Arterial bruit

Evidence of pre-existing vascuiar disease Transient ischemic attacks Cervical arterial bruit and stenosis Myocardial infarction/angina... 

Although auscultation of the abdomen is less important, this method of examination should be performed in certain diagnostic situations. Vascular sounds can occur in the form of arterial bruit or venous hum. 

Arterial bruit A systolic rushing sound synchronized with the heart beat indicates increased arterial blood flow. This often barely audible sound is easier to discern if one listens for arterial bruit and feels the patient s pulse at the same time. It is sometimes heard where aneurysm or stenosis is present in large arteries (e.g. coeliac artery, hepatic artery) as well as in arteriovenous malformations, highly vascularized liver tumours, pronounced acute alcohol hepatitis, 1-2 days after liver biopsy resulting from temporary arteriovenous fistula, or in twisted arteries in cirrhosis. It is seldom found in healthy persons. (10, 13, 44)... 

Renal artery bruit Renal artery stenosis Prerenal azotemia... 

Sandok BA, Whisnant JP, Furlan AJ, Mickell JL. Carotid artery bruits prevalence survey and differential diagnosis. Mayo Clin... 

Eyes Pupillary equality, reaction to light, accommodation, ocular 8. Vascular System Abnormal pulse and amplitude, carotid or arterial bruits. ... 

Patients with renal artery stenosis may have an abdominal systolic-diastolic bruit. 

Subclavian steal is caused by retrograde flow in the vertebral artery. It is a common angiographic or ultrasound finding when there is stenosis or occlusion of the subclavian artery proximal to the vertebral artery origin, particularly on the left, or of the innominate artery. When the ipsilateral arm is exercised, the increased blood flow to meet the metabolic demand may be enough to steal more blood down the vertebral artery, away from the brainstem into the axillary artery. If there is poor collateral blood flow to the brainstem, then symptoms may occur, but this is very rare. The subclavian disease is almost always severe enough to be detectable by unequal radial pulses and blood pressures, and often there is a supraclavicular bruit (Cho et al. 2007). 

A similar trade-off between diagnostic accuracy and risk is necessary when imaging the carotid bifurcation in patients with TIA or ischemic stroke. Performing intra-arterial catheter angiography in everyone is clearly unacceptable because of the risks and cost. Fewer than 20% of patients will have an operable carotid stenosis even if only those with cortical rather than lacunar events are selected (Hankey and Warlow 1991 Hankey et al. 1991 Mead et oL 1999). Coirfining angiography to patients with a carotid bifurcation bruit will miss some patients with severe stenosis and still subject too many with mild or moderate stenosis to the risks. Nor will a combination of a cervical bruit with various clinical features do much better (Mead et al. 1999). 

The most common secondary causes of hypertension are fisted in Table 13-1. A complete medical evaluation may provide clues for diagnosing secondary hypertension. For example, patients with coarctation of the aorta may have diminished or even absent femoral pulses, and patients with renal artery stenosis may have an abdominal systohc-diastolic bruit. 

The peripheral vasculature is considered a target organ. Physical examination of the systemic vasculature can detect evidence of atherosclerosis, which may present as bruits (in the aortic, abdominal, and peripheral arteries), distended veins, diminished or absent peripheral arterial pulses, or lower extremity edema. Peripheral arterial disease is a clinical condition that can result from atherosclerosis, which is accelerated in hypertension. Other cardiovascular risk factors (e.g., smoking) can increase the hkelihood of peripheral arterial disease as well as all other forms of target-organ damage. 

Bruit—An abnormal and often harsh sound heard over a blood vessel, usually an artery, on examination with a stethoscope caused by turbulent blood flow. 

Claudication is a clinical, easy to make diagnosis. Claudication of the upper extremities, although much less frequent than that of the lower extremities, is also a clinical diagnosis. The extremities should be examined carefully. Examination of the peripheral arterial system should include an evaluation of the volume and character of the arterial pulses of the carotids and of the arteries of the upper extremities the subclavian, the brachial, the radial, and the ulnar. Physical examination should definitely encompass the abdominal aorta for abnormal pulsations, ectasias and/or bruits, and the arteries of the lower extremities femoral, popliteal, dorsalis pedis, and posterior tibialis. The pulse volume can be graded on a scale of 0 to 4. In addition to palpation, physical examination of the peripheral arterial system should include auscultation over the carotids, auscultation over the subclavian arteries above, and below the mid-clavicular area. A bruit over the subclavian artery and disappearance of the radial pulse with compression of the subclavian artery is evidence for subclavian syndrome. On occasion, a bruit may be heard by auscultation deep in the axilla. The bruit, a composite of low frequency sounds, is better appreciated when the examiner is using the bell of the stethoscope. 

Auscultation of the groin classically reveals a (new) continuous bruit after sheath removal, and in most cases a concomitant hematoma and/or pseudoaneurysm can be found. The clinical diagnosis must be confirmed by duplex ultrasonography, which will show a triad of typical signs (1) a colorful speckled mass at the level of the puncture site, (2) an increased venous flow with a lack of respiratory variation and a pulsatile arterial component in the affected vein, and (3) decreased arterial flow distal to the suspected fistula. As for pseudoaneurysms, an arteriovenous fistula can also be detected by more sophisticated imaging tools like MR-, CT- and catheter angiography, but the standard imaging tool is still duplex-ultrasound. 

Phonoangiography - This is detection and recording of vascular bruits or murmurs (5). Lesions which narrow the vessel lumen by 50 to 70% produce sufficient intra-vascular turbulence so that recordable murmurs occur. This allows estimation of the parameters of arterial diameter, flow velocity, and wall pressure fluctuations. 

Any of the above before and after reactive hyperemia - In the presence of occlusive arterial disease exercise produces a transient decrease (rather than the normal increase) in blood pressure in the ankle and foot. When measurements are made applying a combination of the technique above with reactive hyperemia, there is more sensitivity for discernment of small lesions. The specificity of the test is not increased however. For example, the effect of anemia altering vascular bruits would not be eliminated by combining exercise with phonoangiography. 

The standard explanation for vascular sound found in most medical textbooks explains that vascular sound is produced by fluid vibrations due to turbulence of the blood in the region of the narrowed vessel or valve. In the case of sound in an artery the sound is referred to as the vascular bruit. In the case of valvular sound the sound is termed a murmur. In fact, turbulence is offered up as the most common explanation for the occurrence of most any vascular sound even if it does not match experimental observations. For example, it is commonly proposed that the KorotkofF sounds of blood pressure determination are turbulence. 

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