Bruits
Commonly an indicator of life- or limb-threatening vascular disease, bruits are swishing sounds caused by turbulent blood flow. They're characterized by location, duration, intensity, pitch, and the time of onset in the cardiac cycle. Loud bruits produce intense vibration and a palpable thrill. A thrill, however, doesn't provide a further clue to the causative disorder or to its severity.
Bruits are most significant when heard over the abdominal aorta; the renal, carotid, femoral, popliteal, or subclavian artery; or the thyroid gland. (See Preventing false bruits.) They're also significant when heard consistently despite changes in patient position and when heard during diastole.
History and physical examination
If you detect bruits over the abdominal aorta, check for a pulsating mass or a bluish discoloration around the umbilicus (Cullen's sign). Either of these signs — or severe, tearing pain in the abdomen, flank, or lower back — may signal life-threatening dissection of an aortic aneurysm. Also, check peripheral pulses, comparing intensity in the upper versus lower extremities.
If you suspect dissection, monitor the patient's vital signs constantly, and withhold food and fluids until a definitive diagnosis is made. Watch for signs and symptoms of hypovolemic shock, such as thirst; hypotension; tachycardia; a weak, thready pulse; tachypnea; an altered level of consciousness (LOC); mottled knees and elbows; and cool, clammy skin.
If you detect bruits over the thyroid gland, ask the patient if he has a history of hyperthyroidism or signs and symptoms of it, such as nervousness, tremors, weight loss, palpitations, heat intolerance, and (in females) amenorrhea. Watch for signs and symptoms of life-threatening thyroid storm, such as tremor, restlessness, diarrhea, abdominal pain, and hepatomegaly.
If you detect carotid artery bruits, be alert for signs and symptoms of a transient ischemic attack (TIA), including dizziness, diplopia, slurred speech, flashing lights, and syncope. These findings may indicate an impending stroke. Be sure to evaluate the patient frequently for changes in LOC and muscle function.
If you detect bruits over the femoral, popliteal, or subclavian artery, watch for signs and symptoms of decreased or absent peripheral circulation — edema, weakness, and paresthesia. Ask the patient if he has a history of intermittent claudication. Frequently check distal pulses and skin color and temperature. Also, watch for the sudden absence of pulse, pallor, or coolness, which may indicate a threat to the affected limb.
If you detect a bruit, make sure to check for further vascular damage and perform a thorough cardiac assessment.
Medical causes
❑ Abdominal aortic aneurysm. A pulsating periumbilical mass accompanied by a systolic bruit over the aorta characterizes abdominal aortic aneurysm. Associated signs and symptoms include a rigid, tender abdomen; mottled skin; diminished peripheral pulses; and claudication. Sharp, tearing pain in the abdomen, flank, or lower back signals imminent dissection.
❑ Abdominal aortic atherosclerosis. Loud systolic bruits in the epigastric and midabdominal areas are common. They may be accompanied by leg weakness, numbness, paresthesia, or paralysis; leg pain; or decreased or absent femoral, popliteal, or pedal pulses. Abdominal pain is rarely present.
❑ Anemia. Increased cardiac output causes increased blood flow. In patients with severe anemia, short systolic bruits may be heard over both carotid arteries and may be accompanied by headache, fatigue, dizziness, pallor, jaundice, palpitations, mild tachycardia, dyspnea, nausea, anorexia, and glossitis.
❑ Carotid artery stenosis. Systolic bruits can be heard over one or both carotid arteries. Other signs and symptoms may be absent. However, dizziness, vertigo, headache, syncope, aphasia, dysarthria, sudden vision loss, hemiparesis, or hemiparalysis signals a TIA and may herald a stroke.
❑ Carotid cavernous fistula. Continuous bruits heard over the eyeballs and temples are characteristic, as are vision disturbances and protruding, pulsating eyeballs.
❑ Peripheral arteriovenous fistula. A rough, continuous bruit with systolic accentuation may be heard over the fistula; a palpable thrill is also common.
❑ Peripheral vascular disease.Peripheral vascular disease characteristically produces bruits over the femoral artery and other arteries in the legs. It can also cause diminished or absent femoral, popliteal, or pedal pulses; intermittent claudication; numbness, weakness, pain, and cramping in the legs, feet, and hips; and cool, shiny skin and hair loss on the affected extremity. It also predisposes the patient to lower-extremity ulcers that heal with difficulty.
❑ Renal artery stenosis. Systolic bruits are commonly heard over the abdominal midline and flank on the affected side. Hypertension commonly accompanies stenosis. Headache, palpitations, tachycardia, anxiety, dizziness, retinopathy, hematuria, and mental sluggishness may also appear.
❑ Subclavian steal syndrome. With subclavian steal syndrome, systolic bruits may be heard over one or both subclavian arteries as a result of arterial lumen narrowing. They may be accompanied by decreased blood pressure and claudication in the affected arm, hemiparesis, vision disturbances, vertigo, and dysarthria.
❑ Thyrotoxicosis. A systolic bruit is commonly heard over the thyroid gland. Accompanying signs and symptoms appear in all body systems, but the most characteristic ones include thyroid enlargement, fatigue, nervousness, tachycardia, heat intolerance, sweating, tremor, diarrhea, and weight loss despite increased appetite. Exophthalmos may also be present.
Special considerations
Because bruits can signal a life-threatening vascular disorder, frequently check the patient's vital signs, auscultate over the affected arteries, and monitor peripheral pulses. Be especially alert for bruits that become louder or develop a diastolic component.
As needed, administer prescribed drugs, such as a vasodilator, an anticoagulant, an antiplatelet drug, or an antihypertensive. Prepare the patient for diagnostic tests, such as blood studies, radiographs, an electrocardiogram, cardiac catheterization, and ultrasonography.
Pediatric pointers
Bruits are common in young children, but are usually of little significance — for example, cranial bruits are normal until age 4. However, certain bruits may be significant. Because birthmarks commonly accompany congenital arteriovenous fistulas, carefully auscultate for bruits in children with port-wine spots or cavernous or diffuse hemangiomas.
Geriatric pointers
Elderly people with atherosclerosis may experience bruits over several arteries. Those related to carotid artery stenosis are particularly important because of the high incidence of associated stroke. Close follow-up is mandatory as well as prompt surgical referral when indicated.
Pictures
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Vein symptoms
» Next page: Skin, mottled (Handbook of Signs & Symptoms (Third Edition))
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