Question re: cardiovascular physical exam

[DoctorWannaBe]

I am going to be tested on the cardiac physical exam tomorrow, and have a couple of questions. I am expected to palpate/auscultate the carotid artery and note whether the carotid pulse upstroke and carotid pulse contour are normal or abnormal. Can someone explain what the upstroke and contour are and what I would do to determine if they are normal or abnormal? Thanks in advance!

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[trudub]

I am going to be tested on the cardiac physical exam tomorrow, and have a couple of questions. I am expected to palpate/auscultate the carotid artery and note whether the carotid pulse upstroke and carotid pulse contour are normal or abnormal. Can someone explain what the upstroke and contour are and what I would do to determine if they are normal or abnormal? Thanks in advance!

Generally you want to palpate the carotid pulse and just feel for abnormality, a very wide feeling pulse can be a sign of aneurysm though fairly rare in the carotid artery. Probably more important is auscultating the carotid pulse for bruits which sound like a loud whooshing noise. Auscultate the carotid and have someone take a deep breath, that sound is what a bruit sounds like. The next step is to note the carotid upstroke. What you should do is auscultate the heart while you palpate one of the carotids. The carotid impulse should be felt on your hand very shortly after you heart the heart beat on auscultation and it should be a fairly brisk feeling upstroke. The purpose for checking this is to check to see if the carotid pulse shows pulsus parvus et tardus which means that the carotid pulse is weak and late. Pulsus parvus et tardus can be a sign of aortic stenosis. Hope this helps.

 

[DoctorWannaBe]

Thanks so much for the explanation. My notes didn't explain the upstroke. Can you tell me what the contour is also?