We shall now assess the arterial pulse, located just medial to the sternocleidomastoid. The carotid is normal in this case in upstroke, peak, and downstroke.

We can get an even better look by putting the cotton swab on the vessel and observing the contour as exaggerated a bit at the tip of the cotton swab. However, beware, just once in a while the arterial pulse may be normal, but there may be a factor enhancing it, and another one operative that’s reducing it. One example is a ventricle that’s volume loaded may have an enhanced carotid upstroke associated with it, but if that ventricle is compromised in terms of ejection fraction, its contractility, with some element of pump failure, that would tend to diminish the arterial pulse, they’ll balance out, so that the pulse, in a given case, could be normal, but there is significant pathophysiology occurring.