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).

Card Tutorial

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.