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The Carotid Pulse

Terms in this set (9)

carotid pulse
provides valuable information about cardiac function and is especially useful for detecting stenosis or insufficiency of the aortic valve. Take the time to assess the quality of the carotid upstroke, its amplitude and contour, and presence or absence of any overlying thrills or bruits.
Assess amplitude and contour
the patient should be lying down with the head of the bed elevated to about 30 degrees. When feeling for the carotid artery, first inspect the neck for carotid pulsations. These may be visible just medial to the sternomastoid muscles. Then place your index and middle fingers (or left thumb) on the right carotid artery in the lower third of the neck, press posteriorly, and feel for pulsations.

A tortuous and kinked carotid artery may produce a unilateral pulsatile bulge.
amplitude of the pulse
This correlates reasonably well with the pulse pressure.
Small, thready, or weak pulse occurs in cardiogenic shock; bounding pulse in aortic insufficiency
contour of the pulse wave
namely the speed of the upstroke, the duration of its summit, and the speed of the downstroke. The normal upstroke is brisk. It is smooth, rapid, and follows S1 almost immediately. The summit is smooth, rounded, and roughly midsystolic. The downstroke is less abrupt than the upstroke.

The carotid upstroke is delayed in aortic stenosis
The timing of the carotid upstroke in relation to S1 and S2
Note that the normal carotid upstroke follows S1 and precedes S2. This relationship is very helpful in correctly identifying S1 and S2, especially when the heart rate is increased and the duration of diastole, normally shorter than systole, is shortened and approaches the duration of systole.
Pulsus Alternans
the rhythm of the pulse remains regular, but the force of the arterial pulse alternates because of alternating strong and weak ventricular contractions. Pulsus alternans almost always indicates severe left-sided heart failure and is usually best felt by applying light pressure on the radial or femoral arteries. Use a blood pressure cuff to confirm your finding. After raising the cuff pressure, lower it slowly to the systolic level. The initial Korotkoff sounds are the strong beats. As you lower the cuff, you will hear the softer sounds of the alternating weak beats.
Paradoxical Pulse.
This is a greater than normal drop in systolic pressure during inspiration. If the pulse varies in amplitude with respiration or you suspect pericardial tamponade (because of increased jugular venous pressure, a rapid and diminished pulse, and dyspnea, for example), use a blood- pressure cuff to check for a paradoxical pulse. As the patient breathes quietly, lower the cuff pressure to the systolic level. Note the pressure level at which the first sounds can be heard. Then drop the pressure very slowly until sounds can be heard throughout the respiratory cycle. Again note the pressure level. The difference between these two levels is normally no greater than 3 or 4 mm Hg.

The level identified at first hearing Korotkoff sounds is the highest systolic pressure during the respiratory cycle. The level identified at hearing sounds throughout the cycle is the lowest systolic pressure. A difference between these levels of more than 10 mm Hg indicates a paradoxical pulse and suggests pericardial tamponade, possible constrictive pericarditis, but most commonly obstructive airway disease
Thrills and Bruits.
As you palpate the carotid artery, you may detect humming vibrations, or thrills, like the throat vibrations in a cat when it purrs.

Although usually caused by atherosclerotic narrowing of the internal carotid artery, bruits can also arise from a tortuous carotid artery with intraluminal turbulence, external carotid arterial disease, aortic steno- sis, the hypervascularity of hyper- thyroidism, and external compression from thoracic outlet syndrome.
The Brachial Artery
In patients with carotid obstruction, kinking, or thrills, assess the pulse in the brachial artery, applying the techniques described previously for determining amplitude and contour."
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