cardiovascular disorders
Cardiovascular Examination
Pulses
Major peripheral pulses in the arms and legs are palpated for symmetry and volume (intensity). Elasticity of the arterial wall is noted. Absence of pulses may suggest an arterial disorder (eg, Atherosclerosis ) or systemic embolism. Peripheral pulses may be difficult to feel in people with obesity or in those who are muscular. The pulse has a rapid upstroke, then collapses in disorders with a rapid runoff of arterial blood (eg, arteriovenous communication, Observation, palpation, and auscultation of both carotid pulses may suggest a specific disorder (see table Carotid Pulse Amplitude and Associated Disorders ). Aging and arteriosclerosis lead to vessel rigidity, which tends to eliminate the characteristic findings. In very young children, the carotid pulse may be normal, even when severe aortic stenosis is present. Auscultation over the carotid arteries can distinguish murmurs from bruits. Murmurs originate in the heart or great vessels and are usually louder over the upper precordium and diminish toward the neck. Bruits are higher-pitched, are heard only over the arteries, and seem more superficial. An arterial bruit must be distinguished from a venous hum. Unlike an arterial bruit, a venous hum is usually continuous, heard best with the patient sitting or standing, and is eliminated by compression of the ipsilateral internal jugular vein. 