Auscultation for carotid bruits* is performed by placing the diaphragm of the stethoscope over the patient's carotid artery while the patient is lying supine. This is demonstrated in Figure 15-7. The patient's head should be slightly elevated on a pillow and turned slightly away from the carotid artery being evaluated. It is often helpful to ask the patient to hold his or her breath during the auscultation. Normally, either nothing or transmitted heart sounds are heard. After one carotid artery is evaluated, the other is examined. After auscultation of the carotid arteries, they are palpated (see Chapter 14, The Heart).
The presence of a murmur should be noted. This may be a bruit resulting from atherosclerotic disease of the carotid artery. On occasion, loud murmurs originating from the heart can be transmitted to the neck. With experience, the examiner is able to determine whether the disorder is local in the neck or distal in the heart.
*A bruit is a sound or murmur heard in a vessel as a result of increased turbulence.
Table 15-1 Characteristics of Physical Signs for Detecting an Abdominal Aortic Aneurysm
Physical Sign Sensitivity (%) Specificity (%)
Definite pulsatile mass 28 97
Definite or suggestive pulsatile mass 50 91
Abdominal bruit 11 95
Femoral bruit 17 87
Data from Lederle FA, Walker JM, Reinke DB: Selective screening for abdominal aortic aneurysms with physical examination and ultrasound. Arch Intern Med 148:1753, 1988.
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