Monday, September 28, 2009

PAD aka Peripheral Artery Disease

Peripheral Artery Disease or PAD is a type of Peripheral Vascular Disease (PVD), in fact, the most common type. I can tell you what PAD is, but it makes more sense if I explain PVD first. Peripheral of course means the outer part of something and vascular has to do with the circulatory system and blood vessels specifically, so PVD would be a disease of the blood vessels outside of the heart and brain. (cardio and cerebral vascular)

In PVD there can be two main causes. One is functional and therefore intermittent. Functional peripheral vascular disease does not involve damage to the vessels themselves. The other type is organic and is most often related to cell tissue (endothelial) and vessel damage like atherosclerosis.

Though we often think of PAD as affecting the arteries in the limbs especially the legs, it really is a narrowing of the arteries (from fatty deposits) of the limbs and organs not counting the heart and brain. In the early stages of PAD, a person often does not feel pain at rest or while sitting because the blood flow is not as strong and vibrant as it would be if they were walking or doing more taxing activity and their arteries are not completely occluded. When a person with PAD does walk any distance however, they may have what is referred to as claudication. Claudication is a really big word for pain in the legs because the blood flow is restricted. The pain isn’t constant though. When the person stops walking the pain will abate.

PAD like other vascular disease, is very often related to diet as well as smoking. People with diabetes, high cholesterol and hypertension are at high risk for PAD. Not getting these diseases and or controlling them is very important. Because PAD IS atherosclerosis (thickening of the artery walls) it is very important that lifestyle changes be made to prevent cardio and cerebrovascular disease, or narrowing of the arteries to the heart and brain. People with PAD are at high risk for heart attack and stroke because of this likely progression.

According to the American Heart Association and the American College of Sports Medicine, people with PAD (and the rest of us) should limit intake of fatty foods and should exercise. YES> It is recommended that people with PAD which causes pain when they walk, be counseled to walk 3-5 times a week, with physician supervision (guidance) in the early stages or stage 1 and 2 of PAD.

Goals of the walking program are interesting. With repetition and consistency, the time to claudication and duration of walking before pain becomes intense should both increase. The ACSM has a level four pain scale, minimal-moderate-intense-unbearable.

There are also four stages of PAD. In the first stage one is not likely to have symptoms while in stage two the intermittent claudication (or pain while walking – like bad cramping) begins. If PAD is not managed and continues to progress, stage three leads to pain at rest and stage four can lead to complete loss of circulation in the limbs. Stage three and four patients are at very high risk for heart disease and surgical interventions.

Indeed the healthy eating and physical activity program can prevent heart disease but the physical activity in this case can also limit loss of functioning and increase a persons ability to continue with their activities of daily living or things that we do that allow us to live independently.

This message was brought to you by someone who is not selling anything – exercise is free medicine!

ACSM Certified News. April May June 2009. N. Markil, BS.

1 comment:

Darius said...

I am a medical resident on cardiology and I also wrote a few words about peripheral artery disease.