Cardiac and Peripheral Evaluation

Testing facilities available: Vascular investigations

• Ankle Brachial Index (ABI)
• Vascular duplex

Arterial Disease

Why is vascular disease important?

Several large studies have proven that there is strong relationship between coronary, cerebrovascular and peripheral artery disease. That is, if you have coronary artery disease you have a greater than 25% risk that you will have or will develop significant cerebrovascular and or peripheral vascular disease. If you have 2 or more coronary arteries with blockages you have a one in three chance of having significant carotid artery disease, which can put you at risk of stroke.

At Coastal Hearts and Vascular we treat the body as a whole, so if we do identify that you are at high risk or have documented evidence of coronary artery disease we may suggest screening for risk of stroke and peripheral vascular disease. This can be as simple as performing a carotid artery duplex and an ABI. Should we find anything significant, we can treat these areas too. No need to have a separate vascular specialist. Dr Sharpe is fully accredited as a vascular physician and is recognised by the Royal Australasian College of Vascular Surgeons for all Endovascular procedures.

Understanding Arterial Disease

To understand atherosclerotic disease the easiest way is to think of your arteries as a river system. Arteries have many twists and turns and branches and much like a river with the most common areas for silt and debri or in this case plaque to form are on the inside of corners or at the branch of the vessel. With modern ultrasound, we can not only see into the artery to visualise the plaque or blockage (B Mode ultrasound), but we can see how the blood flow is affected both above and below the diseased area in real time. We can also measure the speed of blood flow (Doppler ultrasound) which also assists to quantify the degree of disease, as the speed of blood flow increases the size of the remaining opening in the artery decreases.

As with the arteries that supply the heart, all arteries of the body are susceptible to atherosclerosis and other diseases that affect blood supply. When there is a lack of blood supply the muscle beyond the blockage is deprived of oxygen and other nutrients. In the heart when that occurs we call it angina (cardiac ischaemia) or chest pain. If a similar blockage is present in the arteries that supply the leg for example you may feel symptoms like an ache or cramp in the buttock, thigh or calf muscles. This is particularly noticeable when exercising. If you find you need to stop regularly when you walk due to muscle ache or tiredness, and the discomfort settles with rest then you may be experiencing claudication (muscle ischaemia of the leg). The symptoms are often worse when walking up hills or stairs. Sometimes it is difficult to differentiate between referred pain from a bad back or hip so there are a few tests that can help evaluate this.

Ankle Brachial Index  (ABI)

An ABI is a simple 10 min test that checks the pulse measurements and blood pressure in both arms and legs using ultrasound (the pressure should be the same). If there is a drop in blood pressure this can indicate the presence of significant arterial disease. Very low blood pressures at the ankle can put you at a high risk of ulcers of the feet, other cardiovascular diseases and worst case, potential loss of limbs due to gangrene.

Diabetic patients are at particularly high risk and should have this test performed and re-assessed regularly. A normal ABI does not exclude the presence of all arterial disease. Some restrictions in blood flow (stenosis) may only become apparent with an increase in workload, such as walking (much like angina may only be present with exercise). This ‘claudication’ pain often requires further analysis by means of duplex ultrasound.