You May Need to See A Vascular Specialist/Surgeon
You May Need to See A Vascular Specialist/Surgeon
Hello Shirley,
I had problems with one leg following surgery to replace my mitral valve. While my story is long, the point I want to make is that your cardiologist may not be the right person to diagnose it, and you may need to see a vascular specialist.
I had endocarditis and had to have emergency surgery to replace my mitral valve, which was done in May 2011. Immediately following the surgery, while still recovering in the hospital, I had severe pain and swelling in my right foot. I had no pain in the chest related to the heart surgery, but my foot was very painful and I had to keep it elevated to reduce the pain. The doctors did ultrasound and x-ray on my leg and foot while I was still in cardiac recovery at the hospital, but did not find anything wrong. Once home, it was weeks before I could walk at all on that foot without hobbling/limping. Even once I could walk, I got severe pain in my calf in my right leg when I walked as little as a block. When I had my 3 month checkup with my cardiologist, I told him that I had "intermittent claudication" and I thought something was messed up in the circulation in my right leg.
My cardiologist confirmed that the pulse in my right foot was weaker than the pulse in my left foot, and had me make an appointment with a vascular specialist.
Although the cardiologist did refer me to the vascular doctor, the cardiologist was not the one who diagnosed the problem.
The vascular specialist did a test that checks the ratios of blood pressure in your arms and legs, measuring various points on thigh, knee, ankle and toe. In my case the blood pressure dropped substantially in the right leg below the knee. Because of this test, they knew there was some blockage in the artery below my knee on my right leg. The vascular doctor took ultrasound of the artery and saw a blockage. The ultrasound the doctors had previously performed in the hospital were of the veins, not the arteries, which is why they missed it.
The vascular doctor suspected it was blood clots formed on the arterial pump that they had stuck up my artery to keep my blood flowing before they could do the valve replacement surgery. She said these often cause micro-clots which can travel down to the leg where the arteries narrow.
She referred me to a vascular surgeon to perform an arteriogram (injecting radioactive dye to see the blood flow in real-time) and hopefully balloon angioplasty/stent the clots and restore flow. Turns out, the arteriogram showed that it wasn't clots, but some of the endocarditis bacteria had broken off the vegetation on my mitral valve and traveled down the artery to my leg where they formed two mycotic aneurysms which were thrombosed. So, they aborted the balloon angioplasty operation and I am now going to see yet another another vascular surgeon who is collecting history on the aneurysms over time, and I'll decide if I need to do a leg arterial bypass or live with the pain for a while longer.
So, the point I want to get across is that you may need to see a vascular specialist and possibly have a few more specific tests done in order to determine what the nature of the problem really is. The cardiologist may not be able to tell you, although he should be able to refer you to the right person.
Good luck and best wishes.
