Examination of the child's cardiovascular system


 * 1) Medical history (congenital heart defects, acquired heart disease in the family, risk factors,...).
 * 2) Patient appearance (height, weight, dysmorphia, skin color,...).
 * 3) Breathing (speed and method of breathing, shape of the chest,...).
 * 4) Abdominal examination (size and structure of the liver,...).
 * 5) Own cardiovascular examination.

General symptoms of diseases of the heart and blood vessels

 * Central cyanosis,
 * peripheral cyanosis,
 * breathing disorders (tachypnea, dyspnea),
 * fatigue,
 * weight failure,
 * excessive sweating,
 * palpitations,
 * chest pain,
 * hypoxic seizures (in tetralogy of Fallot),
 * club fingers,
 * peripheral edema (at first periorbital in infant and young children),
 * hepatomegaly.

Palpation of the pulse

 * Frequency and amplitude of pulses (on all four limbs).

Peripheral blood flow control

 * Color and temperature of the acral parts of the limbs.

Palpation of the precordium

 * We look for a heart vortex, evaluate the beating of the apex of the heart and the function of the right ventricle.

Auscultation of the heart

 * 1) 2nd intercostal space on the right near the sternum (aortic area) – determine the pulse rate, identify the sounds and determine the rhythm,
 * 2) 2nd left intercostal space (pulmonary region) – we mainly evaluate the second sound (cleft in inspiration?), pulmonary flow murmur (innocent), the first sound (early systolic pulmonary click?),
 * 3) lower left edge of the sternum (tricuspid region) – we are looking for split first sound, systolic and diastolic murmur,
 * 4) tip area (mitral area) – early systolic aortic click?, mesosystolic click?, third sound?,
 * 5) the area above the great vessels in the neck.


 * First sound – arises from the closure of the atrioventricular valves (1. mitral, 2. tricuspid).
 * In children it takes 0.07-0.1 seconds,
 * pathological split of the first soundy (we differentiate between mitral and tricuspid valve closure) – e.g. in tricuspid valve stenosis.
 * noisy first sound to reverse cleft - in mitral stenosis (the valve closes with a delay).
 * The second sound – arises from the closure of the semilunar valves (1. aortic, 2. pulmonary).
 * In children it takes 0.06 seconds,
 * the split of the second sound is physiological if it disappears during exhalation (due to the reduction of venous return and the subsequent shortening of the time when a smaller volume is expelled into the lung),
 * pathological split of the second sound (fixed) – e.g. in the case of left-right shunt (atrial septal defect), or right ventricular failure.
 * The third sound – is produced by the oscillation of the relaxed myocardium of the ventricle at the beginning of diastole, during its rapid filling.
 * Darker and deeper than the first two sounds, therefore it is difficult to hear under physiological conditions,
 * best heard at the apex of the heart,
 * in children and adolescents it has a greater amplitude than in adults, therefore it can be heard in up to 80% of healthy children,
 * it is pathological in newborns and infants,
 * accentuation in abnormal dilatation of the ventricles in heart failure.
 * The fourth sound – arises during a powerful atrial systole, which leads to a rapid increase in pressure in the ventricle and causes vibration of the ventricular muscle.
 * It is not audible in healthy children or adults (ventricles are compliant),
 * audible in heart defects with atrial hypertrophy.

Additional sounds

 * Early systolic click (ejection click),
 * atrioventricular opening tone (snap),
 * heart murmurs – created either by blood turbulence or tissue vibration,
 * physiological heart murmurs:
 * systolic functional murmurs: vibration murmur (Still's), pulmonary ejection murmur, supraclavicular murmur,
 * continuous functional murmurs: swirling venous murmur,
 * pericardial friction murmur.

Palpation of femoral pulses

 * To detect coarctation of the aorta.

Blood pressure measurement

 * The measured value is assessed according to the gender, age and height of the child.
 * Watch out for white coat syndrome!
 * Hypertension is blood pressure equal to or greater than the 95th percentile for a child's sex, age, and height, measured at three different measurements.

Special investigative methods

 * EKG
 * X-rayexamination of the heart and lungs
 * Echocardiography
 * Cardiac catheterization
 * Angiocardiography

Related Articles

 * Examination of the child: Examination of the child's respiratory system ▪Examination of the child's gastrointestinal system ▪Examination of the child's uropoietic system ▪Examination of the child's endocrine system ▪Examination of the child's movement system ▪ Examination of the child's skin and skin adnexa ▪Examination of the child's vision and hearing
 * Congenital defects of the circulatory system