Carotid bruit
You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.
| Carotid bruit Classification and external resources |
|
WikiDoc Resources for Carotid bruit | |
|
Articles | |
|---|---|
|
Most recent articles on Carotid bruit Most cited articles on Carotid bruit | |
|
Media | |
|
Powerpoint slides on Carotid bruit | |
|
Evidence Based Medicine | |
|
Clinical Trials | |
|
Ongoing Trials on Carotid bruit at Clinical Trials.gov Trial results on Carotid bruit Clinical Trials on Carotid bruit at Google
| |
|
Guidelines / Policies / Govt | |
|
US National Guidelines Clearinghouse on Carotid bruit NICE Guidance on Carotid bruit
| |
|
Books | |
|
News | |
|
Commentary | |
|
Definitions | |
|
Patient Resources / Community | |
|
Patient resources on Carotid bruit Discussion groups on Carotid bruit Patient Handouts on Carotid bruit Directions to Hospitals Treating Carotid bruit Risk calculators and risk factors for Carotid bruit
| |
|
Healthcare Provider Resources | |
|
Causes & Risk Factors for Carotid bruit | |
|
Continuing Medical Education (CME) | |
|
International | |
|
| |
|
Businness | |
|
Experimental / Informatics | |
| Cardiology Network |
 Discuss Carotid bruit further in the WikiDoc Cardiology Network |
| Adult Congenital |
|---|
| Biomarkers |
| Cardiac Rehabilitation |
| Congestive Heart Failure |
| CT Angiography |
| Echocardiography |
| Electrophysiology |
| Cardiology General |
| Genetics |
| Health Economics |
| Hypertension |
| Interventional Cardiology |
| MRI |
| Nuclear Cardiology |
| Peripheral Arterial Disease |
| Prevention |
| Public Policy |
| Pulmonary Embolism |
| Stable Angina |
| Valvular Heart Disease |
| Vascular Medicine |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
A carotid bruit is a bruit or sound heard over the carotid artery area, usually by a nurse or physician during auscultation. It is usually the result of a stenosis of the carotid artery, and is unlikely to be heard if the stenosis occludes less than 40% of the diameter of the artery. Likewise, a stenosis of greater than 90% may not be heard, as the flow may be too low.
Many carotid bruits are discovered incidentally in an otherwise asymptomatic patient. A carotid duplex ultrasound may be useful in determining the origin of the bruit, the severity of the stenosis causing it, and the bruit's hemodynamic effects.
- Carotid bruits are best heard with the bell of the stethoscope.
- Carotid bruits are a blowing sound or murmur over the carotid artery
- Are usually associated with carotid stenosis, secondary to atherosclerosis
- Depending on degree of stenosis, may imply an increased risk of stroke
A CT scan may be indicated for patients with ultrasound-proven carotid disease who are at a higher risk for cerebrovascular accidents such as stroke.
Differential Diagnosis
In alphabetical order. [1] [1]
- Aortic coarctation
- Aortic Stenosis
- Arterial Aneurysm
- Arteriosclerosis
- Arteriovenous Fistula
- Excessive compression of the stethoscope over the neck vessels (therefore causing deformities in the vessel wall and turbulence)
- External carotid artery stenosis
- Fever
- Fisher's contralateral systolic bruit
- Heart murmur with radiation to the neck
- Hyperthyroidism
- Internal carotid artery stenosis
- Normal carotid arteries (yet tortuous)
- Takayasu's Arteritis
- Thyroid fistula
- Vascular angioma in the skull
Diagnosis
History and Symptoms
- Special attention should paid to symptoms suggestive of:
- Transient ischemic attack (TIA) symptoms
- Cardiac risk factors
Physical Examination
Heart
- It is critical to assess if there is a heart murmur that is radiating to the carotids.
Abdomen
- The presence of a carotid bruit may indicate that a renal bruit is present as well.
Extremities
- The presence of a carotid bruit may indicate that a femoral artery bruit will be present as well. The distal pulses should be evaluated carefully.
Neurologic
- Neurologic exam should document and focal neurologic findings that might suggest a prior stroke.
Laboratory Findings
- Complete blood count (CBC)
- Lipid panel
- Folate levels
- Vitamin B12
- Thyroid stimulating hormone (TSH)
- Glucose
- Homocysteine level
- Erythrocyte sedimentation rate (ESR)
Echocardiography or Ultrasound
- The degree of stenosis can be evaluated by carotid duplex ultrasound
Other Imaging Findings
- To evaluate symptomatic stenosis that may require surgery:
- Computerized tomographic angiography (CTA)
- Magnetic resonance angiogram (MRA)
- Carotid arteriography
Treatment
- Treat underlying atherosclerotic disease proceses.
- Smoking cessation
Pharmacotherapy
Acute Pharmacotherapies
- Aspirin and/or antiplatelet therapy is recommended for asymptomatic patients
Chronic Pharmacotherapies
- Aspirin and/or antiplatelet therapy is recommended for asymptomatic patients
Surgery and Device Based Therapy
- Symptomatic patients with stenosis of 50-69% benefit more from surgery than medical therapies
- Symptomatic patients with stenosis of greater than 70% should consider endarterectomy
Future or Investigational Therapies
- Carotid angioplasty is under investigation for a possible future treatment
References
Acknowledgements
The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Phone:617-525-6884
List of contributors:
Suggested Reading and Key General References
Suggested Links and Web Resources
For Patients
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
