Epistemis

Abdominal arterial murmurs (Bruit)

Specialty: Cardiovascular.

  • abdominal visceral murmurs
  • renal artery or aorta murmur

Why it occurs

  • Renal artery stenosis (cause of renovascular hypertension)
  • Abdominal aortic aneurysm with turbulent flow
  • Stenosis of the superior mesenteric artery or celiac trunk
  • Abdominal or retroperitoneal arteriovenous malformation
  • Hypervascularized liver tumor (such as hepatocellular carcinoma, which auscultates a liver murmur)
  • Compression of the celiac artery by the middle arcuate ligament

Initial workup

Doppler ultrasound of the kidney and mesenteric vessels to measure the peak systolic velocity of the renal artery (>200 cm/s) and the renal/aortic ratio (>3.5, indicative of significant stenosis >60%); Computed tomography angiography (CT-Angio) of the abdomen and pelvis to anatomically evaluate the presence of atheromatous plaques in the aorta and visceral branches, calcifications or fibromuscular dysplasia; Determination of kidney function (creatinine, GFR) and serum electrolytes.

red flags

Audible systolic or holodiastolic abdominal murmur in the epigastrium, mesogastrium or flanks, associated with severe arterial hypertension refractory to medical treatment (especially if it has a sudden onset in young or elderly people and requires >=3 drugs), sudden deterioration in renal function after the start of an ACEI or ARB, intense postprandial abdominal pain with marked weight loss, or presence of a pulsatile abdominal mass painful These signs warn of critical renal artery stenosis, mesenteric ischemia, or expanding aortic aneurysm.

Standard management

  • Acetylsalicylic acid — antiplatelet agent indicated to prevent ischemic events in atherosclerotic stenosis; 100 mg per day orally
  • Atorvastatin — statin for lipid control and stabilization of arterial atheroma plaque; 40 mg once daily orally
  • Enalapril — ACEI indicated as first choice for the control of renovascular hypertension if the stenosis is unilateral, but strictly CONTRAINDICATED if the renal artery stenosis is bilateral or in a single kidney, due to the risk of anuric acute renal failure; 5 to 10 mg per day orally
  • Amlodipine (useful and safe calcium antagonist for blood pressure control in bilateral renal stenosis; 5 to 10 mg once a day orally).

Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.

PreviousRough systolic ejection murmur (Jet murmur)
Area
Cardiovascular
Listed causes
6
Treatment options
4
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