Leg Pain May Signal Heart Trouble

John Scurtu had cold feet.

Even during the hottest of Houston days, his toes felt as cold as ice.

Born and raised in Romania, Scurtu in his youth was a tennis champion, and later worked professionally in the forestry service. Carrying out his strapping outdoor duties 15 years ago, he experienced leg pain for the first time. After being hospitalized and treated for a blockage in the left leg, he promptly bounced back to his normal activities.

In 1998, by now living in America with a wife and family and working as manager of a Heights-area restaurant, Scurtu began having pain again – this time in his right leg. Physicians treated him with medications and eventually surgery. But he knew that his continuing pain, cold toes, and swollen leg did not signal recovery.

Scurtu was diagnosed with peripheral arterial disease, or PAD, which occurs when arteries in the legs become clogged with atherosclerotic plaque.

Leg pain or cramping is the symptom most commonly associated with PAD. Early pain occurs with exercise – what doctors call “intermittent claudication.” People who feel pain even at rest have a more advanced stage of the disease, and without effective treatment, the condition may in extreme situations lead to gangrene and leg amputation.

“Peripheral arterial disease is often overlooked because patients may just feel that they are growing old or have osteoarthritis or joint pain,” notes George Reul, M.D., cardiovascular surgeon at St. Luke’s and the Texas Heart Institute, and medical director of St. Luke’s Peripheral Vascular Laboratory. “These patients often overlook the early warning signs.”

“Diagnosing peripheral arterial disease early is important, not only because it can progress to the point that the leg is lost but because it is a marker of coronary artery disease and/or heart attack.

Early identification would be straightforward if leg pain upon exertion were always present. But many people with the disease don’t feel leg pain, especially if they have diabetes.

Research reported in the October 2001 issue of the Journal of the American Medical Association suggests that PAD, previously estimated as affecting 8-12 million Americans, may affect even more. The PAD Awareness, Risk, and Treatment, New Resources, and Survival, or PARTNERS, study evaluated 6,900 people at high risk who were over the age of 70 or were smokers and diabetics 50 to 69 years old. The results showed that 25 percent had PAD – 15 percent had PAD alone and 10 percent had PAD plus a history of coronary artery disease. In this study, a relatively simple screening test was used to compare the blood pressure in the person’s arm to that in the ankle. Referred to as the Ankle Brachial Index, it can be performed at any physician’s office.

The test is painless, takes less than five minutes to perform, and can indicate with great accuracy the presence of peripheral arterial disease. Concern is raised when blood pressure at the ankle is lower than that in the arm.

People “at-risk” include those who smoke, have diabetes, have a family history of vascular disease, have high blood pressure, high cholesterol level, or are over age 60. These factors are also predictive of heart disease.

After treatment, most patients return to a normal lifestyle, but a few continue to have limited ability to walk without pain. The incidence of PAD increases with age, and those with the condition are at increased risk for heart disease.

Because early intervention in diagnosing PAD is crucial, cardiovascular specialists urge primary care physicians and at-risk patients to use Ample Brachial Index testing as a basic tool to help identify peripheral arterial disease early, when it can best be treated.

Back on the job at Tutto Bene! restaurant, Scurtu favors his right leg, elevating it whenever he has the opportunity. He converses in German, French, Italian, Hungarian, Russian and English with customers, and while his English isn’t perfect, it’s surprisingly good for a person who reports that he has never studied the language formally.

“From visiting stores and watching TV after I came to the U.S. in 1992, I picked it up.”

He acknowledges that his legs will never be back to the athletic form of his youth as a champion tennis player, but he’s both pain-free and medication-free, and that, he says, “makes me feel lucky.”

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©2006 Texas Medical Center

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