The carotid artery can be positioned close to the surface in some individuals. If a person doesnt have extensive fat tissue, and if the neck is held in certain positions its very easy to see the pulsations. Its just a variation of normal in almost all cases, with the rare rare exception of an aneurysm. In the neck your artery is located fairly deep under the tissus.If you are relatively thin, the pulse may be barely visible when you are at rest. The Veins which return blood to the heart are more superficial and some lie just beneath the skin. These vessels may be very visible as one ages and the skin sags a little. Veins do not have a pulse. Bulging neck veins and Visible pulsations WebMD Symptom Checker helps you find the most common medical conditions indicated by the symptoms bulging neck veins and visible pulsations including. Visible pulsations WebMD Symptom Checker helps you find the most common symptom combinations and medical conditions related to visible pulsations. Click on the combination that matches your symptoms to find the conditions that may cause these problems. If you are able to see your carotid artery pulse in your neck, you're likely quite thin. Rarely a prominent, pulsatile carotid artery in the neck is a.
After you measure the JVP, move on to assessment of the carotid pulse. The 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.
For irregular rhythms, see Table 3-10, Selected Heart Rates and Rhythms (p._), and Table 3-4, First overclocking tool for mac.
Selected Irregular Rhythms (p._).
To assess amplitude and contour, the patient should be lying down with the head of the bed still elevated to about 30°. 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 left index and middle fingers (or left thumb11) 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.
J^ll Although there is a widespread prejudice against using thumbs to assess pulses, they are useful for palpating large arteries.
Decreased pulsations may be caused by decreased stroke volume, but may also be due to local factors in the artery such as atherosclerotic narrowing or occlusion.
Pulsating Carotid Pulse
J^ll Although there is a widespread prejudice against using thumbs to assess pulses, they are useful for palpating large arteries.
Press just inside the medial border of a well-relaxed sternomastoid muscle, roughly at the level of the cricoid cartilage. Avoid pressing on the carotid sinus, which lies at the level of the top of the thyroid cartilage. For the left carotid artery, use your right fingers or thumb. Never press both carotids at the same time. This may decrease blood flow to the brain and induce syncope.
Slowly increase pressure until you feel a maximal pulsation, then slowly decrease pressure until you best sense the arterial pressure and contour. Try to assess:
Pressure on the carotid sinus may cause a reflex drop in pulse rate or blood pressure.
See Table 3-9, Abnormalities of the Arterial Pulse and Pressure Waves (p. __).
■ The amplitude of the pulse. This correlates reasonably well with the pulse pressure.
■ The 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.
■ Any variations in amplitude, either from beat to beat or with respiration.
Thrills and Bruits. During palpation of the carotid artery, you may detect humming vibrations, or thrills, that feel like the throat of a purring cat. Routinely, but especially in the presence of a thrill, you should listen over both carotid arteries with the diaphragm of your stethoscope for a bruit, a murmur-like sound of vascular rather than cardiac origin.
You should also listen for bruits over the carotid arteries if the patient is middle-aged or elderly or if you suspect cerebrovascular disease. Ask the patient to hold breathing for a moment so that breath sounds do not obscure the vascular sound. Heart sounds alone do not constitute a bruit.
Further examination of arterial pulses is described in Chapter 14, The Peripheral Vascular System.
The Brachial Artery. The carotid arteries reflect aortic pulsations more accurately, but in patients with carotid obstruction, kinking, or thrills, they are unsuitable. If so, assess the pulse in the brachial artery, applying e techniques described above for etermining amplitude and contour.
se the index and middle fingers or humb of your opposite hand. Cup
Small, thready, or weak pulse in cardiogenic shock; bounding pulse in aortic insufficiency (see p._).
Delayed carotid upstroke in aortic stenosis
Pulsus alternans, bigeminal pulse (beat-to-beat variation); paradoxical pulse (respiratory variation)
A carotid bruit with or without a thrill in a middle-aged or older person suggests but does not prove arterial narrowing. An aortic murmur may radiate to the carotid artery and sound like a bruit.
your hand under the patient's elbow and feel for the pulse just medial to the biceps tendon. The patient's arm should rest with the elbow extended, palm up. With your free hand, you may need to flex the elbow to a varying degree to get optimal muscular relaxation.
Continue reading here: The Heart
Pulsating Carotid Artery In Neck
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