Carotid Auscultation Research Articles

Cardiac myxoma and cerebral vasculitis: Is there a link?

BackgroundCardiac myxomas present a diagnostic challenge due to their ability to mimic various cardiovascular and systemic conditions. Timely identification is crucial for implementing surgical intervention and averting life-threatening complications.Case presentationWe reported the case of a 49-year-old male patient who presented sudden legs weakness and slurred speech and was admitted 10 h later in emergency department. Physical examination was significant for paraparesis and paraphasia. Cardiac and carotid auscultation was normal. CT brain revealed multiple acute ischemic strokes and MRA was suggestive of cerebral vasculitis. As pre-therapy assessment, the EKG revealed no electrical abnormalities and the chest X-ray showed signs of left atrial enlargement. Transthoracic and transesophageal echocardiography showed a left atrial mass attached to the interatrial septum, measuring 9*5*4 cm and extending into the left ventricular cavity during diastole, which suggested the diagnosis of left atrial myxoma. The patient was referred for open-heart surgery and histopathological examination confirmed the diagnosis of myxoma. The patient weaned off from cardiopulmonary bypass and the postoperative period was uneventful.ConclusionWe reported an interesting case with an unusual and misleading neurological presentation of a cardiac myxoma. The unpredictability of serious complications occurrence must awaken our medical flair, for an early diagnosis among a long list of differentials.

The seventh survey of the Tromsø Study (Tromsø7) 2015-2016: study design, data collection, attendance, and prevalence of risk factors and disease in a multipurpose population-based health survey.

Aims:The Tromsø Study is an ongoing population-based health study in Tromsø, Norway, initiated in 1974. The purpose of the seventh survey (Tromsø7) 2015–2016 was to advance the population risk factor surveillance and to collect new types of data. We present the study design, data collection, attendance, and prevalence of risk factors and disease.Methods:All inhabitants in Tromsø municipality, Norway, aged 40 years and older (N=32,591) were invited to a health screening including extensive questionnaires, face-to-face interviews, biological sampling (blood, urine, saliva, nasal/throat swabs, faeces), measurements (anthropometry, blood pressure, pulse, pulse oximetry) and clinical examinations (pain sensitivity, echocardiography, cognitive, physical, and lung function, accelerometer measurements, eye examinations, carotid ultrasound, electrocardiography, dual-energy X-ray absorptiometry, and heart, lung and carotid auscultation). New research areas in this round were dental and oral health examinations, collection of faecal samples for studies of normal bacterial flora and antibiotic resistance, and 24-hour urine samples for examination of sodium and iodine intakes.Results:Attendance was 65% (N=21,083), and was higher in women, age group 50–79 years, previous attenders, and Norwegian-born individuals. Cardiovascular risk factor levels and prevalence of chronic obstructive lung disease decreased since the last survey, while the prevalence of obesity and diabetes increased.Conclusions:Attendance was stable from the sixth survey. Interaction with participants might be key to maintain participation. Favourable trends in risk factors continue, except for a continued increase in obesity. Both new data collection technology and traditional physical examinations will be crucial for the impact of future population studies.

Auscultation System for Acquisition of Vascular Sounds - Towards Sound-Based Monitoring of the Carotid Artery.

IntroductionAtherosclerotic diseases of the carotid are a primary cause of cerebrovascular events such as stroke. For the diagnosis and monitoring angiography, ultrasound- or magnetic resonance-based imaging is used which requires costly hardware. In contrast, the auscultation of carotid sounds and screening for bruits – audible patterns related to turbulent blood flow – is a simple examination with comparably little technical demands. It can indicate atherosclerotic diseases and justify further diagnostics but is currently subjective and examiner dependent.MethodsWe propose an easy-to-use computer-assisted auscultation system for a stable and reproducible acquisition of vascular sounds of the carotid. A dedicated skin-transducer-interface was incorporated into a handheld device. The interface comprises two bell-shaped structures, one with additional acoustic membrane, to ensure defined skin contact and a stable propagation path of the sound. The device is connected wirelessly to a desktop application allowing real-time visualization, assessment of signal quality and input of supplementary information along with storage of recordings in a database. An experimental study with 5 healthy subjects was conducted to evaluate usability and stability of the device. Five recordings per carotid served as data basis for a wavelet-based analysis of the stability of spectral characteristics of the recordings.ResultsThe energy distribution of the wavelet-based stationary spectra proved stable for measurements of a particular carotid with the majority of the energy located between 3 and 40 Hz. Different spectral properties of the carotids of one individual indicate the presence of sound characteristics linked to the particular vessel. User-dependent parameters such as variations of the applied contact pressure appeared to have minor influence on the general stability.ConclusionThe system provides a platform for reproducible carotid auscultation and the creation of a database of pathological vascular sounds, which is a prerequisite to investigate sound-based vascular monitoring.

The clinical import of a retinal cholesterol embolus: it is a question of symptoms

Correspondence: Paul Varner John J Pershing VAMC, 1500 N Westwood Boulevard, Poplar Bluff, MO 63901, USA Tel +1 573 778 4303 Fax +1 573 778 4164 Email paul.varner@va.gov Abstract: Retinal cholesterol emboli (RCE) are occasionally found on ophthalmic examination. Originally, all RCE were thought to be related to impending cardiovascular morbidity and mortality, but it is now apparent that accompanying symptoms can be used to help better stratify cardiovascular event risk for these patients. Regardless of associated visual symptoms, all patients with RCE but unknown medical status, merit referral to primary care providers for further assessment of cardiovascular health status. Symptomatic patients with known cardiovascular diseases require carotid duplex ultrasonography to determine degree of arteriolar occlusion with possible referral to vascular surgeons for invasive correction of carotid artery occlusive disease. Asymptomatic patients with known cardiovascular profiles may benefit from the addition of only 81 mg aspirin if not otherwise contraindicated. Screening carotid studies should not be considered for these patients. Carotid auscultation in the eye clinic setting is unwarranted for either set of patients.

Change Heart and Vascular Risk with Attitude, Nutrition, Goals, and Exercise (CHANGE)

Synopsis: Cardiovascular disease is the number one cause of death in the United States. Traditional risk factors account for more than 90% of the risk of an initial heart attack. Forty-four percent of the reduction in death from heart disease in recent decades is attributed to risk factor modification. Many individuals are aware of their risk factors; however, they are not aware of their treatment goals. Low-risk individuals identified by the Framingham risk score account for the majority of cardiovascular events. Identification of lifetime risk rather than Framingham risk identifies individuals appropriate for early aggressive risk factor management. Purpose: A Cardiovascular Prevention Program was developed by Christiana Care Health System in January 2008 with the goal of improving management of cardiovascular risk factors and reducing the lifetime cardiovascular risk of community members. Methods: The multidisciplinary team included the Medical Director, Advanced Practice Nurse, Cardiovascular Nurses, Behavioral Health Specialist, Vascular Lab, Marketing, and Heart and Vascular Administration. Through a promotional campaign, community members were invited to visit the Christiana Care Website to complete an online cardiovascular risk assessment. Individuals identified with any cardiovascular risk were invited to come for a free comprehensive on-site screening with a cardiovascular nurse. This included a full lipid profile, blood sugar, body mass index, waist circumference, blood pressure, carotid auscultation, assessment of sex-specific and psychosocial risk factors, and triple vascular screening. Personalized risk factor counseling was provided with an emphasis on patient goals and educating and empowering patients with knowledge. In addition to Framingham risk, the patient's lifetime risk for cardiovascular disease was determined during a multidisciplinary team review, and best-practice recommendations provided to the patient and Primary Care Physician. Results: Key outcomes from 289 patients seen in 2008 reflected risk factor profiles consistent with national statistics. Although 70% met traditional lipid goals, only 18% met lipid goals for lifetime risk of cardiovascular disease. A total of 48% had undiagnosed hypertension. Of patients surveyed 6 months following their visit (n=83), 94% had taken steps to achieve their health goals, and 65% had discussed the results and recommendations with their doctor. Approximately one-third of these patients stated they had changes to their treatment plan by their Primary Care Physician based on the screening results! Conclusions: Educating and empowering patients to take an active role in their cardiovascular prevention, in conjunction with educating their providers on best-practice recommendations based on lifetime risk, results in improved management of cardiovascular risk factors.

Clinical significance of carotid bruits: an innocent finding or a useful warning sign?

Objective: To elucidate the clinical relevance of carotid bruits.Methods: A search using PubMed was performed using the terms: 'carotid bruit', 'stroke', 'cerebrovascular symptoms', 'carotid artery stenosis' and 'carotid artery disease' in various combinations. The reference lists of the gathered reports were also considered.Results: Current evidence shows that a carotid bruit is a useful clinical sign with a high specificity (>90%) for the detection of carotid artery stenosis. The negative predictive value (>90%), as well as the accuracy (>90%), of this inexpensive method, are additional advantages. The low sensitivity (<30%) and low positive predictive values (<30%) of carotid auscultation are its main disadvantages. A carotid bruit is also a useful indicator of systemic atherosclerosis. Carotid bruits are also associated with a higher prevalence of vascular risk factors.Discussion: Carotid auscultation is a useful and inexpensive diagnostic tool that should be included as part of a general physical examination. Its clinical relevance in terms of carotid disease, however, needs to be verified by further investigation (e.g. ultrasonography). Since carotid bruits are predictors of systemic atherosclerosis, their detection provides an opportunity to initiate further investigations and preventive measures.

Accuracy of the screening physical examination to identify subclinical atherosclerosis and peripheral arterial disease in asymptomatic subjects

This study assessed the accuracy of the screening vascular physical examination for predicting asymptomatic peripheral arterial disease (PAD) or subclinical atherosclerosis in asymptomatic and apparently healthy subjects. A standardized physical examination and a carotid and femoral ultrasonography were administered to 2736 men and women aged 20 to 90 years old, with no personal history of cardiovascular disease (CVD) and no complaint of neurologic, coronary, or lower limb symptom. We assessed the accuracy of auscultation for bruits and pulse palpation for identifying the presence of significant carotid stenosis, carotid plaque, femoral plaque, and ankle-brachial index (ABI) <0.9 at ultrasonography. The presence of a femoral bruit provided information on the presence of both an ABI <0.9 (positive likelihood ratio [+LR], 2.90; 95% confidence interval [CI], 1.63 to 5.16) and a femoral plaque (+LR, 3.23; 95% CI, 2.22 to 4.71), and this information was independent from the cardiovascular risk factors. The absence of both pedal pulses also provided additional information, beyond risk factors, on the presence of an ABI <0.9 (+LR, 3.57; 95% CI, 1.93 to 6.60). The presence of a carotid bruit did not affect the likelihood of carotid stenosis, plaque, or intima-media thickness above the median. Unlike carotid auscultation, pulse palpation and auscultation for femoral bruits provided valuable information on the presence of asymptomatic PAD and underlying atherosclerosis in apparently healthy subjects.

Carotid artery auscultation – anachronism or useful screening procedure?

Carotid bruits are supposed to indicate the presence of high-grade common carotid or extracranial internal carotid artery stenosis in a large proportion of patients. Using a stethoscope, we prospectively auscultated 273 carotid arteries of 145 patients blinded to the results of a complete extracranial and intracranial Doppler investigation including extracranial color-coded duplex ultrasound. Fifty-four arteries showed stenosis of ≥ 50%-99%, or occlusion of the extracranial internal or the common carotid artery. In 25 of these arteries, a bruit was present. In 9 out of 16 patients with extracranial stenosis from 70%-99%, a bruit was detected. In one additional patient with a middle-grade external carotid artery stenosis, a bruit was also present. In seven additional patients, a bruit was present in the absence of any carotid artery stenosis, cardiac vitium or goiter. The sensitivity of carotid auscultation for the detection of a 70%-99% stenosis of the common or extracranial internal carotid artery was 56% and specificity was 91%. The positive predictive value of a bruit found during carotid auscultation was 27%, and the negative predictive value of a normal auscultation was 97%. Carotid auscultation is a useful screening procedure in the detection of carotid stenosis or occlusion, but requires confirmation by carotid ultrasound.

Stroke: The Optometrist's Role

: The mechanisms of cerebrovascular insufficiency leading to stroke and transient ischemic attack (TIA) are outlined. Signs and symptoms of TIA are explained in terms of the cerebral and ocular territory supplied by the various cerebral arteries. The internal carotid artery in its cervical course is particularly liable to atherosclerotic lesions; these lesions cause TIA having ocular and general deficits with characteristic patterns of expression. It is suggested that carotid auscultation should form part of the optometric clinical routine provided for hypertensive and diabetic patients and all those 50 years of age and over. Management guidelines for patients at risk of stroke are outlined and a schematic diagram is provided to facilitate recognition of these subjects.