Is a heart attack or stroke in your future? If your blood flow is restricted, you’re at greater risk. Watch for these stealthy symptoms.
You probably don’t spend a lot of time thinking about your circulatory system. And when everything is working properly, you don’t need to: Blood flows freely and efficiently throughout your body, carrying oxygen, infection-fighting white blood cells, nutrients, and hormones. But when your circulation is impeded, it’s a different story.
Circulation issues—in this case, we’re talking specifically about when blood flow is restricted—can cause a host of problems. The most common: peripheral artery disease, coronary artery disease, and carotid artery disease. As these diseases progress, they cause pain, reduce mobility, and put you at greater risk of a heart attack or stroke.
The underlying factor for all three is the same: atherosclerosis, or hardening of the arteries. Age plays a role, since as you get older, blood vessels tend to become less flexible. But a number of lifestyle habits—notably smoking, being sedentary, and eating an unhealthy diet—also matter, as they contribute to the plaque that builds up in the arteries. Plaque narrows the arteries, making it harder for blood to pass through.
“The same type of plaque that can build up in the vessels to your heart can impair circulation to the brain and cause a stroke, or block blood in your legs and cause peripheral artery disease,” says Katherine A. Gallagher, M.D., codirector of the multidisciplinary peripheral arterial disease program at the University of Michigan Cardiovascular Center. “It’s all the same disease process.”
In other words, if you’re at risk for one of these conditions, you’re at risk for all three. The upshot is that there are things you can do to reduce your risk or treat these issues—provided you know that you have them.
Yes, you should work with your doctor to understand your cholesterol, triglycerides, blood pressure, and other risk factors. But you should also be on the lookout for these six warning signs of poor circulation.
1. Your Legs Ache or Cramp When You Walk
This is the most common sign of peripheral artery disease, or PAD. “More than 10 million people in the United States have PAD, and the risk goes up with age,” says Joseph Mills, M.D., chief of vascular surgery and endovascular therapy at Baylor College of Medicine. “Your chances of getting it triples between ages 40 and 70.”
Although many people have PAD and don’t know it, the discomfort means it’s time to take action. The biggest risk factors, aside from age, are cigarette smoking and diabetes, so quitting smoking and getting your blood sugar under control can help a lot. Also crucial: walking.
“The best exercise program for someone with PAD is walking, ideally three times per week for at least 30 minutes at a time,” Dr. Mills says. If that sounds impossible, don’t panic. “If you can only walk for three to four minutes at a time, that’s okay. Take a break, then walk a few more minutes,” he says. “You might only be able to do 10 to 15 minutes for the first few weeks, but try to work your way up slowly.”
2. Your Feet Hurt When You Lie Down
This might sound like the opposite of the symptoms noted above, but so-called rest pain is also a sign of PAD. And in this case, it likely means that the condition has progressed to the point where you might need medication (like a prescription blood thinner) or surgery.
What’s going on? When you’re standing, gravity helps push blood into your feet. But when you lie down, you lose the help of gravity, so circulation to the area decreases even further. “The only thing that makes it better is standing up. Some people can only sleep if they hang their foot off the bed,” Dr. Mills says. “It’s a sign of a severe circulation problem.”
3. You Have a Foot Ulcer or Wound That Isn’t Healing
One in five people with diabetes will get a foot ulcer at some point, Dr. Mills says, but the real problem is that they don’t always know it. “Let’s say you put on new shoes and take your grandkids to the zoo. Most people would stop walking if the shoes felt too tight or they got a blister, but many people with diabetes lose sensation—so they don’t realize it,” he explains.
Although that initial ulcer may be caused by some sort of trauma (like friction from new shoes) combined with neuropathy (nerve damage, so you don’t feel the ulcer and it worsens), it won’t heal properly if blood flow is abnormal. And people with diabetes also often have hardened arteries, including in their legs.
If you have diabetes, your doctor will likely perform a foot exam at least once a year, but you should monitor your feet too. “Inspect your feet every day,” Dr. Mills says. “If you see a callus, blister, or tiny sore, see a foot doctor, who should check sensation as well as blood flow.” Ulcers that don’t get treated can quickly become infected to the point that you need an amputation.
4. You Have Pressing or Squeezing Chest Pain
Chest pain is a possible sign of a heart attack, which happens when blood flow to a part of the heart is cut off. Even if you’re not having a heart attack, this pain, known as angina, could be a sign that your heart isn’t getting the oxygen-rich blood it needs.
Don’t risk it, says Dr. Gallagher. Unless your doctor has previously diagnosed you with angina and given you other instructions, any chest pain warrants a 911 call and a trip to the hospital to get checked out.
5. You’re Unusually Short of Breath or Exhausted
This is another common sign that blood isn’t flowing to the heart as well as it should, Dr. Gallagher says. Again, this can be a medical emergency, especially if you also have chest pain or nausea.
It’s important to know that women are more likely than men to experience subtler signs of heart attack, such as shortness of breath, unexplained tiredness, or nausea. Don’t dismiss these signs—taking action could save your life or a loved one’s.
The bottom line: When in doubt, call 911.
6. You Briefly Lose Vision, Sensation in One Side of Your Face or Body, or Your Ability to Speak Normally
Even if these symptoms last only a minute and then you feel fine, don’t ignore them. You might have just had a transient ischemic attack (TIA). “I don’t like the term mini stroke, because it’s not an actual stroke,” Dr. Gallagher says. “But your chances of having a full-blown stroke next are now much higher.”
During a TIA, blood flow to the brain is temporarily blocked. This can happen because plaque that’s built up in an artery slows down blood flow—or because pieces of plaque break off and lead to a blood clot. Your body then dissolves the clot, restoring blood flow and resolving the symptoms.
But a TIA is still a medical emergency, according to the Centers for Disease Control and Prevention. One reason: You can’t tell in the beginning whether symptoms are from a TIA or a major stroke—and with major stroke, getting medical care fast is critical.
If it turns out to be TIA, crisis averted—but only for now. One in three people who experience a TIA and don’t get treatment have a major stroke within a year, according to the American Stroke Association. And up to 15 percent will have a major stroke within three months.
To reduce your risk of having a stroke, your doctor may recommend medication or even surgery.
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