Let us begin by determining our patient’s blood pressure. I shall place the stethoscope over the brachial artery, inflate the cuff exceeding the systolic pressure, and then we shall slowly deflate it observing the sphygmomanometer. Let’s watch.
Discussion
Our patient's blood pressure is 150/100 mmHg. He had been told he had hypertension in the past. It is therefore likely that this single blood pressure level reflects significant systemic hypertension. Additional determinations should be obtained to confirm this diagnosis. Hypertension is a major risk factor for coronary artery disease.
Carotid arterial pulse
Let us next evaluate our patient’s carotid arterial pulse, located just medial to the sternocleidomastoid in the neck. When i put light pressure on the vessel, I feel that impulse to be normal. Let’s share that by my placing a cotton swab on the vessel and watching the excursion of the tip of that swab. [cut-away]
The normality of our patient’s carotid arterial vessel is expected. In most patients with angina pectoris, that will be the case. Just once in a while, however, the carotid arterial pulse could be abnormal and be a clue to an unusual cause of angina pectoris. For example, with left ventricular outflow tract obstruction at the valve level, you may feel an arterial pulse that is small in amplitude and late rising. In addition, if the obstruction is muscular on the left side and below the valve, you may have a rapid rising arterial pulse and occasionally it may be bifid. So, we found the expected. But carefully examine that carotid pulse for a clue to an unusual diagnosis.