Cardiac Diagnosis from Examination of Arteries and Veins

Distinction between Arterial and Venous Pulsation TH E examiner may acquire much valuable information pertaining to cardiac diagnosis by careful inspection of the major vessels in the neck with proper tangential lighting. It is important that the quick-rising carotid arterial pulsations be not confused with the more gradually rising internal jugular venous pulsations, which also originate beneath the sternocleidomastoid muscle. Distinction between the two may be made in the following manner. The carotid arterial pulse is single; ordinarily two or three venous pulse waves can be seen with each cardiac cycle. Internal jugular venous pulsations are readily obliterated by light pressure over the sternomastoid muscle just above the medial end of the clavicle, whereas carotid arterial pulsations are unaffected. Venous pulsations can be altered by changing the position of the patient. The veins usually become more distended as the patient lies in a horizontal position and less distended as he sits upright. If the venous pressure is low, or normal, the venous pulsations are more evident when the patient is lying flat. In general, with higher venous pressures, the venous pulse is best seen with the patient more upright. If the venous pressure is elevated because of congestive heart failure, sustained abdominal compression will cause the venous pressure to rise and the venous pulsations to ascend higher in the neck.