Most common heart-related conditions
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What is PAD?

If your arteries become too narrow for normal blood flow, your feet and legs will not get the amount of blood they need. This common disorder, peripheral artery disease (PAD), can cause long-term damage to your nerves and other tissues. Learning the risk factors can help you avoid permanent problems.

• What is Peripheral Arterial Disease?
• How do you know you have PAD?

What is Peripheral Arterial Disease?
Peripheral arterial disease (PAD) is a blockage of arteries in the extremities, which can cause cramping in the legs, hips and thighs. Tune in to learn more about PAD.

Participants:
Robert S. Schwartz, MD, FACC
Director of Preclinical Research, Minneapolis Heart Institute,
Minneapolis, MN
Alfred A. Bove, MD, PhD, FACC
Chief of Cardiology; Temple University Medical School

Webcast Transcript:

ANNOUNCER: Chances are you've never heard of peripheral arterial disease, or PAD, a condition that affects an estimated 8—12 million people in the United States alone.

Physicians recommend that if you're over fifty, you should be aware of this all-too-common disease that can affect the blood vessels of your entire body.

ALFRED A. BOVE, MD: Peripheral arterial disease, which we sometimes call PAD, involves the blood vessels of the whole body. It's the equivalent of coronary disease, but in the other vessels of the body. This is often associated with blockage of arteries in the legs, which limits the blood supply to the lower parts of the legs and the feet.

ROBERT S. SCHWARTZ, MD: Atherosclerosis and PAD are pretty much the same thing. Atherosclerosis is the hardening of the arteries. It's the plaque that builds up; it's the calcium, the fats, the fibrous tissue, the scarring that grows into the arteries and stops the blood from flowing into the legs

ALFRED A. BOVE, MD: Since PAD is a disease of blood vessels throughout the body, the warning signs depend on what blood vessels are affected. For example, if the blood vessels of the legs are affected, then many people will experience pain in the muscles, that is, cramp-like pain, which we call claudication.

ROBERT S. SCHWARTZ, MD: The patient would start out walking, develop a cramp in the calves, in the thighs, in the buttocks. Cramping sensation that goes away when the patient stops walking; when the patient resumes walking, the cramp typically comes back, indicating a distinct lack of blood flow into that muscle bed when the muscle is called on to exercise.

ANNOUNCER: PAD affects as many as one quarter of the population over 60, yet the majority of those affected by PAD show no outward symptoms at all. Many times doctors have to rely on a patient's medical history and risk factors to determine whether they have PAD.

ALFRED A. BOVE, MD: The people that are at risk for developing peripheral arterial disease, PAD, are usually people that are older and who have the risks that we know are the same risks as those that cause coronary artery disease. High blood pressure, high cholesterol, cigarette smoking and diabetes, in particular, are major risk factors for PAD.

ANNOUNCER: After it's determined that a patient has symptoms of PAD, doctors will use simple techniques to diagnose the disease.

ALFRED A. BOVE, MD: Many physicians will approach a patient by just feeling the pulses in the feet or in the legs. The pulses in the neck one can feel with the finger. So that the first part of diagnosis is physical examination and looking for signs of diminished pulses in different areas of the body.

A relatively simple tool for measuring the presence of PAD is to use a blood pressure cuff. It's a measure of the comparison between the blood pressure in the lower part of the leg and the blood pressure in the arm, for example, and that's called the ankle-brachial index. And what it is is the ratio of the blood pressure measured in the lower extremity to the blood pressure measured in the upper extremity, the arm.

ANNOUNCER: Once PAD is diagnosed, there are a variety of options physicians can recommend for treatment.

ROBERT S. SCHWARTZ, MD: Peripheral arterial disease can be treated many ways. The first way is to treat it medically. It's very important to stay on a low-fat diet. It's most important to stop smoking. The next step is the utilization of stents. We all know that stents have become used in a big way in the arteries of the heart. We also now are able to use stents in the arteries of the leg or in the pelvis to improve the blood flow.

Finally, for severe cases of PAD, surgery is used in a frequent way to actually bypass the blockages and restore blood to the legs to keep the legs supplied adequately with blood.

ANNOUNCER: Another treatment prescribed for PAD is a monitored exercise program for the patient. This treatment is used to track muscle cramping, also known as claudication.

ROBERT S. SCHWARTZ, MD: If you're experiencing symptoms that you think might be related to peripheral arterial disease, the best thing is to get in to see your doctor. Your doctor will take a simple physical exam, try to feel the pulses in your feet, also in your legs, at the groin level and at the knee level, and if pulses are present there, that pretty much rules out the possibility that PAD is present. On the other hand if the pulses are present but diminished, or possibly even completely absent, this is a strong suggestion that PAD is present.

How do you know you have PAD?
Millions of Americans suffer from peripheral arterial disease (PAD), a disease that occurs when your blood cannot flow efficiently through your arteries. Find out it you are at risk for this serious disease.

Participants:
Robert S. Schwartz, MD, FACC
Director of Preclinical Research, Minneapolis Heart Institute,
Minneapolis, MN
Alfred A. Bove, MD, PhD, FACC
Chief of Cardiology; Temple University Medical School

Webcast Transcript:

ANNOUNCER: Almost eight million people in the United States who have peripheral arterial disease remain undiagnosed and unaware of this condition. Knowing your risk factors can be an important first step in determining if you have PAD.

ROBERT S. SCHWARTZ, MD: The prevalence of peripheral arterial disease is quite significant. As many as a fourth of the population over age sixty has peripheral arterial disease. Patients that are risk of developing PAD are principally the same people who are at risk of having heart attacks, because the disease process is the same. People who are smokers, people who eat a lot of fat, that is, high cholesterol in the diet, people who are diabetics, people who have a family history of artery disease, whether it's in the heart or in the periphery. Also being a male: Men have a higher risk of PAD than do women.

ANNOUNCER: And learning about common symptoms of PAD is key to helping your physician diagnose the disease.

ALFRED A. BOVE, MD: PAD can cause symptoms in a variety of parts of the body. One of the most common problems is blockage to the arteries in the legs, and the patient would experience cramps or pain in the legs with exercise, with walking or climbing stairs, for example; that we call claudication.

ROBERT S. SCHWARTZ, MD: Can PAD be mistaken for other conditions? Absolutely. The most common mistake is called pseudoclaudication. Pseudoclaudication is cramping of the muscles and is usually caused at rest, typically by spinal stenosis, that is, a narrowing of the spinal column, impinging on the nerves to the leg. And what that does is gives, oftentimes, a sensation of cramping that's not due to a lack of blood flow, but rather due to a nervous problem in the central nervous system.

ALFRED A. BOVE, MD: A lot of people complain of cold fingers and cold hands and cold feet, and the most common reason for that is cold weather. The old adage of, "If your hands are cold, put on your hat," is still true. If your body is cold, it'll constrict the blood vessels in your arms and your hands and your feet, and your hands and feet will be cold, not because of PAD, but because the blood vessels are constricted to some extent in a cold environment.

ANNOUNCER: If you think that you have the risk factors and possible symptoms of peripheral arterial disease, it's important to schedule a visit with your physician.

ALFRED A. BOVE, MD: One of the important and interesting problems with PAD is it's often silent for a long time before a patient is aware that there's a problem. When a symptom appears, it's usually very late in the process. That is, the blood vessels have been damaged and been narrowing for a relatively long period of time before a symptom appears.

ROBERT S. SCHWARTZ, MD: If you're experiencing symptoms that you think might be related to peripheral arterial disease, the best thing is to get in to see your doctor. Your doctor will take a simple physical exam, try to feel the pulses in your feet, also in your legs, at the groin level and at the knee level, and if pulses are present there, that pretty much rules out the possibility that PAD is present.