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Hi ~ I Suffer From Vascular Claudication In My Legs...mild
Question: Hi ~ I suffer from vascular claudication in my legs...mild to moderate and I also suffer from LSS neurogenic intermittent claudication. I was diagnosed in 2012. Since then, I stopped smoking, do not drink and have been walking 40 minutes 4 times a week, and I take a bay aspirin, and Crestor 10 mg. for cholesterol which is very good. I also have severe osteo-arthritis in my left knee and tendonitis in my right knee. I still walk, and my pain level is about 4 out of 10. But it is awkward walking....my question is that when I begin to walk, I get a bit out of breath after about 15 minutes due to the pain and awkwardness walking....then after I rest two minutes and continue walking this out of breath stops...So, because of my pain I put more effort into walking...is this the reason? Why? Can you explain please. My heart is certified as being normal.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome on -Ask a Doctor- service!
I reviewed your current medical history and uploaded echo report and would like to explain as follows:
I would agree with you that limb pain experienced while walking may lead to an extra effort and energy consumption manifested with a greater oxygen dept and breathlessness.
But, from the other side this unpleasant breathing feeling should be differentiated from a potential implication of an increased aortic stenosis valvular gradient during physical exertion associated with elevated pulmonary venous pressure and dyspnea.
Another point to consider during differential diagnosis of shortness of breath would be a silent cardiac ischemia. Your resting cardiac echo report could not exclude such an alternatives.
Coming to this point, the best way to conclude on the right cause of your complaint would be to undergo a provocative cardiac imagine test, such as a cardiac stress echo.
It could be performed by exerting on a treadmill (in case your arthritis issues would allow) or a better alternative would be by utilizing a pharmacological approach without the need for a physical exertion (dobutamine stress echo).
In this way, it would be possible to confirm whether direct cardiac issues (aortic stenosis or a coronary artery disorder) could have a role on your symptoms or it is just the limbs pain to be the only responsible.
You should discuss with your attending doctor on the above mentioned issues.
Hope to have been helpful to you!
In case of any further questions, feel free to ask me again.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome on -Ask a Doctor- service!
I reviewed your current medical history and uploaded echo report and would like to explain as follows:
I would agree with you that limb pain experienced while walking may lead to an extra effort and energy consumption manifested with a greater oxygen dept and breathlessness.
But, from the other side this unpleasant breathing feeling should be differentiated from a potential implication of an increased aortic stenosis valvular gradient during physical exertion associated with elevated pulmonary venous pressure and dyspnea.
Another point to consider during differential diagnosis of shortness of breath would be a silent cardiac ischemia. Your resting cardiac echo report could not exclude such an alternatives.
Coming to this point, the best way to conclude on the right cause of your complaint would be to undergo a provocative cardiac imagine test, such as a cardiac stress echo.
It could be performed by exerting on a treadmill (in case your arthritis issues would allow) or a better alternative would be by utilizing a pharmacological approach without the need for a physical exertion (dobutamine stress echo).
In this way, it would be possible to confirm whether direct cardiac issues (aortic stenosis or a coronary artery disorder) could have a role on your symptoms or it is just the limbs pain to be the only responsible.
You should discuss with your attending doctor on the above mentioned issues.
Hope to have been helpful to you!
In case of any further questions, feel free to ask me again.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My Aortic stenosis is mild....my recent echo was normal. That was 3 months ago. I do not have faulty ventricle walls. My GP has said that all is good as has a cardiologist. You even told me previously not to worry. My recent ECG was also normal. CAD would have been picked up before this just by those tests. But, I will be seeing a new Cardiologist soon, and will mention the dobutamine stress echo.
Mild calcified aorta also can signal that the atherosclerosis has stabilized if the mitral valve is not affected badly.
Since my AS is mild, and my other echo results are all normal, I believe that the origin of my occasional breathlessness is the pain associated with my NIC which is predominant by the way, (not my PAD which is secondary) - and not by any CAD. I do not have laboured breathing...I have almost out of breath feeling only. I am not panting or anything like that.
My aortic valve area calculated by continuity equation is at 1.77cml-2.21 cm2. Normal area is =Valve area is between 1.5-2.0 cm2 with a pressure gradient of less than 25 mmHg. So, just a tad over the normal value.
Re silent ischemic attack...there is absolutely NO pain...and I recover quickly...in fact, the more I walk, the less I feel almost out of breath...Comments please and then I will score your advice.
Mild calcified aorta also can signal that the atherosclerosis has stabilized if the mitral valve is not affected badly.
Since my AS is mild, and my other echo results are all normal, I believe that the origin of my occasional breathlessness is the pain associated with my NIC which is predominant by the way, (not my PAD which is secondary) - and not by any CAD. I do not have laboured breathing...I have almost out of breath feeling only. I am not panting or anything like that.
My aortic valve area calculated by continuity equation is at 1.77cml-2.21 cm2. Normal area is =Valve area is between 1.5-2.0 cm2 with a pressure gradient of less than 25 mmHg. So, just a tad over the normal value.
Re silent ischemic attack...there is absolutely NO pain...and I recover quickly...in fact, the more I walk, the less I feel almost out of breath...Comments please and then I will score your advice.
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again!
I totally agree with your idea that a stressful walking complicated by inferior limbs pain may be a reasonable cause of your shortness of breath.
Special receptors are located within our skeletal muscle cells, that can easily perceive abnormal metabolic changes and translate those signals as insufficient oxygen delivery from the brain. This is an important trigger to shortness of breath feeling.
But, just to be sure that no additional causes are implicated as well, I still recommend you to discuss the above mentioned alternative of a provocative cardiac imaging test.
Your aortic stenosis is quite mild, but the echo is done at rest and we don't know how your heart behaves during straining physical activity.
In general, when there is a discrepancy between a mild cardiac finding and an exagerated clinical symptomatology, those provocative tests could be helpful.
Regarding coronary artery disease, in the settings of aortic stenosis, there is no need for the presence of coronary artery obstruction, because cardiac ischemia may happen due to cardiac muscle mass/coronary artery density imbalance, which is present in aortic stenosis patients.
Anyway, I am not supposing that these two alternatives are the main reasons underlying your complaints, but as a cardiologist, I would like to be sure that neither of them is present.
I still remain on the idea that your leg pain may be the main reason underlying your shortness of breath.
So, there is no reason to panic.
I would just recommend discussing with your doctor on the above issues.
Hope to have been helpful!
Wishing all the best,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again!
I totally agree with your idea that a stressful walking complicated by inferior limbs pain may be a reasonable cause of your shortness of breath.
Special receptors are located within our skeletal muscle cells, that can easily perceive abnormal metabolic changes and translate those signals as insufficient oxygen delivery from the brain. This is an important trigger to shortness of breath feeling.
But, just to be sure that no additional causes are implicated as well, I still recommend you to discuss the above mentioned alternative of a provocative cardiac imaging test.
Your aortic stenosis is quite mild, but the echo is done at rest and we don't know how your heart behaves during straining physical activity.
In general, when there is a discrepancy between a mild cardiac finding and an exagerated clinical symptomatology, those provocative tests could be helpful.
Regarding coronary artery disease, in the settings of aortic stenosis, there is no need for the presence of coronary artery obstruction, because cardiac ischemia may happen due to cardiac muscle mass/coronary artery density imbalance, which is present in aortic stenosis patients.
Anyway, I am not supposing that these two alternatives are the main reasons underlying your complaints, but as a cardiologist, I would like to be sure that neither of them is present.
I still remain on the idea that your leg pain may be the main reason underlying your shortness of breath.
So, there is no reason to panic.
I would just recommend discussing with your doctor on the above issues.
Hope to have been helpful!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
PS: My heart rate after I walk is about 100 and is strong, then it calms down. Normal heart rate is 58....calms down quite quickly too. Some days, there is no 'almost out of breath'. It is when the pain starts in my legs and knees that I get this only.
Please advise.
Please advise.
OK, sounds good....but this aortic muscle mass imbalance....why would this cause this? Is my mild AS that significant that it would cause this? What can I do about this? Should I continue walking? Can the AS remain mild...My GP says it can...What vitamins can I take to help?
Brief Answer:
Opinion as follows:
Detailed Answer:
Following a healthy lifestyle and a careful therapy to properly control blood pressure values and lipid profile are the most important components that could help to really slow the progression of aortic stenosis.
Unfortunately no vitamin supplements have provon effective in this regard.
And surely, keeping a physically active profile with everyday walking is the best strategy that needs to be encouraged.
Though the actual degree of aortic stenosis seems mild, we could not be sure of its clinical consequences until verified by a careful provocative test as mentionef above.
In case you will need further clarification please just let me know.
Best regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Following a healthy lifestyle and a careful therapy to properly control blood pressure values and lipid profile are the most important components that could help to really slow the progression of aortic stenosis.
Unfortunately no vitamin supplements have provon effective in this regard.
And surely, keeping a physically active profile with everyday walking is the best strategy that needs to be encouraged.
Though the actual degree of aortic stenosis seems mild, we could not be sure of its clinical consequences until verified by a careful provocative test as mentionef above.
In case you will need further clarification please just let me know.
Best regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
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