What are the symptoms of PAD?

Question

I am 44, am having pain and poor circulation in my legs, Low blood pressure 80/58 for several months, I am a smoker, and have a family history of heart disease. I also have an irregular heart beat and have had severe headaches, blurred vision, and shortness of breath at times.

Answer 1

First and foremost, STOP SMOKING!!!!

The most common symptom of peripheral vascular disease in the legs is pain in one or both calves, thighs, or hips.

* The pain usually occurs while you are walking or climbing stairs and stops when you rest. This is because the muscles' demand for blood increases during walking and other exercise. The narrowed or blocked arteries cannot supply more blood, so the muscles are deprived of oxygen and other nutrients.

* This pain is called intermittent (comes and goes) claudication.

* It is usually a dull, cramping pain. It may also feel like a heaviness, tightness, or tiredness in the muscles of the legs.

* Cramps in the legs have several causes, but cramps that start with exercise and stop with rest most likely are due to intermittent claudication. When the blood vessels in the legs are completely blocked, leg pain at night is very typical, and the individual almost always hangs his or her feet down to ease the pain. Hanging the legs down allows for blood to passively flow into the distal part of the legs.

Other symptoms of peripheral vascular disease include the following:

* Buttock pain

* Numbness, tingling, or weakness in the legs

* Burning or aching pain in the feet or toes while resting

* A sore on a leg or a foot that will not heal

* One or both legs or feet feel cold or change color (pale, bluish, dark reddish)

* Loss of hair on the legs

* Impotence

Having symptoms while at rest is a sign of more severe disease.

Answer 2

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RE:
What are the symptoms of PAD?
I am 44, am having pain and poor circulation in my legs, Low blood pressure 80/58 for several months, I am a smoker, and have a family history of heart disease. I also have an irregular heart beat and have had severe headaches, blurred vision, and shortness of breath at times.

Answer 3

here is your answer in depth from vascular web:

Peripheral Arterial Disease - PAD

More than 20% of people over 70 years of age in this country have PAD

– as many as 30-40 million Americans may be affected by this potentially crippling disease in the years to come!

* PAD blocks circulation to vital arteries.
* PAD is called "peripheral" because it most often effects the legs and feet
* PAD is associated with high blood pressure, diabetes, heart disease and stroke.

Early on, PAD may only cause difficulty walking but in its most severe forms, PAD can cause painful foot ulcers, infections, or even gangrene that results in amputation!

That's why we say,It's a matter of life and limb"

It’s easy to diagnose PAD!
In most cases, a physical exam by your doctor can detect PAD, but it's not always easy to tell how severe it is, particularly if you have other problems like diabetes. PAD can be accurately measured by simple non-invasive tests using a Doppler flowmeter or an ultrasound scan. These tests can be done in minutes without any risk or discomfort

If you have PAD, you need treatment!

* It sounds serious, but it may be simple.
* You need to get more exercise, and change your diet and eat healthier foods
* If you smoke, you need to stop smoking!
* If you’re a diabetic, you need to have good medical treatment and regular exams
* You need to get your blood pressure under good control
* Medical treatments can reduce your blood cholesterol
* Medical treatments can help you walk further
* Medical treatments can reduce your risk of heart attack and stroke

When we keep treatment simple, we keep PAD from getting complicated!
When the treatments above are used in the right combination for each person, the risks of the most serious and lethal complications of PAD are significantly reduced, that's why we call this simple strategy,"Risk Factor Reduction".

Not sure what questions to ask? - Try these.
(Click on the question for the answer.)

What causes PAD? How do I prevent PAD?
Who is at risk for PAD? What is the treatment for PAD?
What are the warning signs of PAD? What does a vascular surgeon do?
How do I find out if I have PAD?



What causes PAD?

PAD is most often caused by atherosclerosis, the process that most people call "hardening of the arteries." Atherosclerosis causes a build-up of plaque in the blood vessels that carry oxygen and nutrients to all tissues of the body. As these plaques worsen they reduce essential blood flow to the limbs, and plaque can even block major arteries completely! These plaques are the same as those that produce blockages in the arteries to the heart, causing heart attacks. While everyone knows how important it is to treat and prevent heart disease, most people are not aware of the seriousness of PAD.

Even many doctors tend to think that PAD is not serious like heart disease since it may only effect the legs. But the truth is, people with PAD are three times more likely to die of heart attacks or strokes than normal people.

Who is at risk for PAD?

The most serious risk factors for the development of PAD are:

* Hypertension (High blood pressure)
* Diabetes
* Smoking
* High cholesterol levels

If you have any of these problems, ask your doctor about your risks of PAD. A thorough exam or simple non-invasive test will be able to diagnose PAD. Men are more likely to have PAD than women, but women are not immune, particularly if they have those other risk factors. PAD can also run in families, so if your parents had serious vascular problems, it is worth a check-up.

What are the symptoms or "warning signs" of PAD?

* Pain in the muscles of your legs during walking or other exercise, called "claudication."
* Pain in the ball of your foot or toes.
* Pain in your foot at night, that gets better when you hang your the foot over the bed.
* Ulcers or sores on your foot, ankle, or toes that will not heal.
* Bluish or black discoloration of your toes.

PAD usually begins innocently enough with some leg or foot discomfort. People get "tiredness" or cramping in their leg muscles when they walk or after other exercise, called "claudication." Since PAD occurs most often in older adults, they think it's "just part of getting old." They may not even tell a doctor about it since it goes away completely when they stop and rest. It's pretty much common sense, "if it hurts, don't do it. " So people begin to reduce the amount of walking and other exercise they do, and that's where the real trouble begins! When people with PAD become less active, their risks of heart attacks and other severe complications of atherosclerosis increase tremendously.

How do I find out if I have PAD?

PAD can be easily diagnosed, and with effective treatment the risks of more severe complications can be significantly reduced or eliminated. A thorough physical exam by your doctor can often detect PAD, but be sure to tell your doctor that you have had problems walking or any other leg symptoms. Some circulatory changes are very subtle and require a more detailed exam. A Doppler is a specialized stethoscope that many physicians use to check circulation. Just like when they use a regular stethoscope to measure the blood pressure in your arm, the Doppler lets them measure blood pressure in your legs and feet. When there are blockages in the circulation to your legs, the blood pressure will be lower. In fact, it's this reduced blood flow to your muscles that causes the cramps or tightness when you walk, not your age!

How can PAD be prevented?

Obviously, we can't prevent all people from developing high blood pressure, and we haven't found a "cure" for diabetes. We can't control exactly what people eat and we certainly can't "force" people to stop smoking. In short, we can't prevent all atherosclerosis, but we can prevent the most serious complications of PAD ! Patients with known PAD can all benefit from the following strategies that we call “risk factor modification”

* Good blood pressure control
* Strict management of diabetes
* Stop smoking and stop the use of all tobacco products
* Management of blood cholesterol levels
* Medications that reduce the risk of blood clot formation
* A program of regular, vigorous exercise

If you or one or your family members or friends have PAD, all these risk factors must be addressed. This will significantly reduce the likelihood that the problem would worsen and that more serious complications would develop. The risk of other serious complications like heart attack and stroke would also be reduced.

How do you treat PAD?

When PAD causes more serious problems, or does not respond quickly to risk factor modification, some form of additional treatment may be necessary.

Claudication due to PAD (pain or cramping in the muscles when you walk) may keep you from getting to your job, or doing your job when you get there. It may also keep you from engaging in sports or other activities that you enjoy. Many doctors will assure you that this is not a dangerous medical problem, and they're right. But it’s more than just a nuisance when it begins to limit your freedom to go where you want to go ! Since these less severe forms of PAD do not pose a threat to your limb, we usually start with more conservative treatments.

Exercise Training – Elite runners often train at higher altitudes so that their leg muscles “learn” to use the lower levels of oxygen in the thin air more efficiently. When you have PAD your muscles are not getting a normal amount of oxygen when you are exercising (walking) because the circulation is impaired, not because the air is too thin. Regular exercise training, where you walk progressively further and more vigorously, can “teach” your muscles to use the oxygen they get more efficiently – and allow you to walk further without pain. It’s not easy – like we all said when we were all more athletic, “no pain – no gain”. The “pain” you get (or tightness, or cramping) is not a sign of injury, and you can push yourself a little each time. And it pays off – with a regular exercise program most people with PAD can more than double the distance they walk and remain pain-free ! There’s no question that a regular exercise program is a lot of work, and requires a lot of personal commitment – but there's no cost (other than the shoes) and none of the risks associated with medicines or more invasive treatments.

Stop Smoking - If you smoke, stop smoking! If you have PAD, you will almost immediately be able to walk further, and many people can walk normally. You will also reduce your risk of heart attack, stroke, and aortic aneurysm rupture, not to mention cancer. It's not easy - if it were easy, everybody would quit, because we all know it not good for you! Today though, there are effective medications and programs that can help you succeed. When you quit smoking, you'll know right away that you are healthier. If you smoke a pack a day, you could save almost $1000 a year - it would be like some one gave you a bonus just to save your own life !

There are a number of medications that have been proven to help patients with claudication walk further. These medicines may help you particularly if you have stopped smoking and begin to get regular exercise. You shouldn't expect the medicines to work "on their own," you obviously have to get up and out walking on your own. Unfortunately, many people with PAD are on several other medications for blood pressure, heart problems, or diabetes; and adding other medications may produce complications. Check with your doctor, or your vascular specialist to see if one of the approved medications may help you walk better.

Critical Limb Ischemia
When PAD worsens, more severe blockages in the arterial circulation lead to a progressive decrease in the oxygen for the tissues that can result in what we call, critical limb ischemia or CLI. Critical limb ischemia may cause:

* Worsening pain in the foot or toes - this may wake you up at night and feel better when you hang your foot down
* Ulcers on the toes or foot that do not heal (even when you have been treated by your doctor)
* Worsening or repeated foot infections

CLI Needs Treatment!

* Undiagnosed and untreated CLI can lead to gangrene.
o In more than 90% of cases of CLI the circulation can be significantly improved with treatment.
o Early diagnosis and effective treatment can prevent gangrene in most cases, and stop it from spreading in the others.
* Gangrene can lead to amputation
o Leg amputation is the most dreaded complication of critical limb ischemia from PAD.
o Early diagnosis and prompt, effective treatment can prevent more than 80% of all amputations!

Treatment of CLI (Critical Limb Ischemia)

Noninvasive Vascular Testing
The accurate diagnosis of CLI usualy begins with direct measurement of the circulation to the foot and leg using noninvasive vascular testing. This may include a combination of Doppler and ultrasound exams. These tests are simple and painless, but they can tell your doctor precisely how severe the blockages in your circulation are, and are often able to see which major vessels are blocked and need treatment. Just as important, these tests can be used to measure your circulation again after successful treatment to see the improvement. Since there are no injections or other risks, these non-invasive tests are ideal for evaluating your circulation at any time.

Arteriography
In most cases of CLI it will be necessary to perform an arteriogram. The arteriograam (also called an angiogram) is a catheterization study where contrast ("dye") is injected in the arteries of the legs to get a picture of the blockages. This will allow your vascular specialist to know several critical things about your condition.

* The exact location and severity of the blockages in the arteries
* The best treatment options for improving the circulation to your leg(s)
* How complicated and risky treatment might be in your particular case

Interventions
In most cases of CLI the circulation to your legs and feet has become critically low. This is past the point where medical treatment alone will improve the situation, and some more aggressive treatment (or "intervention") is required. In the past, surgery was the only choice in this situation, but today many of our interventions are non-surgical which may reduce the risks and complexity of treatment. It would seem preferable to always chose something other than surgery with its obvious risks and discomforts, but the problem with many non-surgical interventions is that they can only be performed successfully in certain situations seen on the arteriogram, and ultimately, most are not as successful long-term when compared to surgery. That is why it is so important to have your situation evaluated by a board-certified specialist in vascular disease. Ask your vascular surgeon if he or she is board-certified before you make a decision about treatment.

Non-surgical Interventions
These include balloon angioplasty ("balloon procedure") with or without placement of a stent ("stent procedure"). Many people think these procedures are only performed in the heart, but in many cases they can be successful in the legs too. These procedures can open up blocked arteries and improve the circulation. The arteriogram is necessary to decide whether these procedures will be successful, but many times they can be performed at the same time the arteriogram is done. This is why it is so important to have treatment under the care of an established vascular specialist. Non-surgical interventions may be performed by a variety of specialists including vascular surgeons, interventional radiologists, and cardiologists.

Surgical Revascularization
In most cases of CLI there are severe blockages in several of the leg arteries. In these cases balloon angioplasty, even with a stent may not be enough to restore the circulation. Surgery is required in these cases to save the leg. In most cases a bypass will be performed. The best procedure is to take a superficial vein from the leg (the saphenous vein) and use it as a "replacement artery.” The bypass is performed to route the blood flow around the blocked segments of artery. This almost always results in a return of normal circulation to the leg and foot. Surgical bypass procedures are obviously only done by surgeons. Board certified vascular surgeons have the most experience and success with these procedures, but they are also successfully performed by general surgeons who have interest and experience with vascular surgical procedures.

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