Let us assess this patient’s carotid arterial pulse located medial to the sternocleidomastoid in the neck. We’re analyzing upstroke, the peak, and the downstroke and, in this patient, it is readily felt. There is no question. It’s a bit of a bounding pulse, and then, to analyze the contour, let’s again use our cotton swab, we’ll place it on the vessel, and observe the tip of the swab to understand the contour.

I can readily feel, and the cotton swab reflects, a rapid upstroke…, two peaks – not one – two peaks in systole, and a rapid collapse, a downstroke that is enhanced. This may be a clue to a diagnosis in a patient with cardiac disease.