Examination of the child´s cardiovascular system

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

General symptoms of heart and vascular disease[edit | edit source]

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

Physical exam[edit | edit source]

Pulse palpation[edit | edit source]

pulse frequency and amplitude (on all four limbs)

Peripheral blood flow control[edit | edit source]

color and temperature of the acral parts of the limbs

Prepaid palpation[edit | edit source]

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

Auscultation of the heart[edit | edit source]

2nd intercostal space at the right of the sternum (aortic area) – we determine the pulse rate, identify the echoes and determine the rhythm
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?)
lower left margin of the sternum (trikuspid area) – we are looking for a cleft of the first echo, systolic and diastolic murmur
tip area (mitral area) – early systolic aortic click?, mesosystolic click? third echo?
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[edit | edit source]

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[edit | edit source]

to detect aortic coarctation

Blood pressure measurement[edit | edit source]

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