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Ochuko Ajari (talk | contribs) /* Causes in Alphabetical Order Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016 Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachuse... |
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*[[Aneurysms]] | *[[Aneurysms]] | ||
*[[Aortic coarctation]] | *[[Aortic coarctation]] | ||
*[[Aortic dissection]] | *[[Aortic dissection]]<ref name="pmid16439729">{{cite journal| author=Demiryoguran NS, Karcioglu O, Topacoglu H, Aksakalli S| title=Painless aortic dissection with bilateral carotid involvement presenting with vertigo as the chief complaint. | journal=Emerg Med J | year= 2006 | volume= 23 | issue= 2 | pages= e15 | pmid=16439729 | doi=10.1136/emj.2005.027862 | pmc=PMC2564071 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16439729 }} </ref> | ||
*[[Aortic stenosis]] | *[[Aortic stenosis]] | ||
*[[aneurysm|Arterial aneurysm]] | *[[aneurysm|Arterial aneurysm]] | ||
*[[Arteriosclerosis]] | *[[Arteriosclerosis]] | ||
*[[Arteriovenous fistula]]<ref>Sauvé J, Laupacis A, Østbye T, Feagan B, Sackett DL. Original article: does this patient have a clinically important carotid bruit? In: Simel DL, Rennie D, eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. New York, NY: McGraw-Hill; 2009. | *[[Arteriovenous fistula]]<ref>Sauvé J, Laupacis A, Østbye T, Feagan B, Sackett DL. Original article: does this patient have a clinically important carotid bruit? In: Simel DL, Rennie D, eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. New York, NY: McGraw-Hill; 2009. | ||
http://www.jamaevidence.com/content/3476758. Accessed 1/7/2015</ref> | http://www.jamaevidence.com/content/3476758. Accessed 1/7/2015</ref><ref name="pmid24826298">{{cite journal| author=Rymer JA, Anderson LL, Posenau JT, Jones WS| title=Remote Stab Wound Resulting in AV Fistula and High-Output Heart Failure. | journal=Case Rep Cardiol | year= 2013 | volume= 2013 | issue= | pages= 902719 | pmid=24826298 | doi=10.1155/2013/902719 | pmc=PMC4008354 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24826298 }} </ref><ref name="pmid8686535">{{cite journal| author=Bavinzski G, Richling B, Killer M, Gruber A, Levy D| title=Evolution of different therapeutic strategies in the treatment of cranial dural arteriovenous fistulas--report of 30 cases. | journal=Acta Neurochir (Wien) | year= 1996 | volume= 138 | issue= 2 | pages= 132-8 | pmid=8686535 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8686535 }} </ref> | ||
*[[Arteriovenous malformations]] | *[[Arteriovenous malformations]] | ||
*[[Atherosclerosis]] | *[[Atherosclerosis]] | ||
*[[Carotid artery disease]] | *[[Carotid artery disease]] | ||
*[[Carotid artery dissection]] | *[[Carotid artery dissection]] | ||
*[[Carotid artery stenosis]] | *[[Carotid artery stenosis]]<ref name="pmid8629537">{{cite journal| author=Santilli JD, Santilli SM, Rodnick JE| title=Prevention of stroke caused by carotid bifurcation stenosis. | journal=Am Fam Physician | year= 1996 | volume= 53 | issue= 2 | pages= 549-56, 559-60 | pmid=8629537 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8629537 }} </ref><ref name="pmid23339889">{{cite journal| author=Morales-Gisbert SM, Plaza-Martínez Á, Sala-Almonacil VA, Olmos-Sánchez D, Gomez-Palonés FJ, Ortiz-Monzón E| title=[Natural history of moderate-degree carotid stenosis in patients with peripheral artery disease]. | journal=Med Clin (Barc) | year= 2013 | volume= 140 | issue= 8 | pages= 337-42 | pmid=23339889 | doi=10.1016/j.medcli.2012.06.031 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23339889 }} </ref> | ||
*[[Carotid body tumor]] | *[[Carotid body tumor]] | ||
*[[Carotid sinus hypersensitivity]] | *[[Carotid sinus hypersensitivity]] | ||
*[[Carotid sinus syndrome]] | *[[Carotid sinus syndrome]] | ||
*[[Carotid-cavernous fistula]] | *[[Carotid-cavernous fistula]] | ||
*[[Coronary artery disease]] | *[[Coronary artery disease]]<ref name="pmid23519510">{{cite journal| author=Subramani KS, Kolhari VB, Manjunath CN, Bhairappa S| title=Familial hypercholesterolaemia presenting with coronary artery disease in a young patient. | journal=BMJ Case Rep | year= 2013 | volume= 2013 | issue= | pages= | pmid=23519510 | doi=10.1136/bcr-2013-008718 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23519510 }} </ref> | ||
*[[Coronary heart disease]] | *[[Coronary heart disease]] | ||
*[[Crohn's disease]] | *[[Crohn's disease]]<ref name="pmid24124342">{{cite journal| author=Taddio A, Maschio M, Martelossi S, Barbi E, Ventura A| title=Crohn's disease and Takayasu's arteritis: an uncommon association. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 35 | pages= 5933-5 | pmid=24124342 | doi=10.3748/wjg.v19.i35.5933 | pmc=PMC3793150 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24124342 }} </ref> | ||
*[[carotid artery stenosis|External carotid artery stenosis]] | *[[carotid artery stenosis|External carotid artery stenosis]] | ||
*[[thoracic outlet syndrome|External compression from thoracic outlet syndrome]] | *[[thoracic outlet syndrome|External compression from thoracic outlet syndrome]] | ||
| Line 173: | Line 173: | ||
*[[Trauma|Neck trauma with damage to the carotid artery]] | *[[Trauma|Neck trauma with damage to the carotid artery]] | ||
*[[Paraganglioma]] | *[[Paraganglioma]] | ||
*[[Peripheral artery disease]] | *[[Peripheral artery disease]]<ref name="pmid23339889">{{cite journal| author=Morales-Gisbert SM, Plaza-Martínez Á, Sala-Almonacil VA, Olmos-Sánchez D, Gomez-Palonés FJ, Ortiz-Monzón E| title=[Natural history of moderate-degree carotid stenosis in patients with peripheral artery disease]. | journal=Med Clin (Barc) | year= 2013 | volume= 140 | issue= 8 | pages= 337-42 | pmid=23339889 | doi=10.1016/j.medcli.2012.06.031 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23339889 }} </ref> | ||
*[[Stroke]] | *[[Stroke]] | ||
*[[Supravalvular aortic stenosis]] | *[[Supravalvular aortic stenosis]] | ||
*[[Takayasu's arteritis]] | *[[Takayasu's arteritis]] <ref name="pmid24124342">{{cite journal| author=Taddio A, Maschio M, Martelossi S, Barbi E, Ventura A| title=Crohn's disease and Takayasu's arteritis: an uncommon association. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 35 | pages= 5933-5 | pmid=24124342 | doi=10.3748/wjg.v19.i35.5933 | pmc=PMC3793150 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24124342 }} </ref> | ||
*[[Thyroid fistula]] | *[[Thyroid fistula]] | ||
*[[Thyrotoxicosis]]<ref>Sauvé J, Laupacis A, Østbye T, Feagan B, Sackett DL. Original article: does this patient have a clinically important carotid bruit? In: Simel DL, Rennie D, eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. New York, NY: McGraw-Hill; 2009. | *[[Thyrotoxicosis]]<ref>Sauvé J, Laupacis A, Østbye T, Feagan B, Sackett DL. Original article: does this patient have a clinically important carotid bruit? In: Simel DL, Rennie D, eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. New York, NY: McGraw-Hill; 2009. | ||
Revision as of 02:23, 14 January 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]
Overview
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.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Causes by Organ System
Causes in Alphabetical Order [1] [2]
Diagnosis
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
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.
- 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.
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
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
- ↑ Sauvé J, Laupacis A, Østbye T, Feagan B, Sackett DL. Original article: does this patient have a clinically important carotid bruit? In: Simel DL, Rennie D, eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. New York, NY: McGraw-Hill; 2009. http://www.jamaevidence.com/content/3476758. Accessed 1/7/2015
- ↑ Demiryoguran NS, Karcioglu O, Topacoglu H, Aksakalli S (2006). "Painless aortic dissection with bilateral carotid involvement presenting with vertigo as the chief complaint". Emerg Med J. 23 (2): e15. doi:10.1136/emj.2005.027862. PMC 2564071. PMID 16439729.
- ↑ Sauvé J, Laupacis A, Østbye T, Feagan B, Sackett DL. Original article: does this patient have a clinically important carotid bruit? In: Simel DL, Rennie D, eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. New York, NY: McGraw-Hill; 2009. http://www.jamaevidence.com/content/3476758. Accessed 1/7/2015
- ↑ Rymer JA, Anderson LL, Posenau JT, Jones WS (2013). "Remote Stab Wound Resulting in AV Fistula and High-Output Heart Failure". Case Rep Cardiol. 2013: 902719. doi:10.1155/2013/902719. PMC 4008354. PMID 24826298.
- ↑ Bavinzski G, Richling B, Killer M, Gruber A, Levy D (1996). "Evolution of different therapeutic strategies in the treatment of cranial dural arteriovenous fistulas--report of 30 cases". Acta Neurochir (Wien). 138 (2): 132–8. PMID 8686535.
- ↑ Santilli JD, Santilli SM, Rodnick JE (1996). "Prevention of stroke caused by carotid bifurcation stenosis". Am Fam Physician. 53 (2): 549–56, 559–60. PMID 8629537.
- ↑ 9.0 9.1 Morales-Gisbert SM, Plaza-Martínez Á, Sala-Almonacil VA, Olmos-Sánchez D, Gomez-Palonés FJ, Ortiz-Monzón E (2013). "[Natural history of moderate-degree carotid stenosis in patients with peripheral artery disease]". Med Clin (Barc). 140 (8): 337–42. doi:10.1016/j.medcli.2012.06.031. PMID 23339889.
- ↑ Subramani KS, Kolhari VB, Manjunath CN, Bhairappa S (2013). "Familial hypercholesterolaemia presenting with coronary artery disease in a young patient". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-008718. PMID 23519510.
- ↑ 11.0 11.1 Taddio A, Maschio M, Martelossi S, Barbi E, Ventura A (2013). "Crohn's disease and Takayasu's arteritis: an uncommon association". World J Gastroenterol. 19 (35): 5933–5. doi:10.3748/wjg.v19.i35.5933. PMC 3793150. PMID 24124342.
- ↑ Sauvé J, Laupacis A, Østbye T, Feagan B, Sackett DL. Original article: does this patient have a clinically important carotid bruit? In: Simel DL, Rennie D, eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. New York, NY: McGraw-Hill; 2009. http://www.jamaevidence.com/content/3476758. Accessed 1/7/2015
Acknowledgements
The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]
List of contributors: