The very fact that I had some difficulty feeling our patient’s carotid arterial pulse tells us something. In addition, when I placed my finger on the pulse, the upstroke is a bit slow, and we confirmed that together. By using the cotton swab and placing it on the vessel we observed that the tip of that cotton swab had a reduced excursion during each systole.
There is a message to this, and it also fits well with what we observed in the blood pressure. You’ll recall the blood pressure was a bit on the low side and the pulse pressure was also a bit on the low side.
Normal vs. Hypokinetic Graphics
By comparing the graphic of a normal patient to our patient, we can appreciate that our patient’s carotid arterial pulse has a small amplitude. The decreased amplitude of the hypokinetic arterial pulse may reflect a decreased stroke volume during left ventricular contraction. This, in turn, can be related to a decreased preload, or filling volume, or poor left or right ventricular function. A small, or hypokinetic pulse, may also be present with outflow tract obstruction.