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Peripheral Artery Disease Questionnaire


Peripheral Arterial Disease (PAD) or Peripheral Vascular Disease (PVD) is a common circulation problem in which the blood vessels, which carry blood in the body (most commonly legs, arms and brain) become narrow or clogged. Please fill out this questionnaire to see if you have the symptoms of PAD.

Do you experience aching, cramping or pain in your arms, legs, thighs or buttocks when you walk or exercise?

If you answered yes to question number one, does the pain subside with rest?

Do you have numbness and tingling in the arms or lower legs and feet?

Are your fingers or toes pale, discolored or bluish?

Are your hands or feet cold to the touch?

Do you have any sores or ulcers on legs or feet that don't heal?

Do you have difficult to control blood pressure on more than two blood pressure medications?

Do you exercise on a regular basis?

Do you have a family history of aortic aneurysm?

Have you ever experienced a stroke, mini-stroke or transient ischemic attack (TIA)?

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