Dynamic vascular auscultation.

Dynamic auscultation, defined as physiologic or pharmacologic maneuvers that alter cardiovascular sounds in predictable ways, is increasingly practiced in cardiac physical diagnosis. Dynamic maneuvers applicable to peripheral arterial sounds have also been described and deserve wider application since arterial occlusive disease is encountered frequently. These little-known maneuvers alter blood flow into and away from a critical stenosis, as well as flow through side branch arteries, thus allowing the examiner to accentuate and localize arterial bruits by modifying their intensity and duration. In this review, the pathophysiology of bruit production is applied to a description of specific bruit manipulations useful in the neck, chest, abdomen, and extremities. Application of these dynamic maneuvers during vascular auscultation should allow more discriminating use of subsequent expensive or invasive diagnostic procedures.