Page 110 - Clinical Pearls in Cardiology

98 Clinical Pearls in Cardiology

hyperthyroidism, due to the hyperdynamic cardiac
motion. This is called as the Means-Lerman scratch.
21. Where will you auscultate for renal bruit in suspected
cases of renovascular hypertension?
Renovascular hypertension is suspected when the onset
of hypertension occurs before the age of 30 or when
previously stable hypertension becomes more difficult
to control. Vascular occlusive disease usually occurs at
the ostium of the renal artery or in the proximal third of
the vessel. The renal arteries are not audible in health.
In patients who have renal artery stenosis, you may be
able to hear a bruit about 5 cm away from the umbilicus
at 10 o’clock and 2 o’clock positions (Fig. 8).

Fig. 8: Sites for auscultating renal bruit