Leg pain indication of impending heart attack?

A cardio-vascular specialist said leg pain, especially if recurring, should be a cause for alarm as it can be an early sign of a vascular condition known as limb ischemia (LI) and an impending heart attack.

Dr. Pablo Joel Nocom, during the Philippine Heart Association's Usapang Puso sa Puso webinar, explained that LI is not just a disease of the legs, but could be a reflection of one's overall cardiovascular health.

Nocom said that LI can also lead not only to amputation but also to stroke, and death if ignored, citing a fatal link between limb pain and cardiovascular disease.

"When arteries in the legs have cholesterol blockage, there is often a parallel hardening of the arteries in the heart and brain," Nocom explained.

"The leg pain that comes with cold sensation is telling you that you may be suffering from poor blood circulation that puts you at high risk of fatal cardiovascular complications," he added.

The physician said that LI has two kinds: Acute LI (ALI), which occurs when blood flow to the arms or legs is suddenly cut off, putting tissues at risk of death within hours.

Without urgent intervention, ALI can lead to permanent disability or even death.

Meanwhile, critical LI (CLI) develops over time, often in people with diabetes, hypertension, or existing heart disease. Nocom said CLI is marked by persistent pain, wounds that refuse to heal, and gangrene.

He added that many patients with CLI face amputations and also suffer from high rates of heart attack and stroke within five years of diagnosis.

Spot early warning signs before it's too late

Nocom urged the public that the symptoms of like: persistent leg pain often worse at night or even at rest, or a sudden severe pain in one limb that does not subside; coldness and paleness in the skin of the arms or legs, along with numbness, tingling, or weakness; the presence of non-healing wounds, ulcers, or darkened patches on the feet or toes, which may signal poor circulation, should be a cause for alarm.

For ALI, Nocom stressed the importance of the 6Ps as a quick diagnostic guide: Pain (sudden, severe pain in the limb), Pallor (pale or bluish skin), Pulselessness (weak or absent pulse in the affected area), Paresthesia (tingling or “pins and needles” sensation), Paralysis (weakness or loss of movement), and Poikilothermia (coldness compared to the rest of the body).

LI is diagnosed through a combination of physical examination, medical history, and diagnostic tests such as the ankle-brachial index, Doppler ultrasound, and angiography to visualize blood flow and identify blockages.

"The absence of pulse in your leg should prod you to seek emergency consultation," the specialist said.

Nocom also said that treatment for limb ischemia in the Philippines is expensive and limited to specialized hospitals.

This is because treatment requires procedures such as angioplasty, bypass surgery, or catheter-based interventions, according to Nocom.

Access to vascular surgeons and interventional cardiologists is also scarce, especially outside Metro Manila, he noted.

"Because treatment is not always within reach, prevention and early detection are critical," he stressed.