Carotid bruits

Neck Jugular venous distention, carotid bruits... 

A complete history and physical examination should assess (1) presence or absence of cardiovascular risk factors or definite cardiovascular disease in the individual (2) family history of premature cardiovascular disease or lipid disorders (3) presence or absence of secondary causes of hyperlipidemia, including concurrent medications and (4) presence or absence of xanthomas, abdominal pain, or history of pancreatitis, renal or liver disease, peripheral vascular disease, abdominal aortic aneurysm, or cerebral vascular disease (carotid bruits, stroke, or transient ischemic attack). 

Gutierrez IZ, Barone DL, Makula PA, Currier C. The risk of perioperative stroke in patients with asymptomatic carotid bruits undergoing peripheral vascular surgery. Am Surg 1987 Sep 53(9) 487-9. 

Fell G, Breslau P, Knox RA, Phillips D, Thiele BL, Strandness DE Jr Importance of noninvasive ultrasonic Doppler testing in the evaluation of patients with asymptomatic carotid bruits. Am Heart Journal 1981 102 221-6. 

Many stroke patients have atherosclerosis, indicating a link between cardiac and cerebrovascular disease (see Table 2.2). But it is difficult for clinicians to predict the likelihood of stroke using signs and symptoms of heart disease. For instance, carotid bruits are more reliably predictive of ischemic heart disease than of stroke. Around 23% of ischemic stroke originates from carotid atherosclerosis. The degree of stenosis alone cannot predict vulnerable lesions [12]. Cerebrovascular ischemic events also result from low-grade carotid stenosis. 

The 4S trial (44), in addition to CAD data, also reported the effects of therapy with simvastatin on noncoronary signs and symptoms during a median follow-up of 5.4 years. Patient assessment for these included a history of symptoms suggestive of intermittent claudication and a physical examination for carotid and femoral bruits that was done at baseline and followed annually. Risk of a new or worsening carotid bruit was substantially reduced by treatment, consistent with a reduction in cere-... 

Cote R, Battista RN, Ahrahamowicz M, Langlois Y, Bourque F, Mackey A. Lack of effect of aspirin in as3miptomatic patients with carotid hmits and substantial carotid narrowing. The Asymptomatic Cervial Bruit Study Group. Ann Intern Med 1995 123 649-655. 

Exts Ankle-brachial index 1.1 Neck No carotid and basilar bruits... 

Thrombosis of the cavernous sinus is characterized by proptosis, chemosis, impaired vision and ophthalmoplegia. If it is not septic, prognosis is good because of collateral drainage and spontaneous recanalization. The same symptoms, with the exception of a possible bruit, may result from arteriovenous shunting in carotid-cavernous fistulae. The treatment of choice in this case is endovascular occlusion (thrombosis ) of the cavernous sinus. 

A localized bruit over the carotid bifurcation (under the jaw) is predictive of some degree of carotid stenosis, but very tight stenosis or occlusion may not cause a bruit at all. Bruits may... 

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). 

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

Sauve JS, Thorpe KE, Sackett DL, et al. Can Bruits Distinguish High-Grade from Moderate Symptomatic Carotid Stenosis Ann Int Med 1994 20(8) 633-7. 

Neck Carotid or vertebral bruit Absent carotid pulse Nuchal rigidity Carotid or vertebral stenosis CCA occlusion Meningeal irritation in S AH or infectious meningitis... 

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

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. 

Breast development, female 562 Bronchiolitis 174 Bronzing of the skin and gums 369 Bruits, carotid/femoral 541-543 Burning pain 600... 

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