Examination of the child´s cardiovascular system


 * 1) anamnesis (congenital heart defects, acquired heart disease in the family risk factors...)
 * 2) patient apperarance (height, weight, dysmorphia, skin color,...)
 * 3) breathing (speed and method of breathing, chest shape,....)
 * 4) examination of the abdomen (size and structure of the liver,...)
 * 5) own cardiovascular examination

General symptoms of heart and vascular disease
central cyanosis, peripheral cyanosis, respiratory disorders (tachypnea, dyspnoea), fatigue, weight failure, excessive sweating, palpitations, chest pain, hypoxic seizures (in Fallot´s tetralogy), stick fingers, peripheral edema (in infants and young children initially periorbital, hepatomegaly

Pulse palpation

 * pulse frequency and amplitude (on all four limbs)

Peripheral blood flow control

 * color and temperature of the acral parts of the limbs

Prepaid palpation

 * we look for a heart vortex, we evaluate the heartbeat and the function of the right ventricle

Auscultation of the heart

 * 1) 2nd intercostal space at the right of the sternum (aortic area) – we determine the pulse rate, identify the echoes and determine the rhythm
 * 2) 2nd intercostal space left (pulmonary area) – we evaluate mainly the second sound (cleft in inspiration?, Pulmonary flow murmur (innocent), the first sound (early systolic pulmonary click?)
 * 3) lower left margin of the sternum (trikuspid area) – we are looking for a cleft of the first echo, systolic and diastolic murmur
 * 4) tip area (mitral area) – early systolic aortic click?, mesosystolic click? third echo?
 * 5) area above the large blood vessels in the neck


 * first echo – cause by occlusion of atrioventricular valves (1st mitral, 2nd tricuspid)
 * in children it takes 0,07-0,1 seconds
 * pathological cleft of the first echo (distinguishing between mitral and tricuspid valve stenosis
 * noisy first episode to inverted cleft - in mitral stenosis (valve closes with delay)
 * second echo – caused by closure of the semilunar valves (1st aortic, 2nd pulmonary)
 * lasts 0,06 seconds by children
 * the cleft of the second echo is physiological if it disappears during exhalation (due to reduced venous return and subsequent shortening of the time when a smaller volume is expelled into lungs)
 * pathological cleft of the second echo (fixed) - eg in case of left-right short circuit (atrial septal defect) or in case of right ventricualr failure
 * third echo – caused by the oscillation of the relaxed myocardium of the ventricle at the ventricle at the beginning of diastole, at the time of its rapid filling
 * darker and deeper than the first two sounds, so it is difficult to hear undedr physiological conditions
 * best heard at the tip of the heart
 * it has a greater amplitude in children and adolescents than in adults, so it can be heard in up to 80% of healthy children
 * in newborns and infants it is pathological
 * accetuation in abnormal ventricular dilatation in heart failure
 * fourth echo – occurs during massive atrial systole, which leads to a rapid rise in ventricular pressure and causes vibration of the ventricular muscle
 * not audible in healthy children or adults
 * audible in heart defects with atrial hypertrophy

Additional sounds

 * early systolic click (ejection click)
 * atriventricular opening tone (snap)
 * heart murmurs - caused by either blood turbulence or tissue vibration
 * physiological heart murmurs:
 * systolic functional murmurs: vibrational murmur (Still´s), pulmonary expulsive murmur, supraclavicular murmur
 * continuous functional murmurs: whirling venous murmur
 * pericardial friction murmur

Palpation of femoral pulses

 * to detect aortic coarctation

Blood pressure measurement

 * we assess the measured value according to the sex, age and height of the child
 * watch out for whhite coat syndrome!
 * hypertension is blood pressure equal to or greater than the 95th percentile for given sex, age and height of a child, measured in three different measurements

Special examination methods

 * EKG
 * Xray examination of the heart and lungs
 * echocardiography
 * cardiac catheterization
 * angiocardiography

Related articles

 * Vyšetření dítěte: Vyšetření respiračního systému dítěte ▪ Vyšetření gastrointestinálního systému dítěte ▪ Vyšetření uropoetického systému dítěte ▪ Vyšetření endokrinního systému dítěte ▪ Vyšetření pohybového systému dítěte ▪ Vyšetření kůže a kožních adnex dítěte ▪ Vyšetření zraku a sluchu dítěte
 * Vrozené vady oběhové soustavy

Links
 Interní propedeutika (2. LF UK) – vyšetření srdcehttps://www.wikiskripta.eu/w/Vy%C5%A1et%C5%99en%C3%AD_kardiovaskul%C3%A1rn%C3%ADho_syst%C3%A9mu_d%C3%ADt%C4%9Bte

Source

 * ws:Vyšetření kardiovaskulárního systému u dítěte