When PAD Is an Emergency

Medically Reviewed by James Beckerman, MD, FACC on November 30, 2023
5 min read

More than eight million Americans have peripheral artery disease (PAD), in which narrowed or blocked arteries lead to circulatory problems in the arms and legs (especially the legs), making it hard to walk without pain. Yet what people with PAD may not realize is that the condition also puts them at a higher risk for coronary artery disease, heart attack, and stroke.

“Patients who have lower extremity PAD have a greater than 80% chance of having some degree of coronary artery disease or carotid artery stenosis (narrowing of the carotid arteries that supply blood to the brain),” says Lee Kirksey, MD, a vascular surgeon at the Cleveland Clinic and vice chair of the clinic’s Vascular Surgery Department. “This is a systemic disease state, so whether you have mild or more severe peripheral arterial disease, you’re at an elevated risk of a heart attack or a stroke.”

At the same time, people with PAD have to contend with the risk of infection, which can spiral into an emergency. Blood flow can become so impaired -- or infection so widespread due to reduced circulation -- that tissue dies. As a result, the toes, feet, or legs may need to be amputated.

The good news, says Peter Henke, MD, professor of surgery at University of Michigan Medicine and chair of the American Heart Association Peripheral Vascular Disease Council, is that PAD doesn’t have to result in a heart attack or the loss of a limb.

“Most patients with PAD can stay very stable with medications and lifestyle changes and never need a procedure,” Henke says. “If things do get worse, there are signals and signs you can look out for.”

Here are signs that it’s time to call 911 or get to the emergency room.

PAD affects the blood vessels leading out from the heart, but it can also put the heart at risk by reducing the amount of blood flowing back to the organ. The longer your heart doesn’t receive enough blood, the more permanent damage accumulates. If you think you might be having a heart attack, call 911 immediately so first responders can begin treatment right in the ambulance.

Chest pain or pressure. Pain, pressure, or a sense of fullness in the chest is a hallmark sign of a heart attack. You may also have pain or discomfort in your jaw, neck, arms, shoulders, or back.

New or worsening fatigue, weakness, or shortness of breath. “When someone often experiences fatigue and heaviness of their legs, that may be confounded if they begin to have shortness of breath related to a cardiac issue,” Kirksey says.

Even if you are used to feeling tired or having difficulty walking, take notice when new symptoms appear or stable symptoms become worse.

Henke says that this is especially true for people who’ve had procedures to treat PAD, such as stents or a bypass. “Those may have hopefully made you better, but if you suddenly notice a deterioration of your symptoms -- you can’t walk, you’re in pain -- seek emergency care. Arteries may be able to be reopened or at the very least you may need blood thinners.”

Nausea, vomiting, or breaking out in a cold sweat. You may also feel lightheaded, dizzy, or faint.

People with circulatory problems like PAD are at greater risk of strokes that happen when the brain doesn’t get enough oxygen-rich blood.

For any stroke symptom, you need to call 911 right away. Don’t wait to see if the symptoms go away. Clot-busting stroke treatments need to be given swiftly.

Sudden confusion. If you begin having serious trouble talking, understanding what others are saying, writing or reading, remembering things, or even thinking, it could be a sign of a stroke.

Numbness or weakness. People with PAD, particularly those who also have diabetes, commonly have numbness or weakness in their legs and feet. But new symptoms, especially if they occur on just one side of the body, can signal a stroke. And pay attention to symptoms outside of your legs. Is one side of your face drooping? When you smile, does it look uneven? Call 911.

New or worsening difficulty walking, dizziness, or loss of balance. When you have PAD, mobility is probably already an issue. But these symptoms can also be signs of a stroke. Take note of new symptoms that seem to appear out of nowhere or are worse than what you’re used to.

Severe headache or changes in your vision. People having a stroke sometimes experience a sudden, excruciating headache. You may also have blurred or double vision.

Infection is a huge risk for people with PAD, Kirksey says.

“It’s not enough to say, ‘I’ll just see my doctor in a week or two.’ Infection or even suspected infection warrants an immediate visit to the ER,” he says. “Just a small trauma to the foot can set off a cascade of progressively worsening symptoms that can threaten the limb.”

Hours or even minutes can be the difference between losing a limb or keeping it.

Sudden, severe pain or inability to move the limb. Especially if the limb is also numb or cool to the touch, this can mean you have a severe lack of blood flow due to a blocked artery.

Beside the risk of amputation, low blood flow can cause nerve damage. “This can lead to chronic leg pain that can be really debilitating for people. That’s another reason to not ignore these things,” Henke says.

Discolored or foul-smelling ulcer, cut, or other wound. “If you have a small ulcer or a cut on your foot and it gets infected, it can rapidly progress to gangrene,” Henke says. “If it’s clean without pus and it doesn’t smell, that’s a better situation. If the toe is turning a dark color and there’s an odor, you need an ER visit.”