Carotid bruit

# 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.
- Aortic dissection

## Common Causes
- Atherosclerosis
- Carotid artery stenosis

## Causes by Organ System

## Causes in Alphabetical Order  

# 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
- 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
- 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