San Francisco Heart & Vascular Institute
	at Seton Medical Center

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• Smoking
• Eating salty, fried, or greasy foods often
• Feeling very stressed
• Not exercising
• Being an African American
• Having an immediate relative who has high blood pressure, heart disease, or has had a stroke
• Being over the age of 60
• Being overweight
• Having a cholesterol level over 200
• Living with diabetes, heart disease, kidney disease or arterial disease of the legs
• Not having blood pressure checked often (or at least in the past year)

Blood pressure is the force created as your heart pumps blood and moves it through your arteries. When the blood pressure is checked, there are two different measurements that are recorded, a systolic and a diastolic blood pressure. A systolic blood pressure is the top number, which measures the force while your heart pumps blood out to your body. Ideally, the systolic blood pressure should be under 130. A diastolic blood pressure is the bottom number that measures the resting time as your heart fills with blood before it pumps blood out to the rest of your body. Ideally, the diastolic blood pressure should be under 85. Patients are considered to be hypertensive (having high blood pressure) when the systolic measurement is 140 or higher and the diastolic measurement is 90 or higher. These pressures tend to increase with age, as the arteries get stiffer.

Hypertension is likely to cause damage to the heart and/or other vital body organs. When high pressure is required by the heart to pump blood through the narrowed arteries throughout the body, one or several problems can occur:

• Heart attack – Heart attacks occur when the heart muscle doesn’t get enough blood. This lack of blood causes a part of the heart muscle to die. This can cause the patient to have severe chest pain or arm or upper back pain, difficulty breathing, dizziness, or nausea. See the section on chest pain and coronary artery disease for more information.
• Stroke – A stroke is just like a heart attack but it affects the brain. The arteries that carry blood to the brain can become narrowed resulting in a lack of blood flow to the brain. During a stroke, the brain is damaged because it does not get enough blood. This can cause the patient to experience body weakness or numbness of the arm, face or leg especially on one side of the body. The patient may also experience difficulty in speaking or understanding language and vision may be blurred or decreased in one or both eyes.
• Kidney Failure – The arteries that carry blood to the kidneys can become narrowed resulting in a lack of blood flow to the kidneys. This can affect the kidney’s ability to remove waste. If waste builds up in the body, it can lead to chemical imbalances in the body. The patient may experience symptoms of dizziness, nausea and symptoms of heart failure. Please see the section on congestive heart failure.
• Blindness – The arteries that carry blood to the eyes can become narrowed, and without enough blood to the eyes, they may become damaged. This can ultimately lead to blindness.
• Congestive Heart failure – Heart failure can occur when the heart pumps too hard for a long period of time as it is trying to keep blood flowing through the narrowed arteries of the body. The patient may experience symptoms of shortness of breath; sudden weight gain and heart beat irregularity. Please see the section of congestive heart failure for further information.

Some life style changes that may reduce the risk of hypertension include:

• Getting blood pressure checked regularly. This is only method to know if you have normal or high blood pressure.
• Stop smoking. Smoking can increase blood pressure and damages the arteries, which can lead to a buildup of plaque. Over time the arteries may narrow and blood flow to the heart and other vital organs may be reduced. Smoking can also cause an increase in blood clots which increases the chance of sudden coronary thrombosis (clot that blocks the artery).
• Eating right. Eating less fat since fat is likely to cause plaque buildup in the arteries of your heart and body, and eating less salt (sodium) to help normalize blood pressure.
• Lose weight. Losing extra weight and maintaining a healthy weight helps to control blood pressure.
• Being active. Exercising helps to control blood pressure helps maintain weight and decreases stress.

If patients have mild hypertension and no heart disease, lifestyle changes may be enough to reduce the mild cases of high blood pressure provided those changes are carried out with determination. Otherwise, medication maybe added to bring the blood pressure into the normal range. For the more moderate to severe cases of hypertension, along with diet and lifestyle changes, medication is necessary to lower the blood pressure. There are many medications available to treat high blood pressure. Some patients respond to some medications better than others do. You will need to work closely with your health care provider to find out which medication will work best for you in lowering your blood pressure. Some common medications that can be used to lower and control high blood pressure are: diuretics, which remove excess water and sodium; beta-blockers, which reduce the heart rate and the output of the heart; and vasodilators, which relax the walls of the arteries. The sympathetic nerve inhibitors work on the nerves of the brain. The nerves of the brain can make the arteries narrow. This type of medication will work on the brain to tell the nerves on the arteries to relax, and lower the blood pressure. Other types of medications used to treat high blood pressure are called angiotensin converting enzyme (ACE) inhibitors, Angiotensin II receptor blockers, and calcium channel blockers. The angiotensin medications work on telling the kidney not to make so much angiotensin. Too much angiotensin can cause arteries to constrict, therefore making the blood pressure high. These medications will limit the amount of angiotensin made by the kidney, and thereby lower the blood pressure. The calcium channel blockers can lower the heart rate and relax the walls of the arteries to lower the blood pressure. However, since medications can have side effects, your health care provider will need to monitor with you the effects on you and your blood pressure. Sometimes several medications may need to be tried before the right medication is found for you. Also, losing weight, limiting salt intake and other basic lifestyle changes are needed to successfully treat high blood pressure, and reduce the other risks of hypertension.

Cholesterol disorders
Cholesterol is a waxy substance made by the liver. The more animal products (cheese, meats, butter, etc.) eaten the more cholesterol the liver makes. With time, cholesterol can build up in arteries and narrow them, which can lead to a heart attack or stroke. High blood cholesterol is also known as hypercholesterolemia, the presence of an abnormally large amount of cholesterol in the blood. When high cholesterol is present, plaque can form in the arteries. Plaque build-up can grow large enough to slow blood flow through the arteries.  This plaque build-up is also known as a narrowing. When the arteries supplying the heart with blood are narrowed, chest pain (angina) may occur. When arteries in the legs are narrowed leg pain or cramping may occur. And, when arteries supplying the brain with blood are narrowed, a stroke may occur. If the plaque ruptures, a blood clot may develop on top of it. If the blood clot completely blocks blood flow through a heart artery, it may result in a heart attack (myocardial infarction); if it occurs in an artery supplying blood to the brain, it may result in a stroke.

Treatments for high cholesterol can include medications such as statins, bile acid resins, nicotinic acid, and fibrates. However, moving towards healthier eating and exercise habits as listed below can play a huge role in controlling high cholesterol.

• Diet - Minimize excess cholesterol and fat intake, especially saturated fat. These fats raise cholesterol levels more than any other substances. Cholesterol and saturated fats are found primarily in foods derived from animals, such as meats and dairy products. Unwanted cholesterol and fats lurk in many foods that might never be suspected of having high amounts of these substances. Here are some dietary guidelines for reducing cholesterol and fat consumption:
1. Eat lean fish, poultry, and meat. Remove the skin from chicken and trim the fat from beef before cooking.
2. Avoid eating commercially prepared and processed food (cakes, cookies, etc.)
3. Increase the relative amount of fruits, vegetables, breads, cereals, rice, legumes, and pasta.
4. Use skim or 1% milk.
5. Avoid breaded fried foods, and fried foods.
6. Eat no more than 2 egg yolks (or whole eggs) per week.
7. Use cooking oils that are high in unsaturated fat (e.g., corn, olive, canola, safflower oils)
8. Use soft margarine. It contains less saturated fat.

• Weight loss - Losing modest amounts of weight (even only 5-10 lbs.) can help lower cholesterol levels. Weight loss should be achieved gradually by modestly decreasing caloric intake and increasing exercise.
• Exercise - Taking a brisk 30-minute walk or a low-level jaunt on a treadmill 3-4 times a week is likely to improve the cholesterol profile. Patients with chest pain and/or known or suspected heart disease should talk to their doctors before beginning any exercise program.

Congestive Heart Failure
The term "heart failure" does not mean that the heart has stopped working. Rather, it means that the heart is failing to work as well as it should. This reduces a person’s energy /activity levels and makes it harder to live a "normal" life. Most often heart failure develops after the heart has been weakened or damaged from another medical condition, such as: coronary artery disease, heart attacks, untreated high blood pressure, heart valve disease, heart infections, diabetes, and/or kidney disease.

When the heart muscle is damaged, it pumps with less force. The heart needs to work harder to circulate blood through the body, causing the heart to enlarge or thicken. This effort by the heart to help to keep more blood flowing can only for a work for some time. Eventually, the muscle will weaken as the stretched-out or thickened heart soon tires. The weakened heart will often have enlarged heart chambers. When the heart is weak and enlarged, less oxygen-rich blood moves through the body. It is hard for the body’s organs to get all the oxygen they need to function properly. For example: the brain may receive less oxygen-rich blood, thereby making the patient feel dizzy; the lungs may fill with fluid making it hard to breathe; the kidneys may receive less blood, making it hard to rid the body of extra fluid; and the ankles and feet may collect fluid, making them swell.

The health care provider should be notified if any of the following symptoms that could be consistent with heart failure occur:

• Shortness of breath, wheezing, or coughing
• Breathing harder while doing normal activities or resting
• Waking up at night with shortness of breath or coughing
• Having problems breathing while lying down (not being able to sleep without using more pillows or needing to sit upright)
• Weakness, tiredness, or dizzy spells
• Frequent urination at night
• Swollen hands, stomach area, lower legs, ankles or feet (edema)
• Shoes feel too tight
• Clothes feel too tight in the waist
• Difficulty getting rings on or off fingers
• Heartbeat changes (fast, slow or irregular) or chest pain
• Lack of appetite, nausea or poor memory

When a patient is diagnosed with heart failure, the health care provider will outline a treatment plan. This will most likely include medications and lifestyle changes, which may keep the patient symptom free and improve his/her quality of life. When heart failure is diagnosed early, medical procedures can sometimes improve heart function. If heart failure is caused by coronary artery disease, cardiac catheterization procedures or surgery can improve blood flow to the heart muscle, and thereby reduce the symptoms of heart failure. If heart failure is caused by certain heart valve problems, surgery to correct the valve problem may help limit the symptoms of heart failure. Medications may also be given with or without heart procedures to make the heart’s workload easier. The key to making the treatment plan a success is up to the patient along with the assistance of the health care team.

Heart failure flare-ups can happen anytime. Some of the things the patient can do to reduce the risk of lapsing back into heart failure include:

• Take medications as directed: Taking too much or too little medication can be harmful. Don’t stop taking medication or change the dosage of the medication without a physician’s order.
• Eat less salt and sodium: Too much salt or sodium in our diet causes the body to hold on to water. The retention of extra water can cause the symptoms of heart failure to return.
• Keep daily logs of your weight: Rapid weight gain may be a signal that the body is holding onto water. Patients should weigh themselves at the same time, wearing the same thing each morning. You should contact your health care provider if you gain 2 or more pounds in a day or 3 to 5 pounds in a week.
• Stop smoking: Smoking can increase blood pressure and damage arteries, which can lead to a buildup of plaque. Over time arteries may narrow and blood flow to the heart may be reduced. Smoking can also cause an increase in blood clots which increases the chance of sudden coronary thrombosis (clot that blocks artery).
• Exercise as directed: A little activity each day can help you feel like you are getting back some of your strength. Remember to listen to your body, and get to know your limits. Stop and rest if you feel short of breath or tired. Ask your health care provider if a out patient cardiac rehabilitation program may be of help in developing an exercise program tailored for you.

Coronary artery disease
The arteries in the heart are normally wide, open, smooth and flexible walled tubes allowing blood to flow easily. A condition known as atherosclerosis exists when the coronary (heart) arteries become narrowed or blocked with fat, cholesterol, and other materials found in the blood stream. These deposits that form in the inner walls of the arteries are known as plaque. As the plaque builds up, it creates a narrowing in the arteries causing the flow of blood to slow down. When this occurs, not enough oxygen-rich blood reaches the heart muscle. The narrowing of the coronary arteries may lead to symptoms of angina or a heart attack. Angina is a pain or discomfort in the chest that is felt when the flow of blood to the heart muscle is temporarily reduced. It is not a heart attack. A heart attack is when a spasm or blood clot forms in the narrow portion of the coronary artery, blocking the artery, and therefore not allowing blood to a portion of the heart muscle. Other symptoms associated with coronary artery disease can include: difficulty breathing, feeling unusually tired or weak, unexplained heartburn or nausea.

There are several risk factors associated with coronary artery disease such as: smoking, high blood pressure, high blood cholesterol, family history of coronary artery disease, having diabetes, kidney disease, being overweight, being under stress, using cocaine and being inactive. African-Americans and women who are past menopause are also at higher risk for coronary artery disease.

If you have one or more of these risk factors you are more likely to have or will have coronary artery disease in your future. Controlling for these risk factors to lessen your changes of developing coronary artery disease is highly recommended. The three major risk factors for coronary artery disease will be briefly reviewed below. Please see the Lifestyle and Education Section for more information.

There are lifestyle changes that can make to reduce their risk for developing coronary artery disease. Some of the major risk factors are:

• Smoking. STOP!!! Smoking can increase blood pressure and damage arteries, which can lead to a buildup of plaque. Over time arteries may narrow and blood flow to the heart may be reduced. Smoking can also cause an increase in blood clots which increases the chance of sudden coronary thrombosis (clot that blocks artery). A patient’s risk for coronary artery disease is directly related to how long and how many cigarettes he/she smokes daily. Once a patient quits smoking, his/her risk of heart attack returns to normal after about three years.
• High blood pressure. Lower high blood pressure. It can cause the walls of arteries to become damaged. This makes it easier for plaques to form in the walls of the arteries.
• Exercise and weight loss can help lower the risk for high blood pressure. This makes it easier for the heart to pump blood.
• Avoiding salty foods, including lunchmeats, some canned foods and potato chips, is also helpful in lowering high blood pressure.
• Take medications as directed by the doctor to lower high blood pressure.
• Reduce high blood cholesterol. High cholesterol contributes to the build up of fat in the arteries that lead to the heart. This can cause partial or total blockages of the coronary arteries.
• Improving the diet can help control this risk factor. To lower cholesterol, eat plenty of fresh fruit and vegetables. Rice, pasta, beans, fish, and poultry are also good choices. Saturated fats found in red meats, palm oil, eggs and butter should be eaten in limited amounts.
• By exercising three or more times each week, (such as bicycling, walking or swimming) patients can help reduce their risk for high blood cholesterol.

If your doctor suspects you have coronary artery disease, he or she may recommend a series of tests that could include a stress test, a heart scan, and/or cardiac catheterization.

Chest Pain
Chest pain (angina) that is caused by plaque build-up in the heart arteries may be mild or intense in nature. Chest pain caused by  narrowed arteries is very rare in previously healthy men under 30 years of age or women under 40, and is uncommon for either sex before the age of 45. Feelings of pressure or squeezing in the chest are often more prominent than actual pain that is usually located in the center of the chest, under the breastbone. Chest pain associated with the heart may also radiate to the back, jaw or shoulder (usually the left) and may be accompanied by nausea, sweating, dizziness, palpitations, or shortness of breath. Stable angina (chest pain caused by temporary inadequate blood flow to the heart muscle) usually lasts 1 to 15 minutes and is provoked by exercise or stress and is relieved by rest or a medication called nitroglycerin. Unstable angina is chest pain that either occurs at rest or is at an increased frequency, severity or duration as compared to the previously mentioned stable angina. Angina and unstable angina can lead to a heart attack. The chest discomfort associated with a heart attack often is prolonged (longer than 15 or 20 minutes) and is unrelieved by rest or nitroglycerin; however, some patients, especially diabetics, can have a heart attack without feeling any chest discomfort at all. Their only symptoms might be shortness of breath, dizziness, or sweating.

Coronary Artery Restenosis
Coronary artery restenosis is a condition that exists when an artery that was opened with balloon angioplasty and/or a stent procedure, closes again. This usually occurs within 6 - 9 months of the procedure. Typically, physicians may try another balloon angioplasty or a stent procedure, or brachytherapy to re-open a vessel that has restenosed. However, if the restenosis is too severe and/or it is too dangerous for the doctor to do either of these two procedures, the doctor may opt to perform a bypass surgery. When there is coronary artery restenosis, the symptoms associated with coronary artery disease and/or chest pain may be present. They include difficulty breathing, feeling unusually tired or weak, unexplained heartburn or nausea.

There are lifestyle changes that patients can make to reduce their risk for coronary artery restenosis. They include the following:

• Smoking. STOP!!! Smoking can increase blood pressure and damage arteries, which can lead to a buildup of plaque. Over time arteries may narrow and blood flow to the heart may be reduced. Smoking can also cause an increase in blood clots which increases the chance of sudden coronary thrombosis (clot that blocks artery). A patient’s risk for coronary artery disease is directly related to how long and how many cigarettes he/she smokes daily. Once a patient quits smoking, his/her risk of heart attack returns to normal after about three years.
• High blood pressure. Lower high blood pressure. It can cause the walls of arteries to become damaged. This makes it easier for plaques to form in the walls of the arteries.
• Exercise and weight loss can help lower the risk for high blood pressure. This makes it easier for the heart to pump blood.
• Avoiding salty foods, including lunchmeats, some canned foods and potato chips, is also helpful in lowering high blood pressure.
• Take medications as directed by the doctor to lower high blood pressure.
• Reduce high blood cholesterol. High cholesterol contributes to the build up of fat in the arteries that lead to the heart. This can cause partial or total blockages of the coronary arteries.
• Improving the diet can help control this risk factor. To lower cholesterol, eat plenty of fresh fruit and vegetables. Rice, pasta, beans, fish, and poultry are also good choices. Saturated fats found in red meats, palm oil, eggs and butter should be eaten in limited amounts.
• By exercising three or more times each week, (such as bicycling, walking or swimming) patients can help reduce their risk for high blood cholesterol.

Valvular Disease / Defective Heart Valves
The heart valves are ring-like structures with two or three tissue flaps (leaflets) that open and close in response to the pressure of blood within the heart chambers. There are four valves in the heart. Two valves are on the right side, the tricuspid and pulmonic valves. And, two valves are on the left side, the mitral and aortic valves. A normal valve is flexible, opening to permit blood to flow through it, yet strong enough to prevent the blood from flowing backwards when it is closed. Valve disease exists when one or more of the heart valves do not work properly. In the majority of cases, it is the valves on the left side which become defective (diseased). Valve disease can occur for a number of different reasons. Rheumatic fever or a bacterial infection can damage the valves. You may be born with an abnormal valve. Narrowing in your coronary arteries can limit blood flow to the heart valves, so the valves do not function normally, or simply as you age your valves wear out. There are two ways that the valves become diseased. They may be come stenosed (a narrowing of the valve). This is a condition that prevents the heart valve from opening fully. The valve may also develop regurgitation (a leaking of the valve). This is a condition that prevents that heart valve from closing tightly. Most valve defects are mild and do not have a big effect on the pumping function of the heart. Some defects can get worse with time, however, and may cause a weakening of the pumping function of the heart muscle. If the doctor suspects heart valve disease, he/she may order an echocardiogram and/or a cardiac catheterization.

Irregular (Abnormal) heart rhythms/ Arrhythmias
An arrhythmia is an abnormal heart rhythm. This abnormal rhythm can cause the heart to pump blood less effectively. There are four chambers in the heart. The two upper chambers are called atria. The two lower chambers are called ventricles. In the upper right chamber, the right atrium, the pacemaker for the heart is located.

This pacemaker, called the sinoatrial node, sends an electric signal to the rest of the atria and to the atrioventricular node, which sends the electrical signal down the electrical pathways in the ventricles. This electrical signal must follow the same pathway from the atria to the ventricles for the heart to pump blood properly. The heart normally beats 60-100 times a minutes.

There are several reasons why an arrhythmia may occur. Sometimes the pacemaker of the heart can develop an abnormal rate or rhythm, or the normal electrical pathway can be interrupted, or another part of the heart takes over for the pacemaker. These can be due to advancing years, or heart disease, and in some cases due to stress, caffeine, tobacco, alcohol, diet pills, and cough or cold medicines.

Symptoms of an arrhythmia vary, depending on what type of arrhythmia is present. For slow heart beats and slow irregular rhythms the patient might feel short of breathe, have chest pains, dizziness, lightheadedness, fainting or near fainting spells, and/or fatigue. For fast heart beats and fast irregular rhythms the patient might feel a strong pounding, palpitation sensation in his or her chest. They also may feel short of breath, have chest pains or dizziness or a near fainting feeling.

There are many types of arrhythmias; some originate in the atria while others originate in the ventricles.

Those originating in the atria:

• Sinus arrhythmia. Cyclic changes in the heart rate during breathing. Common in children and often found in adults.
• Sinus tachycardia. The sinoatrial node sends out electrical signals faster than usual, increasing the heart rate to above 100 beats per minute. This is normal during exercise, but can be abnormal if this fast rate occurs at rest.
• Sick sinus syndrome. The sinoatrial node does not fire its signals properly, so that the heart rate slows down, and then suddenly speeds up. This sudden rate change between a slow (bradycardia) and fast (tachycardia) rate is not influenced by exercise or rest.
• Premature supraventricular contractions or premature atrial contractions (PAC). A beat occurs early in the atria, causing the heart to beat before the next regular heartbeat.
• Supraventricular tachycardia (SVT), paroxysmal atrial tachycardia (PAT). A series of early beats in the atria speed up the heart rate (the number of times a heart beats per minute). In paroxysmal tachycardia, repeated periods of very fast heartbeats begin and end suddenly.
• Atrial flutter. Rapidly fired signals cause the muscles in the atria to contract quickly, leading to a very fast, steady heartbeat.
• Atrial fibrillation. Electrical signals in the atria are fired in a very fast and uncontrolled manner. Electrical signals arrive in the ventricles in a completely irregular fashion, so the heartbeat is completely irregular.
• Wolff-Parkinson-White syndrome. Abnormal pathways between the atria and ventricles cause the electrical signal to arrive at the ventricles too soon and to be transmitted back into the atria. Very fast heart rates may develop as the electrical signal ricochets between the atria and ventricles.

Those originating in the ventricles:

• Premature ventricular complexes (PVC). An electrical signal from the ventricles causes an early heartbeat that generally goes unnoticed. The heart then seems to pause until the next beat of the ventricle occurs in a regular fashion.
• Ventricular tachycardia. The heart beats fast due to electrical signals arising from the ventricles (rather than from the atria).
• Ventricular fibrillation. Electrical signals in the ventricles are fired in a very fast and uncontrolled manner, causing the heart to quiver rather than beat and pump blood.

Heart block is a condition in which the electrical signal cannot travel normally down the electrical pathways to the ventricles. The signal could be delayed or completely interrupted. If there is no electrical connection between the atria and the ventricles, the heart beats very slow, usually less than 35 beats per minute. Very slow heartbeats can cause the heart to stop beating, so immediate medical attention is necessary.

The evaluation with your physician for arrhythmias begins with a discussion of your current symptoms, and your medical history. A physical examination will also be performed to obtain additional information on your current health status. There are several tests that may be performed to determine the type of arrhythmia present. It is standard to have an electrocardiogram (ECG) done. This test records the electrical activity throughout your heart. Another test that maybe performed is a holter monitor or event monitor. This is a device you would wear and carry with you for a day or several days that would record your heartbeats. Occasionally, an electrophysiology study (EPS) is done. During this test, soft wires are placed in your heart to locate the exact place in your heart that is causing the abnormal rhythm. The information obtain through this test can help your physican better plan the treatment for your arrhythmia.

Based on the results of some or all of these tests your physican can determine which therapy will be best to treat your arrhythmia. Sometimes, nothing is needed; however in other cases medications, pacemakers, or mini-defibrillators maybe needed to regulate your heart rhythm. Occasionally, catheter ablation of the rhythm problem site is necessary. This is done in the setting where the EPS test was performed. The physician uses soft tipped catheters that can be guided to the place in the heart where the rhythm problem exists. Destruction of the tissue at this spot by catheter ablation will stop the arrhythmia from occurring again.

Congenital Heart Defects
A congenital heart defect is a deformity of the heart that exists at birth. The most common type of defect is an abnormal hole between the "left side" and the "right side" of the heart, which allows blood to flow in the "wrong" direction. Another common defect is an abnormal narrowing (stenosis) of one of the heart valves and/or of the aorta (the body’s main artery) which can slow down the flow of blood through the body. If a congenital heart defect is severe, it makes it harder for the heart muscle to pump and deliver blood and oxygen to the body. Within a period of time, the heart muscle may weaken and symptoms may develop.

Peripheral Vascular Disease (narrowing involving the arteries throughout the body with the exception of the heart and brain)
Peripheral arterial disease, or PAD, is a condition in which the arteries that carry blood to the arms or legs become narrowed or clogged. This interferes with the normal flow of blood, sometimes causing pain but often causing no symptoms at all. The most common cause of PAD is atherosclerosis. Atherosclerosis is a gradual process in which cholesterol and scar tissue build up; forming a substance called "plaque" that narrows the arteries. Plaque (a buildup of fat and other materials) collects along the inner walls of the arteries. This plaque can narrow or block the arteries. When the artery is narrowed the muscle and/or tissue that is being fed by that artery does not get enough oxygen-rich blood. This can cause oxygen-starvation which may ultimately cause that muscle / tissue to die.

Some of the symptoms of PAD include:

• Leg or hip pain while walking, that stops when resting
• Numbness, tingling or weakness in the legs
• Burning or aching pain in the feet or toes when resting
• A sore on the leg or foot that won’t heal
• Cold legs or feet
• Color change in the skin of the legs or feet
• Loss of hair on the legs

When a patient is being evaluated for peripheral arterial disease, the physician will ask the patient questions about when the pain or discomfort began and how long it lasts. Also, the physician may check the patient’s blood pressure and pulse at his/her leg and arm to see how the blood is flowing. The physician may also check the color of the patient’s feet and look for cracks or infection.

The physician may order a test to see if the arteries in the legs or arms are narrowed or blocked. There are two different tests that detect narrowings or blockages: the Doppler exam and an arteriogram. A Doppler examination is a non-invasive test, which uses harmless sound waves to produce an image of the artery. The second type of examination of the arteries may occur if the Doppler examination was abnormal. This test is called an arteriogram. This test is an invasive test that is done in a special xray room. A special dye is injected into the artery though a small tube. The special dye mixes with the blood and therefore helps the physician see the blood flow and any narrowings or blockages in the artery.

Health problems such as high blood pressure, diabetes, and high cholesterol can make PAD worse. Some of the following recommendations can help a patient manage PAD better:

• Stop smoking – Smoking can increase blood pressure and damage the arteries, which can lead to a buildup of plaque. Over time arteries may narrow and blood flow to the muscles and tissues in the legs and arms may be reduced. Smoking can also cause an increase in blood clots which increases the chance of sudden leg or arm thrombosis (clot which blocks the artery).
• Control blood sugar – high blood sugar can damage the wall of the artery.
• Be more active – exercise improves blood flow and can even help the smaller arteries take upon additional blood flow
• Eat right – too much fat in the diet can raise cholesterol, and may lead to the build up of plaque in the arteries.
  

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