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I have a desktop with a Sapphire Radeon HD 4850 (512mb) video card, which is a few years old.

It works like a champ, but the shoddy fan that came with the card has started to sound like a lawnmower! I tried blowing dust out of the fan with some compressed air (even getting between the flutes of the heatsink), but no improvement. I took the heatsink/fan completely off and reseated it as well in case it was a rattle issue due to a loose screw, but again no dice.

How easy is it to replace this sort of thing? I don't want to buy a new card, since the existing card is still working fine. But I have had trouble finding an exact match for the stock heatsink/fan.

What do I need to know to choose a good third party solution?

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Not very easy, but doable. Unlike processors, video cards don't really have standard heatsink mount formfactors or fan formfactors. Unless you're going for a really fancy cooler, its probably not worth replacing the heatsink (which is probably going to be a LOT of work to remove).

Replacing the fan should be fairly trivial, and is probably the smartest way to go about it. The fan dosen't need thermal contact with anything (unlike your heatsink), is probably held together by 2-3 screws and should be easily swapped. Its one of those things a local shop may be better at. You need to find the size of the fan and simply replace it. You'd also want to find a fan with the same number and position of screws (I've seen 3 and 4 hole fans) and the same size - apparently the measurement techniques used on case fans may work here too, though its worth looking at @synetech's answer as well as this question since they deal specifically with video card fans. You'd also want to see if its a conventional fan(with radial blades) or a blower fan - Yours looks like a standard one.

The specific component you are looking for when replacing a fan is a VGA fan - looking that up on your favourite online retailer should probably get you started. They also may have heatsink kits, but as I mentioned, its probably not worth the effort.

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For the record, the entire heatsink assembly had to be removed and disassembled in order to remove the fan. I found the part number of the fan and ordered a replacement from Hong Kong, since I couldn't find any in the US. That fixed the problem. – Nathan Feb 26 '13 at 18:54

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