Physical examination maneuver

Physical Exam

Carotid Artery Palpation

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Video coming September 2026

How to Perform

With the patient's neck relaxed, gently palpate one carotid artery at a time, low in the neck (medial to the sternocleidomastoid, below the thyroid cartilage to avoid the carotid sinus). Assess the pulse's amplitude, contour, and rate of upstroke relative to the apical impulse or heart sounds; never compress both carotids at once.

How to Interpret

Aortic Dissection

Asymmetric carotid pulses on bedside palpation

Rule in

Somewhat helpful

Rule out

—

Evidence:Limited

Diminished or absent carotid pulse on bedside palpation

Rule in

Somewhat helpful

Rule out

—

Evidence:Limited

Aortic Stenosis

Slow-rising (parvus et tardus) carotid pulse

Rule in

Helpful

Rule out

Somewhat helpful

Evidence:Strong

Takayasu Arteritis

Asymmetric carotid pulses

Rule in

Helpful

Rule out

—

Evidence:Limited

Diminished or absent carotid pulse

Rule in

Helpful

Rule out

—

Evidence:Limited

References

Ohle R, Kareemi HK, Wells G, Perry JJ. Diagnosing acute aortic syndrome: a systematic review with meta-analysis. Acad Emerg Med. 2018;25(4):397-412. PMID: 29265487.
Azoyan L, et al. Diagnostic accuracy of clinical findings for Takayasu arteritis: a rapid review and meta-analysis. Int J Vasc Med. 2025. PMID: 40963697.
Azoyan L, et al. Diagnostic Accuracy of Clinical Findings for Takayasu Arteritis: A Rapid Review and Meta-Analysis. Int J Vasc Med. 2025;2025:6092362. PMID 40963697.
Shellenberger RA, Crass S, Jevicks J, Badhwar A, Albright J, Kumar A. Bedside Physical Examination for the Diagnosis of Aortic Stenosis: A Systematic Review and Meta-analysis. CJC Open. 2023;5(5):373-379. doi:10.1016/j.cjco.2023.02.007. PMID: 37377515; PMCID: PMC10290951.
McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.

Related Diagnoses

Aortic Dissection Aortic Regurgitation Aortic Stenosis Carotid Artery Stenosis Carotid Dissection Hyperdynamic State Hypertrophic Cardiomyopathy with Obstruction Mixed Aortic Valve Disease Severe Left Ventricular Dysfunction Takayasu Arteritis

Related Chief Complaints

Abdominal Pain Anxiety Arm Claudication Arm Fatigue with Use Arm Pain Back Pain Balance Problems Chest Discomfort Chest Pain Chest Pressure Chest Tightness Chills Cold Extremities Confusion Cough Diarrhea Difference in Arm Blood Pressure Difficulty Speaking Difficulty Walking Dizziness Double Vision Drooping Eyelid Epigastric Pain Exercise Intolerance Exertional Chest Pain Exertional Dyspnea Facial Droop Fatigue Fever Flushing Headache Heart Murmur Heat Intolerance Incidental Finding Jaw Pain Leg Swelling Lightheadedness Nausea Neck Bruit Neck Pain Neck Swelling Night Sweats Numbness on One Side Orthopnea Pain Radiating to the Back Palpitations Paroxysmal Nocturnal Dyspnea Pounding Heartbeat Shortness of Breath Slurred Speech Small Pupil Sudden Vision Loss Sweating Syncope Tearing Chest Pain Transient Numbness Transient Vision Loss Transient Weakness Tremor Vision Changes Warmth Weakness Weakness on One Side Weight Gain Weight Loss Wheezing

Related Systems / Regions

Cardiovascular Neck

Related Bedside Tests

🎬Video coming Sept 2026

Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more

Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more

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Cardiac Auscultation

Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more

Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more

🎬Video coming Sept 2026

Point of Maximal Impulse

aka Apical impulse; apex beat

Rule in:VHLeft Ventricular Dilation, HLeft Ventricular Hypertrophy, SHCardiomegaly +7 more

Rule out:VHLeft Ventricular Dilation, SHLeft Ventricular Hypertrophy, MHCardiomegaly +7 more

🎬Video coming Sept 2026

Brachial Artery Palpation

Rule out:VHAortic Stenosis

🎬Video coming Sept 2026

Carotid Artery Auscultation

Rule in:SHCarotid Artery Stenosis

Rule out:MHCarotid Artery Stenosis

🎬Video coming Sept 2026

Rule in:HAtrial Fibrillation, SHHypothyroidism, SHPneumonia +7 more

Rule out:VHAtrial Fibrillation, MHAdverse Short-term Outcome in Confirmed Pulmonary Embolism, IECardiac Tamponade +5 more