From the Guidelines
Hearing heart sounds on the neck is often pathological and warrants further investigation to determine the underlying cause. Normally, heart sounds are not prominently audible in the neck. If heart sounds, particularly murmurs, are clearly heard in the neck vessels, this often indicates significant cardiovascular pathology. For example, aortic stenosis can produce a harsh systolic murmur that radiates to the carotid arteries, while aortic regurgitation may cause a diastolic murmur heard along the left sternal border that can sometimes be detected in the neck. Venous hums from increased or turbulent blood flow through the jugular veins may also be heard in the neck, which can occur in conditions like hyperdynamic circulation, anemia, or thyrotoxicosis. Additionally, bruits heard in the neck suggest carotid artery stenosis, which is a risk factor for stroke. When examining a patient with audible heart sounds in the neck, a complete cardiovascular assessment is warranted, including echocardiography and possibly carotid ultrasound, to identify the underlying cause and determine appropriate management, as recommended by the ACC/AHA guidelines 1. Some key points to consider in the assessment include:
- The characteristics of the murmur, such as its timing, pitch, and radiation
- The presence of symptoms or signs of heart failure, myocardial ischemia/infarction, syncope, thromboembolism, infective endocarditis, or other clinical evidence of structural heart disease
- The grade of the murmur, with grade 3 or louder midpeaking systolic murmurs warranting further evaluation 1. It is essential to prioritize a thorough evaluation to determine the underlying cause of audible heart sounds in the neck, as this can have significant implications for morbidity, mortality, and quality of life. The most recent guidelines from the ACC/AHA 1 provide a framework for the assessment and management of patients with valvular heart disease, including those with murmurs that radiate to the neck or back. By following these guidelines and prioritizing a comprehensive cardiovascular assessment, clinicians can provide optimal care for patients with audible heart sounds in the neck and improve outcomes.
From the Research
Hearing Heart Sounds on the Neck
Hearing heart sounds on the neck can be a normal phenomenon, as heart sounds can be detected on the neck skin surface in healthy individuals 2.
Pathological Conditions
However, certain pathological conditions of the cardiovascular system can cause murmurs and aberrations in heart sounds, which can be detected through phonocardiography 3.
Detection and Analysis
Studies have shown that signal processing and wavelet analysis can be used to quantify the distribution of amplitude and frequency content of heart sounds for diagnostic purposes 3, 4.
Key Findings
- Heart sounds can be detected on the neck skin surface in healthy individuals using a contactless, machine-learning assisted method 2.
- Signal processing and wavelet analysis can distinguish between normal and abnormal heart sounds 3, 4.
- Mean frequency can be used to discriminate between healthy and unhealthy heart sounds 4.
- Automatic segmentation and feature extraction methods can be used to analyze heart sounds and detect cardiac disorders 5, 6.
Detection Methods
Different methods have been proposed for detecting and analyzing heart sounds, including: