What Your Legs Can Tell You About Your Heart Health

August 23, 2020

Your legs are marvelous creations and an engineering feat. They allow you to stand upright, carry you near and far and allow you to dance.

What’s not so obvious is that your legs also can tell you a lot about the state of your heart and circulatory system through three conditions:

Peripheral Artery Disease

PAD is a disease of the arteries, the vessels that carry oxygen-rich blood from the heart to the body’s organs and limbs. PAD happens when fat and cholesterol in the artery wall form plaque, which leads to blockages. This process is call atherosclerosis.

The blockages ultimately narrow the artery and decrease blood flow to the legs. People who have PAD often have plaque and blockage in other areas of the body, too. When it’s in the arteries to the heart, it’s called coronary artery disease, which is a risk factor for heart attack. When it’s in the arteries of the brain, it’s often called carotid artery disease, and is a risk factor for stroke.

PAD Is Serious

PAD is a serious vascular condition. It affects 8.5 million Americans age 40 and older, and about one in five Americans older than age 70. It can impair your ability to walk and quality of life. PAD is a leading cause of amputation in the United States, and having PAD is a serious peripheral vascular disease that increases the risk of having a heart attack or stroke.

Risk factors for PAD include:

Age 70 or older
Tobacco smoker
Diabetes
High cholesterol
High blood pressure
Family history of PAD
Atherosclerosis in other areas/prior heart attack or stroke
Chronic kidney disease
African-Americans have two-fold risk of PAD

How Your Legs Can Indicate PAD

If you have pain, cramping or aching in your leg muscles that comes on with activity such as walking and goes away with rest, it could indicate PAD.

Other symptoms include difficulty walking due to tiredness in the legs, pain in the legs and feet when you’re at rest, sores on the legs and feet that do not heal, color changes in the feet, poor hair or nail growth. You also can also have PAD without experiencing symptoms.

A doctor can diagnose PAD by taking a detailed medical history, conducting a physical exam to assess the pulses, and also do an ankle-brachial index (ABI) assessment. The ABI is a test where blood pressures are measured in the arms and legs to assess for PAD. Treatments for PAD can include rehab, medication and revascularization.

Deep Vein Thrombosis

Another cardiovascular disease your legs hold clues to is Deep Vein Thrombosis (DVT), a disease of the veins. Veins are the vessels that carry oxygen-depleted blood from the limbs and muscles back to the heart and lungs to be re-circulated.

In DVT, blood clots form in the veins of the legs and sometimes in the arms, and can cause chronic damage to the leg veins.

A piece of the clot can break off and travel to the heart and lungs, a condition called pulmonary embolism (PE). PE can be a life-threatening condition.

Risk factors for DVT include:

Surgery, trauma or a cast on the leg
Pregnancy and childbirth
Prolonged hospital stay
Long-haul air or car travel
Cancer
Family history of DVT or PE and familial hypercoagulable states
Chronic inflammatory conditions such as lupus, or inflammatory bowel disease
Obesity
Older age

Risk factors for atherosclerosis can be risk factors for DVT and PE too, such as smoking, high cholesterol, diabetes, and obesity.

How Your Legs Can Indicate DVT

DVT can cause pain and swelling in the leg and tenderness in the leg and calf.

The diagnosis of DVT starts with a medical history and performing a physical exam. A clinical risk score also can determine the likelihood of DVT and an Doppler ultrasound test is done to make the diagnosis. Treatment can include blood-thinning medications, elastic compression socks or, and some patients, procedures for removing or dissolving the clot to open the veins.

Leg Swelling and Chronic Venous Insufficiency

Chronic venous insufficiency or varicose veins is another disease of the veins. It can be caused by DVT or varicose veins, injury, poor function of the calf muscle pump, vein compression and other causes.

How Your Legs Can Indicate Chronic Venous Insufficiency

Chronic venous insufficiency can cause swelling of the legs that does not go away. Other signs are discoloration of the legs or other skin changes, or ulcers or sores on the legs.

A doctor can diagnose venous insufficiency through a physical exam. In some cases, imaging is done as well. Treatment can include compression stockings or wraps, skin and wound care, topical ointment, and exercise to strengthen the calf muscles. Some special supplements may help venous insufficiency.

For varicose veins, treatment can include treatments such as thermal ablation, sclerotherapy and ambulatory phlebectomy.

In some cases, swelling in both of the legs can be due to other conditions in addition to venous insufficiency, such as congestive heart failure, kidney, and liver disease. For this reason, it is important that patients with leg swelling be evaluated to determine the cause.