onset
Ulceration: site and onset size and discharge color and amount
Fever
Impotence onset management received
Loss of sensation -parasesthesia and weakness
Systemic Effect of Vascular Diseases
CVS: Chest pain .SOB .Cough lower limb oedema
CNS .loss of consciousness Convulsion and weakness
Eyes :loss of vision
kidney: urine amount and colour
GIT : food angina
Risk Factors
Diabetes Melitus - HTN - Hyperlipidaemia- Ischaemic Heart Disease- CVA
Smoking and ALCAHOL abuse
Past Medical History
HOSPITALIZATIONS
ANGIOGRAPHY
ANGIOPLASTY
BYPASS SURGERY
SIMILAR CONDITION
Family History
FH of VASULITIS
FH of HYPERLIBIDAEMIA AND DIABETES
Drug History
DRUGS: Asprine clopidogril statin
Social History
Job
Health Insurance
Supporter
