Dr. John McNeil: 'Painful leg cramping can signal you're at risk for heart attack, stroke.'

Have you been noticing painful cramping in your hip, thigh or calf muscles that goes away when you stop and rest? Have you chalked up these episodes to normal aging? It’s possible that these cramps may indicate you’re experiencing peripheral arterial disease (PAD).

"PAD is a progressive narrowing of the blood vessels that may be a warning sign that you’re at risk for having a stroke or heart attack. Twenty percent of people who have PAD symptoms — pain that causes you to stop what you’re doing but goes away with short rest — will have a stroke or heart attack. Fifteen to 30 percent of people experiencing leg pain associated with PAD will die from cardiovascular disease,” said board-certified interventional cardiologist John R. McNeil, MD, during a free online health lecture that addressed the symptoms, diagnosis and treatment of PAD.

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Watch "Is that pain in your leg muscles serious?"

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https://www.bch.org/media/video-center/cardiology/bch-lecture-is-that-pain-in-your-leg-muscles-ser2/

Atherosclerosis

Dr. McNeil described the three layers of a normal artery: the intima, a layer of skin, and the media that regulates blood flow. He said in a diseased artery, or one with atherosclerosis, there’s a buildup of cholesterol, calcium and fibrous tissue creating a significantly narrowed lumen, which limits blood flow. To illustrate his point he shared, “Atherosclerosis is similar to when the inside of a pipe becomes rusted, and you no longer have enough water pressure to take a shower.”

Symptoms of PAD

Dr. McNeil emphasized, “If your arteries become narrowed, this can cause a stroke or heart attack and, if it includes the legs, you may experience a condition called claudication.”

Claudication involves three symptoms:

1. You won’t have pain when you are at rest.
2. When you exert yourself, you’ll notice a pain that’s telling you to stop what you’re doing and rest.
3. The pain typically goes away after 10 minutes of rest.

“You’ll experience different symptoms depending on where the blockage is,” said Dr. McNeil. “If the blockage is high up in the leg arteries you may feel buttock pain, further down you may feel thigh pain, toward the thigh, you may feel calf pain and, in the calf, you may feel foot pain.”

Dr. McNeil noted that there are four conditions that can be confused with claudication. These also result in leg pain:

1. Pseudoclaudication—a pinching of the spinal cord (not related to vascular disease) that causes nerve pain in the legs. It may hurt when you’re in an upright position but goes away when you flex or bend.
2. Nocturnal Leg Cramps—the nerve ending releases a chemical that causes your muscle to contract.
3. Calf Pressure and Tightness—can be caused by exercise.
4. Arthritis—pain in the joints, including knees and hips.

Iliac endofibrosis in athletes

“Because Boulder is such an active community, I’d like to mention iliac endofibrosis of athletes,” said Dr. McNeil. “Iliac endofibrosis is a rare disease that we see in healthy runners and cyclists and results from repetitive flexion and extension of the iliac blood vessels. This condition is often undiagnosed, or misdiagnosed as vascular disease, in these athletes.”

Iliac endofibrosis causes a tough, fibrous tissue to build-up on the inside layer of the damaged artery. This tissue can narrow the artery and prevent it from dilating during high-intensity exercise. Symptoms usually appear at maximal or near maximal exertion and cease during rest. Those with this disease will notice a cramping, weakness and loss of power in their legs.

Diagnosis and treatment are similar to that described below for PAD.

Diagnosing PAD

Four tests can be used to diagnose PAD:

1. Ankle Brachial Index—This is a simple test involves taking blood pressure in the arm and the leg. A normal number is “1.” Significantly less than “1” indicates a severe limitation of blood flow.
2. Carotid Dopplers—This test looks for disease in carotid arteries using ultrasound and categorizes the narrowing of arteries as mild, moderate or severe.
3. Computer Tomography (CT)/Magnetic Resonance Imaging (MRI) Scans—CT/MRI scans create images that clearly view the degree of disease in the blood vessels.
4. Angiography—Angiograms allow us to take pictures of the blood vessels to see the degree of disease.

Primary Treatments for PAD

1. Risk Factor Reduction—With the exception of family history and aging, most PAD risk factors are modifiable, including tobacco use, diabetes, high blood pressure, obesity, sedentary lifestyle and high cholesterol.
2. Medications— Medications that have been used with success include aspirin, Plavix, cilostazol and pentoxifylline.
3. Exercise—Exercise is extremely important in managing PAD and helps grow new blood vessels, improve symptoms and decrease pain.
4. Percutaneous Intervention—There are different techniques used for opening clogged arteries, including angioplasty. Angioplasty uses a balloon threaded through a blood vessel to open the vessels and squeeze the cholesterol plaque out of the way. Stents can then be used to hold open the blood vessel.
5. Surgery—With bypass surgery, the surgeon ties a bypass graft to go around the blockage. Dr. McNeil noted, “This is a good technique for this situation.”

Dr. McNeil emphasized, “PAD can be diagnosed quickly, easily and painlessly. Diagnosis and treatment are important steps that can be taken to reduce your risk of PAD, which can lead to more serious symptoms or even death.”

Make an appointment

Please visit the Boulder Heart website or call (303) 442-2395 for more information and to schedule an appointment with John R. McNeil, MD.

Click here to view/download slides shown in this lecture.

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