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Transmitted murmurs in patients undergoing hemodialysis
1Department of Medicine, University of Pittsburgh, PA 15261.
Archives of Internal Medicine
|June 1, 1989
Summary
Bruits from hemodialysis vascular access can be heard in the neck and chest. Fistula compression helps differentiate these transmitted sounds from cardiac murmurs, aiding accurate diagnosis.
Area of Science:
- Vascular Surgery
- Nephrology
- Cardiology
Background:
- Vascular access is crucial for hemodialysis.
- Bruits can be auscultated over vascular access sites.
- Understanding bruit transmission is important for diagnosis.
Purpose of the Study:
- To investigate the transmission patterns of bruits from hemodialysis vascular access.
- To determine if the location of vascular access influences bruit transmission.
- To evaluate the utility of fistula compression in differentiating transmitted bruits from cardiac murmurs.
Main Methods:
- Forty patients undergoing hemodialysis were prospectively studied.
- Bruits were auscultated over vascular access sites (forearm and upper arm).
- The transmission of bruits to the chest and neck was documented. Fistula compression was performed as a diagnostic maneuver.
Main Results:
- Bruits from forearm access were localized to the ipsilateral clavicular and cervical regions.
- In 80% of patients with upper arm access, bruits transmitted to the sternal edge.
- Fistula compression effectively distinguished transmitted vascular bruits from cardiac murmurs.
Conclusions:
- The location of hemodialysis vascular access influences the transmission of audible bruits.
- Upper arm access is associated with a higher incidence of bruit transmission to the sternal edge.
- Fistula compression is a valuable bedside technique for differentiating transmitted vascular bruits from cardiac murmurs, improving diagnostic accuracy.