Friday, September 5, 2008


A middle age man with known atherosclerotic disease presents with left arm claudication, fatigue, coolness, and tingling. He gets dizzy when he exercises the arm. On examination, you note the left arm has a 15mmHg lower systolic pressure than the right arm. Palpation of both radial pulses shows a decreased amplitude and delayed arrival on the left side.

Challenge: If blood is flowing in the wrong direction, what syndrome is this?

1 comment:

Craig said...


This is subclavian steal syndrome which refers to retrograde flow in the vertebral artery due to ipsilateral subclavian artery stenosis. Blood flows from the contralateral vertebral artery to the basilar artery and then retrograde through the ipsilateral vertebral. The incidence is much higher than the clinical syndrome. Symptoms are due to ischemia of the ipsilateral upper extremity and less commonly, vertebrobasilar ischemia of the brainstem.

Source: UpToDate.