The Rational Clinical Examination
David L. Simel, Drummond Rennie
Carotid Bruit
David L. Simel, Larry Goldstein
Clinical Scenario
Topics Discussed:
carotid bruit
Excerpt:
"A 65-year-old woman returns to your office to review her home
blood pressure recordings. She frequently has a systolic pressure
of approximately 130 to 145 mm Hg. While examining her, you slip the
stethoscope onto her neck and hear a focal, unilateral bruit. The
patient notices a change in your facial expression while you are
listening to her neck, so she asks, "Did you hear something?" You tell
her you heard a "squeaky noise" and then immediately
wonder whether she (or you) needed that information. You realize
you need to know whether the presence of a bruit suggests that the patient
might have a carotid stenosis severe enough to warrant a surgical
evaluation. She reminds you that her father, after being healthy
all his life, had a stroke when he was 72 years old. ..."
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