Heart attacks are acute events that are rarely preceded by obvious warning signs, but symptoms may sometimes strike hours or weeks before the cardiac event. The majority of health bodies advise looking out for signs of shortness of breath, shoulder pain, or chest discomfort. According to one study, pain in the legs may also be an important signal of an impending heart attack.
Body pain can reflect different types of vascular disease depending on where it occurs in the body.
When it affects exclusively the lower limbs, for instance, it could signify blood flow problems due to peripheral artery disease.
It is important, however, to note that leg pain isn’t a symptom of a heart attack, but it can be a sign of heart disease.
In a 2019 study published in JAMA Cardiology established that about five percent of people with PAD experience a heart attack within 30 months.
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The study identified two types of heart attacks, with type 1 myocardial infarctions caused by acute thrombotic coronary events.
Type 2 myocardial infarction, on the other hand, tends to follow an acute imbalance between oxygen supply and demand.
The report states: “Advanced limb symptoms appeared to be a stronger predictor of type 2 myocardial infarction than of type 1 myocardial infarction.
“Myocardial infarction in patients with PAD was associated with an increased risk for cardiovascular death and […] events requiring hospitalisation.”
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In the initial stages of PAD, symptoms can be scarce, with most complications striking exclusively during exercise and stopping at rest.
The Cleveland Clinic explains: “The first symptoms of PAD are usually pain, cramping or discomfort in your legs or buttocks (intermittent claudication.
“This happens when you’re active and goes away when you’re resting.”
As the condition advances, however, claudication may become apparent at night, when the body is completely relaxed.
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This is a sign that arterial clogging is impeding blood flow to the extremities and depriving the limbs of oxygen.
It should be noted that PAD tends to develop over the course of decades, sometimes taking 50 or so years to present symptomatically.
The signs of PAD also represent a spectrum of disease severity, with some cases presenting asymptotically.
In fact, around 20 to 50 percent of patients diagnosed with the condition are asymptomatic, despite showing signs of pronounced disease when tested.
“As the disease progresses and blood vessels narrow, arterial flow into the lower extremities worsens, and symptoms may manifest either classic intermittent claudication or as atypical claudication or leg discomfort,” explains the Agency for Healthcare Research and Quality (AHRQ).
It adds: “Intermittent claudication is defined as lower extremity discomfort that is exertion but does not consistently resolve with rest.”
The more advanced the disease, the greater the chances are that someone will develop severe claudication, which could reduce their walking distance and cause them pain when at rest.
The final stage of PAD – clinically termed critical limb ischaemia – is defined as rest pain that lasts more than 14 days, ulceration or gangrenous tissue.