Recurring leg pain should not be dismissed as simple fatigue or aging, as it may be an early sign of a vascular condition called limb ischemia (LI) and even an impending heart attack, a cardiologist warned on Wednesday, August 27.

During the Philippine Heart Association’s (PHA) Usapang Puso sa Puso webinar, Dr. Paolo Joel Nocom, the chair of PHA Council on Coronary Artery Disease, said LI can also lead to stroke, amputation, or death if ignored.

“LI is not just a disease of the legs—it is a reflection of your overall cardiovascular health,” he said.

“Kapag may bara sa ugat ng paa, malaki ang posibilidad na may bara rin sa ugat ng puso o utak. Kaya’t ang simpleng pananakit o panlalamig ng binti ay maaaring senyales na nasa panganib ang iyong puso (When there is blockage in the arteries of the legs, there is a high possibility that there is also blockage in the arteries of the heart or the brain. That is why simple leg pain or a cold sensation in the legs may be a sign that your heart is at risk),” he explained.

Nocom, who is also head of the Philippine Heart Center Section of Peripheral Artery Disease, Division of Vascular Medicine, stressed that leg pain with cold sensation may point to poor blood circulation that puts patients at high risk of fatal cardiovascular complications.

According to him, limb ischemia has two kinds: Acute Limb Ischemia (ALI) and Critical Limb Ischemia (CLI).

He noted that ALI occurs when blood flow to the arms or legs is suddenly cut off, putting tissues at risk of death within hours.

Without urgent intervention, this can lead to permanent disability or death, he warned.

Meanwhile, he said that CLI develops over time, often in people with diabetes, hypertension, or existing heart disease.

Nocom added that it is marked by persistent pain, non-healing wounds, and gangrene.

Studies show many patients with CLI face amputation and also suffer from high rates of heart attack and stroke within five years of diagnosis.

The cardiologist urged the public to take symptoms seriously: persistent leg pain especially at rest, sudden severe pain in one limb, cold and pale skin, numbness, tingling, weakness, and wounds that do not heal.

For ALI, Nocom underscored the “6Ps” as a quick diagnostic guide: Pain, Pallor, Pulselessness, Paresthesia, Paralysis, and Poikilothermia.

“Bukod sa pulselessness o pagkawala ng pulso, kapag naramdaman mo ang isang sintomas, maaaring hindi iyan arterial disease, pero kung walang pulso ang binti, kumonsulta ka na agad dahil iyan ay emergency,” he stated.

According to Nocom, treatment for limb ischemia in the Philippines is “limited.”

Procedures such as angioplasty, bypass surgery, or catheter-based interventions remain expensive and accessible only in specialized hospitals, he said.

He noted that access to vascular surgeons and interventional cardiologists is also scarce, especially outside Metro Manila.

“Sa ating bansa, mahal ang gamutan at limitado ang mga espesyalista. Kapag huli na ang pagkonsulta, mas mataas ang tsansang umabot sa putol ng paa o ikamatay ng pasyente (In our country, treatment is expensive and specialists are limited. If consultation comes too late, the chances are higher that it will lead to leg amputation or even death of the patient),” Nocom said.

He stressed that “because treatment is not always within reach, prevention and early detection are critical.”

Medications such as anticoagulants, antiplatelets, and cholesterol-lowering drugs are commonly prescribed.

Nocom also warned that smoking is the top culprit in acquiring peripheral artery disease (PAD), which can lead to limb ischemia.

To prevent the disease, he urged the public to quit smoking, keep blood sugar, blood pressure, and cholesterol under control, eat a heart-healthy diet, and stay physically active.

“Lifestyle changes must go hand in hand with timely medical attention,” Nocom said.