Case History/ Examination
A 30-year female weighing 59 kg presented three months back with a 4-year history of easy fatigue in the bilateral upper limbs, initially triggered by strenuous activity. She was diagnosed anemia with multivitamin deficiency and managed accordingly. However, fatigue progressively worsened over the last seven days and is now present even on general activities. Recently, she also experienced limb claudication, jaw claudication while eating, bilateral temporal headaches with orbital pain, and painful intermittent blurred vision, which worsened in the last three days. Additionally, she reported dizziness and lightheadedness for the past three days.
On examination, her systolic blood pressure was 60 mmHg with an unrecordable diastolic pressure, respiratory rate was 24 breaths per minute, pulse was 97 beats per minute(bpm), temperature was 97°F, and oxygen saturation was 98% on room air. She had a Glasgow Coma Scale (GCS) score of 15/15, and her random blood sugar was 150 mg/dL. Physical examination revealed pallor in the bilateral palpebral conjunctiva, a feeble pulse in the right radial artery with no pulse in the left radial artery, palpable bilateral dorsalis pedis, a bruit over the right carotid artery, and absent bruit over the left. Systemic examinations were otherwise normal. There was no similar history in the family.