Can Identification of PAD prevent a heart attack

[Lee Kirksey, MD]

The resounding answer is yes. After years of campaigning to increase public awareness about Cardiovascular disease (CAD), I am always surprised at the number of people who have a poor understanding of the process especially of the relationship between lower extremity symptoms and coronary blockages which may lead to heart attack. As a healthcare system, we clearly do a very poor job of educating people about identifying the symptoms of disease. Unfortunately, our system is stuck in a "Medical Treatment Model" and has not made a shift to a "Disease Prevention Model"

Peripheral Arterial Disease or PAD is a subset of the large category of Cardiovascular disease. PAD is the term for blockages that occur outside of the  heart including the blood vessels of the neck (carotid) responsible for strokes; the blood vessels of the legs that are responsible for pain with ambulation (claudication) , gangrene and amputations; the blood vessels of the kidneys responsible for hypertension and kidney failure.

Of these groups, the legs are by far the most easily diagnosed by patient's complaints, physician examination and very easily performed tests like the ABI (Ankle Brachial Index). This is because the arteries are very superficially located (in most people) and I can within two minutes tell most people if they do or do not have blockages within the leg blood vessels. This is important for several reasons. One, if we identify developing blood vessel blockages in the legs, we can become more aggressive in treating the medical factors of blood pressure, lipids and diabetes as well as smoking cessation. If these fail to improve the symptoms, then many procedures are available to improve the situation and these procedures are more easily done and more effective in less advanced disease.

More importantly, if a patient has abnormal circulation in the arteries of the legs, there is an 80% chance that they will have significant blockages in the blood vessels of the heart. By identifying the process of leg blockages by physical exam or if a patient complaints of pain in the legs with ambulation or more severe symptoms of ulceration; we are alerted to be very aggressive in treating the identical risk factors for heart disease. If patients and primary care doctors were aware of this very simple premise and applied it every day, we would make a significant impact on the prevention, identification and treatment of heart disease. Think about it, of all the readers who have PCP's when was the last time you remember your PCP or NP palpating your pulses in the groin, behind the knee and on the foot. The complete vascular examination of the legs requires 3 minutes. But in the context of the myriad of other "active" medical issues that must be addressed in a brief 15 minute encounter, vascular exam falls on a low priority list.

The problem is that although vascular specialists are familiar with this 5-10 minute evaluation,  the familiarity of non specialist is much less. That's why it is just as important to improve awareness among PCP's, nurses, NP's as it is for patients. In fact, if one can measure their blood pressure, you can measure your ABI

photo source www.cardiovascularsystemsinc.com

[Benellat]

I have reoccuring leg pain, the pain is usually behind the thigh also the lower leg region & ankle  It is very painful and last for 3,4,or 5 days and the pain goes away. It may go away for one,two or three months and withnot notice the pain comes back again.  It feels like a deep profound pain, no swelling or itching occurs, its not a cramp like pain but deep and steady pain.  I get relief by taking an asparin, and hot tub baths.  This has been happening to me for more than fifteen years and no doctor have been able to give me a reasonable reason for this pain. Today I am 64 years of age. Help Please!!!