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It Hurts When I Walk

February 11, 2010 12:00 PM with Dr. David Marmor

Pain in your legs, that develops in the muscles of the legs when walking, may not be the result of muscle or joint problems, but something far more serious. David Marmor, MD, Cardiologist, will discuss how leg pain can be a sign of a cardiac condition and what you can do to seek the proper treatment.

Grant (Moderator) - 11:58 AM:
Hello chat participants. The physician is delayed just a minute and will be joining us momentarily.

Moderator (Moderator) - 11:59 AM:
Welcome! Today’s chat: It Hurts When I Walk, will begin shortly. Please start submitting your questions and Dr. David Marmor will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Cardiovascular Care Pages to obtain more information.

Dr. David Marmor (NorthShore) - 12:02 PM:
Hello. My name is Dr. David Marmor, I am a cardiologist with NorthShore University HealthSystem. Today I will be discussing leg pain that could be a result of lack of blood flow to the legs.

  Beth (chicago il) - 12:02 PM:
I feel like electrical currents are racing through my legs at times. It started out in a mild fashion but sometimes can be relentless once I lay down. Sometimes I can stop it by moving it sometimes not. Sometimes painful sometimes annoying.
Dr. David Marmor (NorthShore)
Beth- is your pain worse with exerting yourself? or does it generally occur at rest?

  Colleen (Kenilworth, IL) - 12:03 PM:
How can you prevent PAD?
Dr. David Marmor (NorthShore)
Colleen - Peripheral arterial disease (PAD) is a manifestation of atherosclerosis, just like coronary artery disease that causes heart attacks, or cerebrovascular disease that leads to strokes. It generally results from the same risk factors for all atherosclerotic disease, namely cigarette smoking, diabetes, hypertension, and high cholesterol. the first step to preventing PAD is identifying who is at risk, and modifying their risk factors.

  Colleen (Kenilworth, IL) - 12:06 PM:
What other disease is pain while walking linked to?
Dr. David Marmor (NorthShore)
As a cardiologist, the leg pain that I focus on is from atherosclerotic disease. but other things can present in a similar fashion; commonly spinal stenosis, which is a narrowing of the spinal canal that can lead to leg pain, or sciatica. this can often mask as claudication (the term used for leg pain due to arterial insufficiency).

  Jenni (Highland Park, IL) - 12:08 PM:
Is restless leg syndrome related to PAD at all? Is RLS often the misdiagnosis for PVD?
Dr. David Marmor (NorthShore)
good question Jenni. The answer is usually no. RLS generally occurs at night at rest, and generally doesn't worsen with exertion.

  Lois (Winnetka) - 12:09 PM:
My legs cramp when I walk, also at night. I walk on the treadmil 20 min each day, but take no meds. How can I help manage the pain?
Dr. David Marmor (NorthShore)
It would be important to find out the reason for your leg cramping. I would start by evaluating your risk factors for atheroclerosis, doing a physical exam focusing on your peripheral pulses, and do a simple screening test called an ankle brachial index to assess for arterial insufficiency. If there is a confirmed diagnosis of peripheral arterial disease, we would assess for the severity of the blockage, and consider starting medical and exercise therapy. But we first need to determine why you are having the leg cramping before deciding how to manage the pain. Often leg pain and cramping can result from other diagnoses than PAD.

  Jenni (Highland Park, IL) - 12:14 PM:
I am 31 with type 2 diabetes and high blood pressure (both of which I manage with medication). Lately when I wake up I have a tingle on my feet that usually goes away within 5 minutes of being up and walking around. Could this be a sign of PAD?
Dr. David Marmor (NorthShore)
If the sensation gets better with walking and exertion, it's unlikely that it represents PAD. However, with diabetes, I would always take any compliant of foot symptoms seriously, as it can indicate peripheral neuropathy. That being said, with both diabetes and high blood pressure, it would be important to be aggressive about treating risk factors for atherosclerosis, especially LDL cholesterol.

  Lois (Winnetka) - 12:17 PM:
I have had the ABC test, and have been diagnosed with PAD.
Dr. David Marmor (NorthShore)
Lois- The first thing I would focus on is treating your overall risk factors for atherosclerosis, like cholesterol, blood pressure, and blood sugars if you are diabetic. PAD is a strong predictor of heart attacks and stroke, and it is extremely important to address any controllable risk factors to reduce your overall cardiovascular risk. Regarding the leg pain, several things can be of benefit. The most effective intervention is a supervised exercise program, as there is data that participation markedly increases one's exercise tolerance and mitigates symptoms. there are also some medications that can be of benefit, like cilostazol (pletal). If the symptoms are still limiting despite aggressive medical therapy, then it may be worthwhile to further image the arterial system of the legs, and consider a revascularization procedure, like angioplasty or vascular bypass surgery.

  Colleen (Kenilworth, IL) - 12:21 PM:
What are treatment options for PAD?
Dr. David Marmor (NorthShore)
Colleen- First thing to focus on is risk reduction for major cardiovascular events, like heart attack and stroke. People with PAD are at up to 6 times the risk of the general population, so I manage these patients very aggressively in terms of lipid and blood pressure control, and risk factor modification. For symptomatic PAD, there are medications that can help. Actually one of the most effective interventions is a supervised exercise program, as this has been showed to increase exercise capacity and decrease symptoms in clinical trials. If symptoms are severe, then revascularization is an option. this can either be done through angioplasty, which is done in the catheterization lab, or arterial bypass surgery, which involves bypassing the blocked artery with a vein or synthetic graft.

  Colleen (Kenilworth, IL) - 12:28 PM:
At what age are most people diagnosed with PAD?
Dr. David Marmor (NorthShore)
As with any manifestation of atherosclerosis, the risk of the disease increases with age. The recent guidelines from the American Heart Association and American College of Cardiolgy recommend identified the following groups as being at elevated risk, even in the absence of symptoms: -patients over 70 -patients over 50 with a history of cigarette smoking or diabetes - patients over 40 with diabetes and another known risk factor for atheroclerosis - patients with known atherosclerosis elsewhere (heart, carotid arteries, etc.)

  Jenni (Highland Park, IL) - 12:35 PM:
What is the treatment for PAD?
Dr. David Marmor (NorthShore)
First and foremost treat the risk factors for atherosclerosis. PAD patients are at substatially elevated risk of heart attacks and stroke, so we need to be very aggressive in treating cholesterol, blood pressure, antiplatelet medicines and modifying risk factors. There are medications that are effective for reducing PAD symtpoms, but probably the most effective intervention for symptoms improvement is a supervised exercise program. If symptoms are severe or lifethreatening (like leg gangrene), we get more aggressive about revascularizing through angioplasty or lower extremity bypass surgery.

  Lois (Winnetka) - 12:39 PM:
I walk on the treadmil, is there any other exercise that would be helpful?
Dr. David Marmor (NorthShore)
Lois- I would recommend talking to your doctor about enrolling in a supervised exercise program. We offer a program directed at patients with lower extremity PAD that has been successful in improving symptoms. It is great that you walk on the treadmill, and you absolutely should continue to do so; but trained physical therapist and cardiac rehab nurses will have some good ideas.

Dr. David Marmor (NorthShore) - 12:55 PM:
Thank you very much for taking the time to participate in this chat. Hopefully this will help to spread awareness about peripheral arterial disease, its important implications in terms of overall cardiac risk, and the fact that it is a treatable disease.

Moderator (Moderator) - 12:55 PM:
Thank you again for participating in our chat today. For more information please visit our Cardiovascular Care Pages

Also, a transcript of this chat will be available shortly.

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