June 1, 2008
Leg Pain May Be Signal of Heart Problems
Most people know that blockage of arteries in the heart can lead to heart attacks and blockage of arteries in the brain can lead to stroke.
But what about blockage in the legs? Many people don't have a clue, but they should: Buildup of plaque in the legs means it's likely elsewhere in the body, as well.Atherosclerosis in the limbs is called peripheral arterial disease or peripheral vascular disease. Having it dramatically increases the risk of heart attack, stroke and amputation, but many are unaware of it or attribute its passing pain to old age, arthritis or being out of shape.
An estimated 10 million Americans have the disorder, also known as PAD.
"When you're living a sedentary life it doesn't hurt you," Dr. Thomas Whitsett, director of vascular medicine at the University of Oklahoma Health Sciences Center, said of the intermittent pain, called "claudication."
The pain stops when the person stops moving.
Testing for the disease Lifestyle changes, particularly exercise, are the first response to peripheral arterial disease, followed by medication and surgery.
Those with peripheral arterial disease have the same likelihood of having a heart attack or stroke as someone who already has had a heart attack or small stroke, Whitsett said, adding: "It's a harbinger of bad things to come."
Moreover, he said, the chances of dying from complications of peripheral arterial disease are greater than those of breast cancer or lymphoma.
"When someone comes in with leg symptoms, I always listen to their neck," Dr. James Melton, medical director of the Vascular Institute at Oklahoma Heart Hospital, said of the increased stroke risk.
Testing for peripheral arterial disease is straightforward: Using a blood pressure cuff on the ankle and a Doppler ultrasound device, doctors determine how much the pressure in the lower extremity differs from the arm's blood pressure.
Melton said peripheral arterial disease and heart disease go together in 70 to 80 percent of his patients.
"It's a global disease. It's not isolated to one part of the body," he said.
'My toes would get numb' The reason the blocked vessels cause leg pain is that the person can't generate a high enough heart rate to cause chest pain, called angina.
"It's like a charley horse you've never had before," Melton said of the intense leg pain.
Reginald Jenkins had to return from working in Afghanistan for military contractor KBR because of the pain in his legs.
"My legs would start hurting and my toes would get numb," the Army retiree and Desert Storm veteran said, describing how it was an ordeal to walk from his bedroom to his front door when his peripheral arterial disease became severe.
Jenkins finished up his tour in 2005 and returned to the United States, taking a job as a security guard at Fort Sill. In April, Dr. Feroz Maqbool implanted two stents in Jenkins' legs to improve his circulation.
"I could tell the difference the day I walked out of the hospital," he said.
Jenkins, 55, wants to return overseas. He's able to run again and can endure the difficulties of life abroad.
"As soon as I get that paperwork turned in, I'm going," he said.
Waiting to treat disease Treatment of peripheral arterial disease has evolved as it has for other disorders: Doctors use balloons, stents, liquid nitrogen -- even lasers -- to dislodge worrisome plaque. Free clots and reduced circulation can lead to gangrene.
Reduced blood flow also means slower healing.
"There are people out there who have had sores on their foot for years and don't know what caused it," Melton said.
Maqbool, who treats most of his patients at the Oklahoma City VA Medical Center, said the aggressiveness of treatment depends on the effect of the pain on one's life.
"It's a quality-of-life issue and basically avoiding surgery," he said, calling peripheral arterial disease "quite common" among veterans.
"Most of the time we see severe or critically severe disease," he said. Veterans often "tough it out" rather than seek care, he added.