Is this patient’s central venous pressure normal and what is the wave form of the venous impulse? Well, we locate the venous impulse, the inferolateral aspect of the sternocleidomastoid, undulating just a bit below the sternal angle. A normal central venous pressure.

Then we analyze the contour of that venous impulse, and to do so, we get help from the timing mechanism of the carotid arterial pulse, that tells us when systole is occurring. We look at the venous impulse and we see a wave just prior to the carotid impulse, and that’s a little bit bigger than the second venous impulse, a little bit smaller and just after the carotid arterial impulse. Hence, we have a normal venous wave form with a wave just prior to systole and another smaller one just after systole.