Feeling and seeing a pulse in notch between collarbones? Is this normal?

September 28, 2010 1:42 PM

I happened to stumble upon several health articles yesterday that mentioned that young, normal people should not feel a pulse in the little notch between your collarbones at the base of the neck. However, I can definitely feel a pulse in this area.

When I look into the mirror, I can also see the area slightly pulsating in time with my heartbeat. I'm 27 years old and I haven't had any health problems that I know of. I do have scoliosis though so I wonder if that has anything to do with it. I've never had any major treatment regarding scolosis, and I don't have a regular doctor.

I'm wondering if any of you can feel a pulse in that area. Not sure if I should be concerned or if I should make a dr appt. I'm concerned b/c this pulse could be a sign of aortic problems according to the article (aneurysms, tortuosity, etc).

posted by starpoint to health & fitness (19 answers total)

I'm 23 and healthy (or at least thought I was until reading this question), and I can feel a pulse there.
posted by oinopaponton at 1:46 PM on September 28, 2010

I can too, if I press hard enough. The carotid artery runs up the front of the neck from the diagrams I've seen. Also -- your fingers have a pulse in them. If you've ever bashed your finger and felt it throb, you know what I mean. (that's why they tell you not to take a pulse with your thumb ever, because you can confuse whether you're feeling a pulse in your thumb or the wrist).

But if you're really concerned about your vascular health, definitely go see a doctor.
posted by custard heart at 1:46 PM on September 28, 2010

If you have health insurance your provider might have a nurse consult line you can call for free to at least talk to someone more knowledgeable than the internet.
posted by ghharr at 1:51 PM on September 28, 2010 [1 favorite]

I'm 29. My blood pressure is always slightly low or just right. I can feel a pulse there by touching lightly.

Can you link to the article?
posted by morganannie at 1:51 PM on September 28, 2010

29 year old male, run the mile and a half in 9 minutes. I can feel a pulse.
posted by Biru at 1:54 PM on September 28, 2010

I'm concerned b/c this pulse could be a sign of aortic problems according to the article (aneurysms, tortuosity, etc).

Stop trying to self-diagnose via the internet. You do not have the knowledge or expertise necessary to make any kind of diagnostic. There is such a thing as "medical student's disease", and if medical students can get this stuff wrong, some internet nobody for sure cannot be trusted to make any kind of valid assessment of a condition.
posted by splice at 1:58 PM on September 28, 2010 [3 favorites]

health articles

There's the problem. 99% of medical information on the internet is flatly made up by unscrupulous marketers, who have mostly tried to snow people with claims about "natural" or your-alternative-medicine-or-other-nonsense-buzzword-here products in the hope of getting them to speak such gibberish that they are unable to communicate with real doctors (who could reassure them that there's nothing wrong).
posted by Inspector.Gadget at 2:04 PM on September 28, 2010 [4 favorites]

I have a strong pulse there. 23 and recently in shape.
posted by ramenopres at 2:10 PM on September 28, 2010

As Inspector.Gadget said, the "article" is probably bogus. Do not trust random medical information on the internet. Always look at the source. Always refer to the source when repeating the information.

You should link to the article here.
posted by grouse at 2:13 PM on September 28, 2010 [1 favorite]

I'm 24 and not what I'd call super-healthy. I cannot feel a pulse there (unless I push really hard, but even then I think it's just my fingers).

Long story short, yeah, don't get your medical info from the internet. Go to a doctor if you're concerned.
posted by phunniemee at 2:13 PM on September 28, 2010

Here is the links to the articles I read:

http://en.wikipedia.org/wiki/Suprasternal_notch#Evaluative_tests_using_the_suprasternal_notch
http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/pd/pstep37.htm

And then there was one other article written in a medical journal by a doctor who also said that there should not be a pulse. I can't find the article at the moment but if I do I'll post it. Just to be clear I'm not talking about the cartoid artery/neck pulse, but the collarbone suprasternal notch.
posted by starpoint at 2:47 PM on September 28, 2010

IANAD yet, but I'm halfway through gross anatomy, so treat this first paragraph as well-researched bunk and the second as hastily-researched bunk. The most prominent vessels to run past your suprasternal notch *are* your left and right carotid arteries. The R and L subclavian arteries run deeper and to the side, and your aortic arch proper is a bit further down into your rib cage, so you're definitely talking about your carotid arteries. If anyone pushes deep enough into their suprasternal notch, they'll find that pulse.

It looks like Dr. Chandrasekhar's test is looking primarily for an *abnormal* pulse there. A brief lit search shows that abnormal pulses/thrills can be secondary to increased stroke volume caused, in turn, by aortic regurgitation. So the test isn't completely out of left-field. I'd avoid trying to self-administer it if I were you, though-- heart sounds are actually really difficult to sort out, even to medical residents, so if it's got you worried I'd go see a doctor about it. Heck, at 27 you might want to consider finding yourself a regular doctor and getting checkups/vaccinations every couple years. Maybe use your entry physical as an opportunity to bring it up.
posted by The White Hat at 3:18 PM on September 28, 2010 [2 favorites]

IANAD, nor am I in med school. I do have PVC's (proven!) and have learned some about what you can measure or not on your own pulse.

Using your own fingers to test anything regarding your pulse other than your heart rate is about worthless. You can touch your knee cap and start feeling your pulse. You can touch a desk and feel your pulse. Some abnormalities (PVC's, PAC's) can be detected with your finger, but it isn't going to tell you much without an ECG or other testing.

Seconding The White Hat, see a GP if you are worried.
posted by Mister Fabulous at 4:45 PM on September 28, 2010

I have aortic regurgitation. My pulse is quite evident at the base of my neck: an observant person could count my heart beats from six feet away in a well-lighted room. So, yes, a visible pulse can be a sign of heart problems.

However, it is far from the only sign that my heart is unusual. The problem is congenital and everyone who has listened to my heart for as long as I can remember has remarked on my prominent murmur. Aortic valve disease is unlikely to spontaneously develop in a generally healthy guy in his 20s. Unless you've been told you have a murmur and failed to follow up, I think you can safely assume this is just an anatomical quirk.

A question: Are you a skinny guy? That might help explain why your heart beat is relatively easy to detect. I doubt the scoliosis has anything to do with it. I don't know much about it, but it doesn't usually involve the circulatory system, does it?
posted by reren at 5:16 PM on September 28, 2010 [1 favorite]

I can feel something similar, have a murmur any doctor with a stethoscope can hear, get it checked by a cardiologist (who is also my primary care doctor, swell, isn't it?) about once a year. I'm on stimulant meds, too, because why the hell not. I'm totally fine, not going to die.
posted by the young rope-rider at 5:50 PM on September 28, 2010

I am an anatomist. Blood vessels do not read the textbook or Wikipedia. I spend a significant part of my day saying 'Huh, well, I've never seen one do that before, but there you go.'

As for pulse in the suprasternal notch being half-assed internet medicine: no. It's true that it has been noted as a sign of aortic dilatation or other bad cardiovascular abnormalities since well before the Flexner report. It's not a made-up correlation. Right there is a tiny piece of human ingenuity in medical history, everyone. No imaging, crummy stethoscopes, all physical exam, and someone picked that out.

I can't believe I am about to link to Yahoo Answers here, but I am. In fact, given the username and date, I suspect you asked it. The second answer is full of medical sense and anatomy fact. Also note the part about seeing the pulse. That's important, because the sign is intended as a pointer towards aortic disease, usually--and the difference between pulse in the aorta and pulse in the (much narrower, more distal from the heart) carotids. And, as that poster--and people here--have said: see a doctor if you're concerned. Of all the medical issues that can't be definitely determined from written descriptions on the internet, this is one of the least able to be determined. This sign is one derived from a trained, experienced practitioner performing a direct physical exam with hands, stethoscope and eyes. None of that has happened here.
posted by Uniformitarianism Now! at 6:23 PM on September 28, 2010 [6 favorites]

I mean, I understand that you can see the pulse. I can see mine. My arteries are A-OK as of February, which was when I had my last thorough cardiac work-up.

Knowing the differences and spectrum between 'eh, a little pulsing that I see when I stare at it with my anxious laser eyes, increasing my heart rate, and therefore ratcheting the pulse up' and 'reren's obvious and abnormal aortic pulse' requires an MD, and not just an MD--someone actually examining it.
posted by Uniformitarianism Now! at 6:28 PM on September 28, 2010

@reren - I'm a woman, 5'5 and about 125-130lbs or so.

@Uniformitarianism Now! - OK you caught me. I asked that question yesterday. I guess the consensus is to see a doctor. I made an appointment at the local family doctor. Or should I try to see a cardiologist directly?
posted by starpoint at 7:24 PM on September 28, 2010

See a GP. Understanding and evaluating a body's benign variations from the norm (or clearly explaining how difficult it is to evaluate your own pulse), or noting a change/variation that requires follow-up is a significant part of a GP's job. (Well, some of the in-depth explaining and education about noting changes from baseline and understanding your own baseline is really an RN's job...great nurses are worth their weight in emerald-studded platinum. Because what will probably happen is you will get your entry physical, this will turn out to be probably a normal variant, and you can ask the GP and the nurse about how to monitor your own cardiovascular health and changes. There have been times when I've said 'look, I feel stupid for asking, but can you explain a bit what I should watch out for or what kind of things are usually normal? Because I just don't know.'

And if you have a good practice, if you DO have something seriously and imminently wrong, they will call the ambulance right then, or if it's not imminent but needs more evaluation, they'll refer. People view primary care providers warily partly because of the mess that is health insurance and partly because we forget that specialists know ONE THING REALLY WELL.

My close friend was on an internship (veterinary), and the brilliant specialist my friend had done research with brought in a pet. My friend was terrified of making a mistake and kept deferring to the specialist until the specialist finally stopped and said 'look, I haven't dealt with X body system in twenty years. I am here because I need this service's general knowledge and opinions. Tell me what YOU think.'
posted by Uniformitarianism Now! at 5:06 AM on September 29, 2010 [1 favorite]