When you walk, do you get pain in the calves?
It is common for patients to see their doctors for limb pain. Predictable discomfort that occurs with exertion in the legs may be the first sign that you have heart problem brewing. Peripheral arterial disease or PAD affects eight to 12 million patients in the US.
The typical symptoms can be described as cramping pain in the calf, thigh or buttocks. In some patients, the symptoms might be rather cryptic and go unrecognized for years. I have seen patients with the spectrum of presentations ranging from impotence to an ulcer and gangrene in the foot. The implications of PAD for many reach farther than walking distance and include a chance of
heart attack and stroke. The process of atherosclerosis in the legs and the heart is associated with cholesterol laden plaques and inflammation inside the artery wall.
Diabetes, smoking, hypertension and age are strong risk factors for the development of PAD.
When a plaque in the heart raptures it can cause a fatal heart attack, in the brain circulation it can cause a stroke, and in the legs it can lead to a blockage that will cause leg pain with exertion or at its worst levels even at rest.
A simple study to measure the blood pressure in the arms and legs can determine if PAD is present. This test known as the Ankle Brachial Index (ABI), has very profound implications. If the ABI level is dramatically reduced, research data suggests that almost 25 percent of those patients will die from a heart attack or stroke.
A study of average Americans determined that more people are aware of Cystic Fibrosis, Lou Gering's Disease, and Multiple Sclerosis than PAD. Less than a third of Americans knew that PAD could lead to a heart attack, stroke or amputation.
A new patient of mine came to the hospital after a heart attack. After successful treatment she confided that she hadn't been able to walk any distance without severe pain in the hips for one or two years. She underwent successful stent implantation in an artery in her pelvis and now she is walking without pain. In her case, the cart was out of the barn years ago.
If a patient is identified to have PAD based on the ABI test, he should be treated to reduce the risk of progressive heart disease. These treatments include aspirin, cholesterol lowering medications, aggressive control of blood pressure and smoking cessation education. Walking programs help with symptoms, but when specific criteria are met, angioplasty, stents and surgery may be needed.
