Next, we evaluate the venous impulse, both the mean pressure and the wave form. We identify the sternal angle here that will assist us in assessing the venous pressure, and we note that the venous impulse per se is located here on the inferolateral aspect of the sternocleidomastoid, just a bit below the sternal angle. And now, we analyze the contour of that impulse. To do that, we get help from a timing mechanism, that is, the carotid impulse. We place a cotton swab over that impulse, and by so doing, we can then time the venous impulse against systole as reflected by the carotid impulse.