Loyola University Medical Education Network Patient Centered Medicine 2
December 1, 2012

Harvey Session - Carotid Pulses, Neck Veins, Precordial impulses
Michael Koller, MD

Harvey Workshop (Optional) - Carotid Pulses, Neck Veins, Precordial impulses

Workshop: Saturday, 10:00a.m. - 4:00 p.m., Conference  (LL50),  Cardiopulmonary Patient Simulator
 Group of 4 students, in 10 minute blocks
Reading Assignment
Bates' guide to Physical Examination and History Taking:
    10 Edition,Jugular Venous Pulsations pp. 336, 351-2

Key Concepts and Learning Objectives

  1. Identify by palpation the following types of carotid artery pulsations
    a. Normal carotid pulse
    b. Pulsus Tardus et Parvus with Aortic Stenosis
    c. Bounding carotid pulse as with Acute Mitral Regurgitation
    d. Hypodynamic (weak) carotid pulse from low cardiac output
    e. Bisfriens carotid pulse as with Chronic Aortic Regurgitation and Hypertrophic Cardiomyopathy

  2. Identify by inspection
    a. Normal jugular venous pulsations with "a" wave larger than "v" wave
    b. Canon "a" waves as with pulmonic stenosis and pulmonary HTN
    c. Large "v" wave as with tricuspid regurgitation
  3. Identify by palpation
    a. Normal location and size of point of apical impulse
    b. Dustained apical impulse
    c. Laterally displaced apical impulse
    d. Parasternal lift
    e. Left Ventricle S3 and S4
    f. Right ventricle S4
    g. Laterally displaced PMI #17
  4. Identify delayed and weak femoral pulse with aortic coarctation



Last Updated: 11/20/12
Created: 08/24/1998