title: Can a transient exertion-related carotid (TERC) murmur heard during a symptom-limited exercise test be used as a means for managing sports concussion?
abstract: We hypothesize that a transient exertion-related carotid (TERC) murmur flow murmur similar in nature to a "bruit" heard best at the carotid artery during exercise in healthy individuals can be used as a means for assessing post-concussion injury exertion tolerance. Typically there are no arterial sounds heard at the carotid artery in healthy individuals. Bruit, heard at rest, is an indicator of cardiovascular disease. Listening for a flow murmur or bruit-like sounds during exercise may indicate brain blood flow autoregulation and that this audible change in brain blood flow autoregulation could be used to assess exercise tolerance. We present very preliminary evidence supporting our hypothesis in that a transient exertion-related carotid (TERC) murmur is heard at a HR (HR) of approximately 150 beats per minute (bpm) in healthy individuals and 120bpm in concussion patients. Future prospective clinical studies to validate this hypothesis and these methods may aid clinicians who manage concussion patients by using this method to help guide exertion protocols.
authors.affiliation: Departments of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH, USA. Electronic address: joseph.clark@uc.edu.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Clark
authors.affiliation: Division of Interventional Pulmonology, Department of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, OH, USA.
authors.forename: Danielle N
authors.initials: DN
authors.lastname: Caudell-Stamper
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, OH, USA.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Dailey
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, OH, USA.
authors.forename: Jon G
authors.initials: JG
authors.lastname: Divine
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000628:therapy*; D001314:Auscultation / Q000379:methods*; D001924:Brain Concussion / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000503:physiopathology; D002339:Carotid Arteries / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D005080:Exercise Test; D017079:Exercise Tolerance; D006337:Heart Murmurs / Q000175:diagnosis*; D006439:Hemodynamics; D006801:Humans; D005082:Physical Exertion; D013177:Sports; D055815:Young Adult