Pediatric cardiovascular

physical examination
Pimpak Prachasilchai
Pediatric cardiologic consultant
Queen Sirikit National Institute of Child Health
 Cardiovascular examination
• Inspection
• Palpation
• Percussion
• Auscultation
 Inspection
• Dyspnea
 Inspection
Cyanosis

• Central cyanosis

• Clubbing finger
 Inspection
Clubbing finger
 Inspection
Clubbing finger
Dysmorphic feature/Syndrome
Down syndrome
Noonan
Turner syndrome
Marfan syndrome
Congenital rubella
 Inspection
• JVP (Performed in children > 8 year old)
– The patient is kept at 45 degree
– Turn their head slightly to the left
– No greater than 3 cm.
 Inspection
• Failure to thrive (FTT)
• Chest shape
– Pectus cariatum
– Pectus excavatum
• Visible precordial bulge: Long standing cardiac
disease
• Scars
Visible precordial bulge
 Signs in the hands in endocarditis
• Splinter haemorrhages: a longitudinal, red-brown
haemorrhage under a nail.

• Janeway lesions: non-tender, haemorrhagic

lesions that occur on the thenar and hypothenar
eminences of the palms (and soles).

• Osler’s nodes: red-purple, slightly raised, tender

lumps, typically found on the fingers or toes.
 Vital sign
• Blood pressure
• Pulse
• Respiratory rate
• Temperature

• Saturation
• Capillary refill time
 Blood pressure
• What size cuffs are preferred?

• Width: 40% circumference

 Assessment of pulse
• Rate
• Rhythm
• Volume
• Symmetry (Radio-femoral delay)
Minimum SBP = 70 mmHg + (2 x Age in years)
 Palpation
• Apex beat
• Parasternal heave
• Thrills
Auscultation
 Auscultation
• S1
• S2
• S3
• S4
• Heart murmur
• Ejection click
• Pericardial friction rub
 Heart murmur
• Pitch
• Systolic/Diastolic
• Area where best heard
• Intensity
• Posture in which best heard
Heart murmur
Heart murmur
 Innocent murmur
• Functional/benign
• Accentuated during period of febrile illness
and high output states
• Asymptomatic
• Normal CXR
• No others abnormal CVS examination
• Less than grade III