To evaluate the venous impulse, one must first, of course, identify the impulse in the neck, located at the inferolateral aspect of the sternocleidomastoid muscle. There we see that undulating movement, and it is occurring a bit below the sternal angle, hence, this is a normal central venous pressure. Then, we evaluate the wave form, using a timing mechanism from the carotid. We place the cotton swab on the carotid to get our timing mechanism, and we can clearly see that there is a larger wave just before the carotid impulse, a slightly smaller wave just after.

These are the normal “a” and “v” waves. [Cut-Away]