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Signs
 
 

Abnormal Carotid Pulse Character

 
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Overview

Palpation of the carotid arteries in the neck is used to assess for the strength and character of the pulse - these cannot be adequately assessed by palpating the radial pulse.
  • How to Assess

  • Palpate the common carotid arteries, located in the anterior neck medial to the sternocleidomastoid. Palpate the arteries one at a time. Care should be taken to avoid stimulating the carotid sinus.

Amplitude

Bounding pulse - strong, sustainedHypertension, hypermetabolic states
Waterhammer / collapsing pulse: strong pulse with sudden collapse.Aortic regurgitation, patent ductus arteriosus
Pulsus tardis & parvis: weak pulse with a delayed systolic peakAortic stenosis
Plateau pulse: slow upstrokeAortic Stenosis
Anacrotic pulse: small volume pulse with slow upstroke and a notched wave on the upstrokeAortic Stenosis
Pulsus alternans: regular alternation between strong and weak beatsLeft ventricular failure

Contour

Rapid rate of risePremature ventricular contraction, mitral regurg, VSD, aortic regurgitation, HOCM
Slow rate of rise Aortic stenosis
Bisferiens pulse (double beating pulse)Aortic regurgitation
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