Strong Pulsations

[Capleton]

Thank you for taking my question.  I am a 26 year old male.  As long as I can remember I suffer from what I describe in laymans terms as a "strong pulse".  This is the case despite having an average blood pressure of about 113/70.I have a BMI of 26 so I am not thin, yet my pulse is so strong that it is clearly visible in many places.I also suffer from pulsatile tinnitus on exertion, which I put down to having narrow eustachian tubes and sinus problems.

For example my carotid arterties appear to make very prominent pulsations, so much so that friends of mine remark on it.  Another example is my abdominal aorta.  My entire lower abdomen moves with my heart beat.  It is more evident if I hold my breath.  Another example is crossing my legs, my legs bounce prominently with each beat (much more so than normal people).  

I also have visible but slight pulsations at each sternoclavicular joint and if I put my index finger in my suprasternal notch I feel a pulse.  This is particularly the case on exertion.

A few months ago I had an echo done, holter monitor, ecg, blood tests etc and the cardiologist said everything was normal.  

I guess my question is what is causing these prominent pulsations?  Is it possible to have a heart/left ventricle on the larger side (but still normal) that would be causing this?  I was told my heart is normal size but this constant awareness of my heart is slightly annoying.

[Forum-M.D.-CA]

If an echocardiogram, heart physical exam and EKG show no structural abnormalities  in your heart valve function, systolic or diastolic functions then this feeling is most likely caused by peripheral vasoconstriction and/or stiff blood vessels. The latter is very common in the elderly who have acquired atherosclerosis and have very stiff pulsations of their blood vessels and consequent systolic hypertension. But you are too young to have this and in addition don't have hypertension.
Such symptoms if localized to a few places can be caused by aneurysms or dilatation of blood vessels n the area, so I would recommend ultrasound of your carotids and abdominal aorta to verify that these aren't present. These aneurysms are much more common in the elderly, but can very rarely affect people congenitally (from birth.) The other two possibilities are usually seen on echocardiograms: aortic insuficiency ( at your age from a bicuspid aortic valve), and HOCM. Just make sure these were effectively ruled out when the echocardiogram was read.

[Capleton]

Just to add that I feel healthy and do not suffer from dyspnea and I exercise quite regularly.  I also wanted to say that one of the main times my pulse feels very strong is when standing up.  I seem to have a hyperdynamic heart beat when standing up and this lasts for maybe 20 seconds and my carotids look very prominent at this time.  Perhaps all of this is just normal for me? I don't know. Thanks