Dr. Maciej Malinski is on the medical staff at Sherman Hospital. He has been kind enough to answer some frequently asked questions related to maintaining a healthy heart. Look for additional heart information from Dr. Malinski in the coming weeks.
Q: My legs hurt when I walk, and my doctor told me that I have narrowing of the arteries in my legs. What does this mean? What are the treatment options for this condition?
A: What you describe is called intermittent claudication (leg pain with walking). This is a symptom caused by the narrowing of the arteries that supply blood to the legs.
In the early stages symptoms including pain, cramping or weakness in the legs, buttocks or arms occurs with activity and disappear when activity stops. As the narrowing progresses, the symptoms may worsen and include:
- abnormal gait
- pain at rest
- hair loss on legs
- change of color on the legs or arms
In the very advanced stages one may see blackened toes indicating that tissue has died (gangrene). The disease is called peripheral arterial disease (PAD), or peripheral vascular disease (PVD).
I always tell my patients that the same process can affect other arteries in the body, and that we name diseases according to which organ or part of our body gives symptoms. The disease process in the arteries is the same and is the result of atherosclerosis (cholesterol build up in vessels) or a blood clot. If the artery supplying the brain with blood is affected it is called a stroke. If the artery supplying heart muscle with blood has atherosclerosis, a patient will have an angina or a heart attack, and in the case of legs they will have claudication.
The patient with symptomatic disease should see a vascular specialist, usually a cardiologist. The treatment depends on:
- severity of symptoms
- location of the narrowing
- the patients overall condition
Nowadays, most of the patients are treated in the angiography suit with angioplasty, stenting or excision of the plaque (atherectomy). Bypasses are done less frequently.
In the pictures you can see the result of treatment in one of my patients. I did atherectomy (“shaved” the calcified cholesterol plaque), and the patient’s symptoms completely resolved. The most important treatment involves risk factor modification. Without it, the disease will progress, and the patient will probably continue to have a need for repeated vascular procedures.
PAD is common among smokers and people who have diabetes. It is critical for diabetics to control their blood sugar levels and for smokers to quit smoking. Patients with PAD, and particularly those with diabetes, have to carefully monitor their feet for cuts or wounds.
The mainstay of the therapy is exercise, it will improve symptoms and if the patient had a vascular procedure will help to sustain the result of it. Patients with PAD also should be treated for hyperlipidemia (elevated cholesterol), hypertension (high blood pressure), and take aspirin.
I think that every patient with symptoms that are suggestive for PAD should be seen by cardiovascular specialist to have appropriate diagnostic testing, treatment, and most importantly to address the risk factors.
Do you have a question for Dr. Malinski? To submit your question, either post it in the comments section below or email firstname.lastname@example.org with the subject line “Question for Dr. Malinski.” For more information on heart health, click here to visit Sherman’s Heart and Vascular Center.
This post is published by Sherman Health to provide general health information. It is not intended to provide personal medical advice, which should be obtained directly from your physician.