STUDY - Technical - New Dacian's Medicine
bruit
(vascular murmur) (Classical / Allopathic Medicine)
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 time of onset in the cardiac cycle. Loud bruits produce
intense vibration and a palpable thrill. A thrill, however,
doesn't provide any 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. They're also significant when heard
consistently, despite changes in patient position and when
heard during diastole.
ALERT:
If you detect bruits over the abdominal aorta:
- check for a pulsating mass or a bluish discoloration around the umbilicus (Cullen's sign)
- ask the patient about severe, tearing pain in the abdomen, flank, or lower back
- check peripheral pulses, comparing the intensity in the upper extremities to that in the lower extremities
monitor vital signs
- withhold food and fluids until a definitive diagnosis is made
- prepare the patient for surgery, if appropriate.
If you don't detect bruits over the abdominal aorta, perform a focused assessment.
If you detect bruits over the abdominal aorta:
- check for a pulsating mass or a bluish discoloration around the umbilicus (Cullen's sign)
- ask the patient about severe, tearing pain in the abdomen, flank, or lower back
- check peripheral pulses, comparing the intensity in the upper extremities to that in the lower extremities
monitor vital signs
- withhold food and fluids until a definitive diagnosis is made
- prepare the patient for surgery, if appropriate.
If you don't detect bruits over the abdominal aorta, perform a focused assessment.
HISTORY:
If you detect bruits over the thyroid gland:
- ask the patient if he has a history of hyperthyroidism or signs and symptoms that suggest it, such as nervousness, tremors, weight loss, palpitations, heat intolerance and, in female patients, amenorrhea
- watch for signs and symptoms of life-threatening thyroid storm, such as tremor, restlessness, diarrhea, abdominal pain, and hepatomegaly.
If you detect bruits over the carotid artery:
- ask the patient about signs and symptoms of a transient ischemic attack, including dizziness, diplopia, slurred speech, flashing lights, and syncope.
If you detect bruits over the femoral, popliteal, or subclavian artery:
- ask the patient if he has experienced edema, weakness, or paresthesia of the extremities
- ask the patient if he has a history of intermittent claudication.
If you detect bruits over the thyroid gland:
- ask the patient if he has a history of hyperthyroidism or signs and symptoms that suggest it, such as nervousness, tremors, weight loss, palpitations, heat intolerance and, in female patients, amenorrhea
- watch for signs and symptoms of life-threatening thyroid storm, such as tremor, restlessness, diarrhea, abdominal pain, and hepatomegaly.
If you detect bruits over the carotid artery:
- ask the patient about signs and symptoms of a transient ischemic attack, including dizziness, diplopia, slurred speech, flashing lights, and syncope.
If you detect bruits over the femoral, popliteal, or subclavian artery:
- ask the patient if he has experienced edema, weakness, or paresthesia of the extremities
- ask the patient if he has a history of intermittent claudication.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
If you detect bruits over the thyroid gland:
- palpate the thyroid gland for enlargement
- note exophthalmos if present.
If you detect bruits over the carotid artery:
- observe the patient's speech, noting aphasia
- check the patient's pupils for proper reaction
- test muscle strength and coordination, noting weakness.
If you detect bruits over the femoral, popliteal, or subclavian artery:
- watch for a sudden absence of pulse, pallor, or coolness, which may indicate a threat to the affected limb
perform a thorough cardiac assessment.
Take the patient's vital signs.
If you detect bruits over the thyroid gland:
- palpate the thyroid gland for enlargement
- note exophthalmos if present.
If you detect bruits over the carotid artery:
- observe the patient's speech, noting aphasia
- check the patient's pupils for proper reaction
- test muscle strength and coordination, noting weakness.
If you detect bruits over the femoral, popliteal, or subclavian artery:
- watch for a sudden absence of pulse, pallor, or coolness, which may indicate a threat to the affected limb
perform a thorough cardiac assessment.
SPECIAL
CONSIDERATIONS:
Because bruits can signal a life-threatening vascular disorder, frequently check the patient's vital signs and auscultate over the affected arteries. Be especially alert for bruits that become louder or develop a diastolic component.
Because bruits can signal a life-threatening vascular disorder, frequently check the patient's vital signs and auscultate over the affected arteries. Be especially alert for bruits that become louder or develop a diastolic component.
PEDIATRIC
POINTERS:
Although bruits are common in young children and usually of little significance - for example, cranial bruits are normal until age 4 - some bruits may be significant.
Because birthmarks commonly accompany congenital arteriovenous fistulas, carefully auscultate for bruits in a child with port-wine spots or cavernous or diffuse hemangiomas.
Although bruits are common in young children and usually of little significance - for example, cranial bruits are normal until age 4 - some bruits may be significant.
Because birthmarks commonly accompany congenital arteriovenous fistulas, carefully auscultate for bruits in a child with port-wine spots or cavernous or diffuse hemangiomas.
AGING ISSUES:
Elderly patients with atherosclerosis may have bruits that can be heard 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.
Elderly patients with atherosclerosis may have bruits that can be heard 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.
PATIENT
COUNSELING:
Instruct the patient to inform the physician if he develops dizziness, pain, or other symptoms that suggest stroke because his condition may be worsening.
Instruct the patient to inform the physician if he develops dizziness, pain, or other symptoms that suggest stroke because his condition may be worsening.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)