"ABI test" warns of heart attack and stroke
Circulatory disorders can lead to dramatic long-term consequences such as heart attack, stroke, and limb amputations. A painless and reliable vascular test can determine circulatory disorders and thus help to reduce the risk of life-threatening diseases.
As the German Heart Foundation writes in a current announcement, the so-called “ABI test” can painlessly and reliably detect dangerous circulatory disorders such as “shop window disease” and coronary heart disease. This vascular test is carried out with a blood pressure cuff and Doppler ultrasound.
Millions of people affected do not know about their illness
People with peripheral arterial occlusive disease (PAD, colloquially known as smoker's leg), the problem with pain when walking, often in the calves, becomes apparent.
Because these patients have to stand for a longer period of time - for example in front of a shop window - the pain subsides, the PAD is also called "shop window disease". According to estimates, four to five million people suffer from this circulatory disorder in Germany. However, about three million people do not know about their illness, because the shop window disease occurs late.
"Patients with PAD have a high risk of suffering from a heart disease such as a heart attack or a stroke because they often also contain deposits in the coronary artery or neck arteries," warns Prof. Dr. med. Heribert Schunkert from the board of the German Heart Foundation in the current issue of the heart foundation magazine HERZ today.
In addition, in advanced stages of pAD, ulcers ("open leg") or even leg amputation are threatened. "This makes it all the more important for us to identify those with an increased risk at an early stage and treat the diagnosed cardiovascular disease," says the director of the Clinic for Adult Cardiology at the German Heart Center Munich (DHM).
Simple and completely painless examination method
With the measurement of the ankle-arm index, also called “ABI test” (ABI: Ankle Brachial Index), medicine offers a simple and completely painless examination method. "The ABI test can show whether the blood vessels are free or constricted - even before symptoms appear," explains the vascular specialist and senior physician at the angiological outpatient clinic at the DHM, Prof. Birgit Steppich.
For the ABI measurement, the doctor puts blood pressure cuffs on the upper arm and ankle of the patient. After a rest phase, the cuffs are then inflated like a classic blood pressure measurement. With a Doppler ultrasound device, the systolic blood pressure (upper blood pressure value) is measured once on the ankle and then on the upper arm. Both measurements are carried out on the right and left.
The ABI is determined by dividing the ankle determined by the blood pressure measured on the upper arm. This result (quotient) is the ABI. “Everyone aged 65 and over should have the ABI test carried out once by their doctor. People with risk factors for cardiovascular diseases or a PAD in the family should do it from the age of 50, ”recommend Schunkert and Steppich.
Typical risk factors
According to the Heart Foundation, there is a PAD if the calculation results in a value below 0.9. With an ABI quotient, normal values are between 0.9 and 1.2. The lower the ABI, the more advanced the dangerous circulatory disorder.
“But ABI values above 1.3 are also pathological. They show a special type of vascular stiffening, the media calcification, which occurs especially in patients with diabetes and kidney weakness, ”explains Schunkert.
When calcifying media, the vein has lost its elasticity and cannot be pushed in with the blood pressure cuff. Typical risk factors, in addition to old age, for developing PAD are:
- Diabetes mellitus
- Fat metabolism disorders (high cholesterol)
- high blood pressure
- hereditary disposition
- in ten percent of patients other factors such as inflammatory processes.
Change of lifestyle
Accordingly, a lifestyle change by refraining from smoking, paying attention to normal weight, healthy eating and sufficient endurance exercise, if possible 30-40 minutes three to five times a week, is an integral part of the therapy.
Medications such as platelet inhibitors (thrombosis inhibitors) and statins (cholesterol-lowering agents) can also be used. As the German Medical Association (BÄK) and the National Association of Statutory Health Insurance Physicians (KBV) explain on their joint portal “patienten-information.de”, meaningful studies show that statins and antiplatelets reduce the frequency of heart attacks and strokes as well as mortality.
Statins also relieve PAD pain. As a side effect, statins can cause muscle weakness and platelet inhibitors can cause bleeding.
Structured walking training can also help patients who experience pain when walking.
In some cases, the narrowed vessel is expanded using a small balloon (balloon dilation). Furthermore, it is sometimes recommended to use an additional stent. Surgery can also be used to treat PAD.
ABI measurement can save lives
The conclusion of the German Heart Foundation: An ABI measurement can save lives: PAD can be determined quickly and risk-free, as can the individual risk of heart attack and stroke.
Patients with PAD and an increased risk of cardiovascular diseases can be discovered and, thanks to early diagnosis and therapy, saved from life-threatening complications.
The informative value of the risk-free ABI measurement has been proven since 2001 by a large study (“getABI study”).
Where the pain comes from
Finally, the specialists from the Heart Foundation explain where the leg pain comes from in PAD.
The cause of pAD is arteriosclerosis (arterial calcification), the “calcification” of arteries: blood lipids, lime, connective tissue and inflammation-promoting cells are deposited in the inner wall of the blood vessels and form so-called plaques that protrude into the vessel and constrict it.
The arteries of the legs and pelvis are mostly affected. As a result, there is no longer enough blood in the legs and there is pain because the muscle cells in the calves do not receive enough oxygen and nutrients. This explains the pulling pain in the calf ("overacidification"). (ad)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- German Heart Foundation: Life-saving vascular test warns of heart attack and stroke, (accessed: December 22, 2019), German Heart Foundation
- Federal Chamber of Physicians (BÄK) and National Association of Statutory Health Insurance Physicians (KBV): Peripheral arterial occlusive disease pAVK, (accessed: December 22, 2019), patienten-information.de