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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