Understanding the Urgency of PAD

Written by Jennifer Rainey Marquez

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More than eight million Americans have peripheral artery disease (PAD), in which narrowed or blocked arteries lead to circulatory problems in the arms and legs (especially the legs), making it hard to walk without pain. Yet what people with PAD may not realize is that the condition also puts them at a higher risk for coronary artery disease, heart attack, and stroke.

“Patients who have lower extremity PAD have a greater than 80% chance of having some degree of coronary artery disease or carotid artery stenosis (narrowing of the carotid arteries that supply blood to the brain),” says Lee Kirksey, MD, a vascular surgeon at the Cleveland Clinic and vice chair of the clinic’s Vascular Surgery Department. “This is a systemic disease state, so whether you have mild or more severe peripheral arterial disease, you’re at an elevated risk of a heart attack or a stroke.”

At the same time, people with PAD have to contend with the risk of infection, which can spiral into an emergency. Blood flow can become so impaired — or infection so widespread due to reduced circulation — that tissue dies. As a result, the toes, feet, or legs may need to be amputated.

The good news, says Peter Henke, MD, professor of surgery at University of Michigan Medicine and chair of the American Heart Association Peripheral Vascular Disease Council, is that PAD doesn’t have to result in a heart attack or the loss of a limb.

“Most patients with PAD can stay very stable with medications and lifestyle changes and never need a procedure,” Henke says. “If things do get worse, there are signals and signs you can look out for.”

Here are signs that it’s time to call 911 or get to the emergency room.

1. Chest pain or pressure. Pain, pressure, or a sense of fullness in the chest is a hallmark sign of a heart attack. You may also have pain or discomfort in your jaw, neck, arms, shoulders, or back.

2. New or worsening fatigue, weakness, or shortness of breath. “When someone often experiences fatigue and heaviness of their legs, that may be confounded if they begin to have shortness of breath related to a cardiac issue,” Kirksey says.

Even if you are used to feeling tired or having difficulty walking, take notice when new symptoms appear or stable symptoms become worse.

Henke says that this is especially true for people who’ve had procedures to treat PAD,

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