I seem to have PAD

[Bicuspid]

Since March I have experienced slight tingling in my toes and stronger tingling in my fingers (sometimes my lower arms) when in bed.  I had a heart attack on 13 June but the hospital cardiologist thought the tingling might be nerve related.  So at first my doctor assumed Carpal tunnel syndrome and I have been wearing wrist braces at night.  But a Physiotherapist did not diagnose Carpel tunnel and, although I am still waiting on an appointment with a Neurologist (for possible Nerve Conduction Test) I now believe it is PAD.  I say this because even when wearing wrist braces, the tingling occurs if my hand is above the level of my heart when in bed.  I assume it needs gravity to get enough blood through to the fingers.  Two days ago I experienced pain on the inside of my leg towards the rear just above the knee.  Suspecting DVT I had an ultrasound but no obstruction was found anywhere in the nerves from top to bottom of that leg and the pain subsided about 3 hours later.  I am already taking aspirin, metoprolol, clopidogrel, perindopril and atorvastatin. I find I can avoid the tingling with bricks raising the head of the bed and by sleeping on my back with my hands palm down beside me - I actually tie them down with a ribbon which I lie on.  My question is broadly what should I do?  I am in Sydney - maybe you can tell me who to see.  Is it likely that I should have some operation (preferably not requiring GA) such a my stent operation.

[Lee Kirksey, MD]

Hello
How are you? Symptomatic Peripheral artery blockages of the upper extremities are quite uncommon. Even when blockages occur, they usually do not cause symptoms. Any doctor should be able to examine you and determine if you have circulation disorders of the upper extremities. Identical non invasive test of the upper or lower extrimites called PVR- pulse volume recording or ABI ankle brachial index can be performed in a vascular lab to confirm the presence or absence of PAD as the cause of your symptoms

The more likely cause of the symptoms is nerve disorder because of a pinched nerve. The evaluation by your neurologist should reveal abnormal EMG-nerve conduction if cervial or lumbar spinal cord stenosis is present.

Good luck

[Bicuspid]

PS  Of course I should have said no obstruction was found in the veins (not nerves) in my legs. I should also have mentioned that my BP is well controlled now and my cholesterol level is very good - less than half what is was at the time of the heart attack.  I have also lost 8Kg and now have BMI less than 23, so no obesity problem - nor diabetes.  I am 62 but look and feel 10 years younger, possibly due to taking numerous antioxidants etc for over 30 years.