Cardiac examination

 

General examination

Is child ill / well?

Comfortable at rest / breathless?

Any O2 device or monitoring (ECG, SaO2) seen?

Is child well nourished? Plot weight & height

Any dysmorphic features / malformations?

Pallor / Cyanosis?

Clubbing of fingers? Splinter haemorrhages?

Oedema of feet/ raised JVP/ sweaty?

Vital Parameters:

Temperature- are peripheries cold?

Record Heart rate (normal for age range?)

– Is pulse regular

– Pulse volume normal/ thready/ bounding?

– Any Radial/ Femoral pulse delay?

– Femorals palpable in newborn?

Capillary refill time- centrally & peripherally

Resp rate

Use of accessory muscles

– Nasal flaring

– Head bobbing

– Intercostal recession

– Tracheal tug

Records SaO2; is O2 needed?

Blood pressure

Other systems:

– Look for Hepatomegaly

– Is spleen absent?

– RS: Basal crackles?

Inspection of Precordium & Thorax:

– Any scars? 

   Midline sternotomy

   Left lateral thoracotomy

   Chest drain scars

– Pectus / pigeon chest deformity?

 

Palpation:

– Locate apex beat

   4th / 5th ICS left mid-clavicular

– Any thrill of murmur?

– Parasternal heave?

[Heart borders can be percussed to note cardiomegaly]

Cardiac Auscultation:

– All 4 heart areas

– Heart sounds S1 & S2

– Is S2 split (ASD)?

– Is S3 heard (gallop)?

 

If murmur heard:

– Which heart valve area

– Soft / Loud?

– Systolic / Diastolic / Continuous?

– Is there a thrill?

– Is it radiated to carotids (AS) or left axilla (MR)?

– Is there a rub (rare, think pericarditis)