Aortic valve calcification (AVC) and peripheral artery disease (PAD) are systemic manifestations of atherosclerosis that frequently coexist yet are often evaluated through separate diagnostic pathways. In rural, resource-limited settings, access to comprehensive cardiovascular imaging may be delayed or unavailable. Handheld point-of-care ultrasound (POCUS) offers a portable, bedside modality with demonstrated diagnostic utility for screening and triage when standard imaging is inaccessible. This case highlights the role of handheld POCUS in the concurrent evaluation of cardiac and peripheral arterial disease during a single encounter. POCUS was performed using a Butterfly iQ3 in Tarapoto, Peru, on a 61-year-old man with uncontrolled diabetes mellitus presenting with cyanosis and necrosis of the left foot. Physical examination revealed a palpable left popliteal pulse with absent distal pedal pulses. Using the cardiac preset, POCUS demonstrated marked aortic valve calcification with hyperechoic leaflet thickening, restricted excursion, and mild aortic regurgitation. Two-dimensional imaging and color Doppler were used to qualitatively assess valvular morphology. The examination was extended to the lower extremity using a high-frequency linear vascular preset, revealing eccentric plaque and complete occlusion of the posterior tibial artery, consistent with advanced PAD and correlating with ischemic findings. Differential diagnoses included vasculitis and necrotizing soft tissue infection; preserved proximal pulsatility, lack of systemic illness, and absence of inflammatory sonographic features supported arterial occlusive disease. POCUS findings enabled rapid diagnostic clarification, risk stratification, and urgent vascular surgery referral. Follow-up outcome data were unavailable at the time of submission.
