A 56-year-old man presents to the emergency room complaining of severe pain in his left foot that woke him from sleep. He has recently experienced pain in both calves and feet and he can barely walk for 100 feet without pain. Occasionally, he experiences mild pain in his feet at night, but the pain usually gets better when he sits up and hangs his feet off the bed. This time, the pain was more severe and did not improve, and he now feels like the foot is numb and he cannot move his toes.
Medical history The patient has a history of chronic stable angina, hypercholesterolemia, and hypertension, for which he takes aspirin, atenolol, and simvastatin. Physical examination He is afebrile. HR: 72 bpm BP 125/74 mm Hg Head and neck examination are significant for a right carotid bruit His chest is clear to auscultation; his heart rhythm is regular with a nondisplaced apical impulse, an S4…
