Cardiovascular Examination in Pediatrics

Introduction

The cardiovascular examination in pediatric patients is crucial for early detection of congenital and acquired heart diseases. Unlike adults, children have different physiological responses and heart characteristics that must be interpreted with age-specific considerations.

Steps of the Cardiovascular Examination

1. History Taking

• Prenatal History: Inquire about maternal infections, drug/alcohol use, and family history of congenital heart disease.
• Neonatal History: Cyanosis, feeding difficulties, respiratory distress.
• Developmental History: Growth delays, poor weight gain, recurrent infections.
• Family History: Sudden cardiac death, genetic syndromes, arrhythmias.

2. General Inspection

• Cyanosis or Pallor: May indicate congenital heart disease.
• Respiratory Distress: Suggestive of heart failure.
• Edema: Uncommon in children but may be a sign of congestive heart failure.
• Activity Level: Fatiguability, poor feeding, or exercise intolerance.

3. Vital Signs

• Heart Rate: Age-dependent, tachycardia may suggest heart failure or arrhythmias.
• Blood Pressure: Measure in all four limbs if congenital aortic arch abnormalities are suspected.
• Respiratory Rate: Tachypnea may be a sign of heart failure in neonates.
• Oxygen Saturation: Evaluate for cyanotic congenital heart disease.

4. Palpation

• Peripheral Pulses: Assess symmetry, strength, and rhythm.
• Precordial Activity: Increased precordial activity may suggest volume overload.
• Liver Size: Hepatomegaly may indicate right-sided heart failure.
• Capillary Refill Time: Prolonged refilling suggests poor perfusion.

5. Auscultation

• Heart Sounds:
  • First (S1) and Second (S2) Heart Sounds: Normal splitting of S2 may be widened in atrial septal defects.
  • Murmurs: Classified based on timing (systolic, diastolic, continuous).
  • Gallops: S3 and S4 sounds may indicate heart failure.
• Extra Sounds: Clicks may indicate valvular abnormalities.

Common Pediatric Cardiovascular Conditions

• Congenital Heart Disease (CHD): Cyanotic (e.g., Tetralogy of Fallot) and acyanotic (e.g., Ventricular Septal Defect).
• Arrhythmias: Supraventricular tachycardia (SVT), bradyarrhythmias.
• Hypertension in Children: Secondary causes like renal disease, coarctation of the aorta.
• Cardiomyopathies: Dilated, hypertrophic, and restrictive.

Conclusion

A thorough cardiovascular examination in children is a fundamental step in identifying early abnormalities. It should be performed systematically, combining history, inspection, palpation, auscultation, and appropriate diagnostic testing.

Source recommendations

1. American Academy of Pediatrics Guidelines on Pediatric Hypertension

1. https://publications.aap.org/pediatrics/article/140/3/e20171904/38358/Clinical-Practice-Guideline-for-Screening-and
2. https://www.mdcalc.com/calc/4052/aap-pediatric-hypertension-guidelines
3. https://publications.aap.org/pediatricsinreview/article/40/7/354/35303/Pediatric-Hypertension-Review-of-Updated
4. https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.118.11819
5. https://www.aap.org/

2. American Heart Association Guidelines on Pediatric Cardiovascular Examination

1. https://atlas.heart.org/
2. https://cpr.heart.org/en/cpr-courses-and-kits/healthcare-professional/pediatric
3. https://elearning.heart.org/course/437
4. https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf
5. https://elearning.heart.org/courses

3. European Society of Cardiology Guidelines on Congenital Heart Diseases

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Grown-Up-Congenital-Heart-Disease-Management-of
2. https://academic.oup.com/eurheartj/article/42/6/563/5898606
3. https://pubmed.ncbi.nlm.nih.gov/32860028/
4. https://www.jacc.org/doi/10.1016/j.jacc.2021.09.010
5. https://pubmed.ncbi.nlm.nih.gov/20801927/