Carotid Pulse

The jugular venous pulse must be distinguished from the carotid pulse. There are important differences between arterial and venous pulses that allows the examiner to distinguish them at the bedside. The normal carotid arterial pulse is characterized by a single peak that is quick and sharp. Following the peak, the skin subtly recedes back to its former position until the next pulse occurs, but there is no obvious or aggressive inward movement. The pulse is confined to a smaller area of the neck than the jugular venous pulse. The arterial pulse is unaffected by patient positioning, respiratory cycle, or abdominal pressure (abdominojugular reflux). It is easily palpable with a finger (we prefer to use the thumb).

 

Patient 1:

This patient was admitted to the hospital for an unrelated condition and was noted to have a normal carotid pulse visible at the bedside. While the normal carotid pulse is typically palpable, not all are visible. Hyperdynamic states (e.g., sepsis) can make the pulse visible. These videos demonstrate the typical features of an arterial pulse.

Normal Carotid Pulse

Annotated

Narrated

Patient 2:

This is a young woman with cystic fibrosis who was admitted for an exacerbation. She was noted to have a visible normal carotid pulse.

Normal Carotid Pulse

Patient 3:

This is a middle-aged woman who was admitted to the hospital with heart failure with preserved systolic function. She has a normal visible carotid pulse.

Patient 4:

This is an older woman with metastatic carcinoid syndrome who developed infective endocarditis of the tricuspid and aortic valves. She has an easily visible arterial pulse in the neck; note the single outward pulsation that is quick and sharp.

This patient also has an S4 gallop.

Patient 5:

This is an older woman admitted to the hospital for biliary obstruction from pancreatic cancer, found to have simultaneously visible arterial and venous pulses in the neck.