The Sound of Heart Trouble Brewing?
Noise picked up via stethoscope may tell more than risk for stroke

(HealthDay News) -- A particular sound that a doctor can hear through a stethoscope just might signal heart trouble.

Called a "carotid bruit" (pronounced brew-ee), the noise is caused by turbulent blood flow in the main artery to the brain. It's traditionally considered a sign of heightened risk for a stroke, but evidence now indicates that it might also indicate problems with the heart.

Researchers analyzed 22 studies involving 17,295 people who were followed for an average of four years and found that those with carotid bruit were more than twice as likely to have a heart attack or die of cardiovascular disease.

"The presence of a carotid bruit should heighten clinical concern for coronary heart disease," physicians at Walter Reed Army Medical Center in Washington , D.C. , reported in The Lancet .

The carotid arteries are a pair of blood vessels that run along either side of the neck. The so-called internal carotid arteries supply oxygen-rich blood to the brain, according to the U.S. National Heart, Lung, and Blood Institute. (The external carotid arteries supply the face, scalp and neck.)

The Journal of the American Medical Association , in one of its patient education articles, said that a carotid bruit could be a sign of carotid artery disease. The condition, in which fatty plaque accumulates in the carotid arteries, can lead to stroke.

And, a literature review conducted by researchers in the United Kingdom concluded that carotid bruit is a good indicator of carotid artery stenosis, or narrowing of the carotid arteries. A carotid bruit might indicate systemic atherosclerosis, or hardening of the arteries, due to plaque build-up over time, they said. In addition, carotid bruits are associated with a higher prevalence of vascular risk factors. The report appeared in the journal Neurological Research .

Just how clinicians might use this piece of diagnostic information, though, remains unclear. But some say the presence of carotid bruit may prompt doctors to take more forceful action to modify people's cardiovascular risks.

"The [study authors'] recommendation that they be even more aggressive with risk modification, that is good clinical judgment," former Cleveland Clinic cardiologist Dr. Deepak Bhatt, now chief of cardiology at the VA Boston Healthcare System and director of the integrated interventional cardiovascular program at Brigham and Women's Hospital and the VA system, told HealthDay .

According to the Radiological Society of North America, someone who has a carotid bruit may be referred for carotid ultrasound, a noninvasive imaging procedure that captures detailed pictures of the carotid arteries. Carotid ultrasound also might be performed, it said, if the person is older or has advanced diabetes, elevated blood cholesterol or a family history of stroke or heart disease.

On the Web

To learn more about heart disease risk factors, visit the American Heart Association.

SOURCES: HealthDay News ; Deepak Bhatt, M.D., M.P.H., chief of cardiology, VA Boston Healthcare System, and director, integrated interventional cardiovascular program, Brigham and Women's Hospital and VA system, Boston; May 10, 2008, The Lancet ; Sept. 23/30, 1998, Journal of the American Medical Association ; June 2008, Neurological Research ; National Heart, Lung, and Blood Institute, Bethesda, Md.; Radiological Society of North America (www.radiologyinfo.org)
Author: Karen Pallarito
Publication Date: May 31, 2009
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