From the Research
In a patient with congestive heart failure (CHF), carotid arteries would typically demonstrate diminished pulse volume and intensity, with a reduced amplitude and force, and may exhibit pulsus alternans, pulsus parvus et tardus, or pulsus bisferiens due to altered hemodynamics, as supported by studies on the effects of CHF on arterial distensibility 1. The carotid pulse would feel weaker than normal, and upon auscultation, you might hear a pulsus alternans (alternating strong and weak beats) in severe CHF.
- The reduced cardiac output and stroke volume in CHF lead to decreased blood flow through the carotid arteries, resulting in these characteristic pulse abnormalities.
- The compromised cardiac function in CHF also leads to reduced arterial distensibility, which can be reversed with treatment, such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers 1. Some key points to consider when examining a CHF patient include:
- Correlating carotid findings with other clinical signs such as jugular venous distention, peripheral edema, and pulmonary congestion for a comprehensive assessment.
- Considering the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers to improve arterial distensibility and reduce morbidity and mortality in CHF patients 2. The most recent and highest quality study on this topic is from 2002, which found that CHF is characterized by a reduction of distensibility of large-elastic and middle-sized muscular arteries, and that this reduction can be reversed with treatment 1.