Carotid bruit

Carotid bruit

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.

• Aortic coarctation
• Aortic Stenosis
• Arterial Aneurysm
• Arteriosclerosis
• Arteriovenous Fistula
• Carotid-cavernous 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
• Vasculitis

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

Acknowledgements

The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

List of contributors: