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)