Carotid bruit
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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] [2]
- 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
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]
List of contributors: