Discomfort in the legs must be taken very seriously, especially by people 70 and older.
It is one of the main symptoms of peripheral arterial disease, which affects more than 8 million people in the United States and exponentially elevates the risk of heart attacks or strokes.
Peripheral arterial disease (PAD) is the partial or total blockage of the arteries outside the heart and occurs most frequently in arteries in the pelvis and legs. It is potentially dangerous because its presence reduces blood flow to the extremities and the kidneys. This eventually may result in the amputation of one of the limbs.
“PAD can be deadly because its diagnosis usually is a sign that the patient has heart problems,” said Dr . James Benenati, director of the Peripheral Vascular Laboratory at Baptist Hospital in Kendall. “The processes involved in this disease are the same as those associated with other major cardiac complications, such as heart attacks or strokes,” he added.
The classic symptom of PAD is pain or discomfort in the legs when walking. The symptoms disappear when a person rests and recur when activity resumes. This is because “there is a concentration of lactic acid that cannot be processed because the blockage in the artery prevents the flow of oxygen to the affected area,” said Dr. Terry King, peripheral vascular surgery specialist at Cleveland Clinic Florida in Weston. “But once the patient is at rest, the blood flow to the area increases, along with a cleansing of the lactic acid, so the patient can walk again without trouble for a period of time,” he added.
Only 40 percent of patients, however, experience the classic symptoms of PAD.
“This is very worrisome because 50 percent of individuals who have been diagnosed with PAD will suffer a cardiovascular event or stroke in the next five years, of which 30 percent will be fatal,” said Dr. Mehrdad Farid, a specialist in vascular medicine at Cleveland Clinic Florida.
“Patients with PAD are at high risk for heart attacks or strokes. We need to be more aggressive with the process of identification and diagnosis of patients, because they need treatment,” he said.
As such, the American Heart Association, the American College of Cardiology and the Society for Vascular Medicine have launched awareness campaigns over the past two years demanding a more proactive diagnosis policy, particularly among high-risk patients.
One of the main risk factors for PAD is the patient’s age, because the disease becomes more common as the person ages. It is estimated that 20 percent of the population 70 and over suffer from this ailment. And “the older the patient, the greater the likelihood that he will acquire it. For example, it is more common in individuals who are 70 than in those who are 60, and more prevalent among people who are 80 than among those who are 70,” said Benenati.
Another important factor is diabetes: 23 percent of diabetics in the United States suffer from PAD, which further complicates their cardiovascular health and increases the risk of gangrene and the amputation of their arms or legs.
The consumption of tobacco, even if the patient stopped smoking years ago, high cholesterol, high blood pressure, obesity, kidney disease, history of heart problems in the family and the presence of other factors such as elevated levels of homocysteine, an amino acid, which raises the levels of inflammation in the body, complete the picture of risk factors for PAD. The American Heart Association recommends that a test for the disease be given to anyone over 70 who presents any of these factors, although Farid acknowledges there is an ongoing debate between the doctors and specialists who want to lower the required age to 50 and the insurance companies, who don’t want to pay for the test.
The diagnosis of PAD is normally done with a physical exam and a test to determine the peripheral pulses, known as the ankle-brachial index (ABI), which compares the blood pressure in the limbs with the pressure in the arms.
“This is one of the less invasive and simplest methods we have,” said Farid. “We measure the pressure in the ankles and divide it by the pressure in the arms. If the result is less than 0.9, the patient is diagnosed with PAD.”
Depending on the severity of symptoms and the location of the blockage, the specialist may also prescribe other tests such as ultrasound or Doppler, MRI, or peripheral angiograms, which use X-rays and special dyes to determine flow problems in the arteries.
“Not all blockages in the arteries cause devastating effects,” said King. “In most cases, we prescribe an exercise regimen to encourage the body itself to create alternative routes for blood flow that will bypass the obstruction,” he explained.
Recent studies show that patients with PAD will benefit greatly from a regime of supervised training, he noted. The time they can walk without pain improves an average of 180 percent after three months of exercise, he added.
The exercise, combined with diet and medications, helps prevent and control the risk factors. Thus, emphasis is placed on controlling cholesterol levels and blood pressure and, in cases of diabetic patients, on stabilizing the blood sugar.
Finally, most experts agree that patients with PAD should take daily medications such as aspirin or anticoagulants that inhibit platelet function.
source: miamiherald
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