Transmitted murmurs in patients undergoing hemodialysis.

Forty patients undergoing hemodialysis were examined for bruits transmitted from the vascular access arm. In patients with forearm access, the bruits were localized to the clavicular and cervical regions on the same side. However, transmission to the sternal edge was noted in 8 of 10 patients with upper arm access. Compression of the fistula is a useful maneuver that allows the clinician to distinguish transmitted murmurs from those arising in cardiac valves.