Cardiovascular system examination in children

Undergraduate
Cardiology
Author

Dr. Samuel Blay Nguah

Published

April 22, 2024

This post outlines the steps in the undergraduate examination of the Cardiovascular System.

Courtesy and permission

The following are requisite steps in this examination. Remember to always ask for permission before undergoing any examination. Be courteous with minimal discomfort to the patient and guardian.

General Examination

  • Respiratory distress
  • Nutrition (Generally)
  • Swelling or Oedema
  • Dysmorphic features
  • Presence of medical devices e.g. Nasal prongs

General Examination - CVS

Hand, Arm & Leg

  • Pallor
  • Peripheral cyanosis
  • Capillary refill
  • Clubbing
  • Warmth
  • Pulse
    • Rate
    • Volume
    • Character
    • Radio-Radial & Radio-Femoral delay
    • Collapsing/Bounding
  • Blood pressure

Head & Neck

  • Pallor
  • Central cyanosis
  • Jaundice
  • Facial oedema
  • Neck pulsations
  • JVP (Older children)

Precordium

Inspection

  • Visible pulsations
  • chest wall deformities
  • Scars and scarifications
  • Chest shape

Palpation

  • Thrill
  • Apex beat location
  • Heave
  • Heart sounds

Auscultation

  • Heart sounds - S1, S2
  • Additional heart sounds - S3, S4
  • Murmur
    • Area loudest
    • Systolic or diastolic
    • Radiation
    • Grade

Others

  • Hepatomegaly
  • Edema extent - Pedal, sacral, facial
  • Auscultation of lung bases

Murmurs

Warning: package 'tibble' was built under R version 4.5.1
Warning: package 'purrr' was built under R version 4.5.1
Table 1: Heart diseases and their murmur charateristics
Murmur Location Condition
Pansystolic LLSB VSD, Tricuspid regurgitation
Pansystolic Apex Rheumatic Heart Disease, Mitral valve prolapse
Ejection systolic URSB Aortic stenosis
Ejection systolic ULSB ASD, Pulmonary stenosis, Tetralogy of Fallot, Coarctation of the aorta
Continuous 2nd left ICS Patent Dutus Arteriosus