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The Cardiovascular Exam in Infants and Children

The Cardiovascular Exam in Infants and Children. Heart Rate. Most labile of the vital signs Wide variations are normal Sensitive to multiple stimuli. Blood Pressure. Blood pressure increases with age Use appropriate cuff Repeat if abnormal. Respiratory Rate.

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The Cardiovascular Exam in Infants and Children

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  1. The Cardiovascular Exam in Infants and Children

  2. Heart Rate • Most labile of the vital signs • Wide variations are normal • Sensitive to multiple stimuli

  3. Blood Pressure • Blood pressure increases with age • Use appropriate cuff • Repeat if abnormal

  4. Respiratory Rate • Sensitive but non-specific for CHF • Most reliable while asleep • Minimal dyspnea with heart failure

  5. Inspection • Growth (linear growth is spared) • Color (cyanosis, pallor) • Respiratory effort • Precordial bulge • Apical impulse

  6. Palpation • Pulses (upper and lower) • Precordial activity • Thrills • Liver edge • Perfusion • Skin temperature

  7. Pulses

  8. Auscultation • Use your own stethoscope • Insist on quiet surroundings • Be methodical • Be patient • Come back and listen again • Don’t get discouraged

  9. Heart Sounds • S1- closure of AV valves • Increased in ASDs • Obscured by holosystolic murmurs • Variable in complete heart block

  10. Heart Sounds • S2- closure of semilunar valves • Increased P2 if increased pulmonary artery pressure • Fixed splitting in ASDs

  11. Heart Sounds • S3- rapid filling of ventricles • Normal sound in children • Usually in ages 3 to 16

  12. Heart Sounds • S4- atrial contraction • Uncommon in children, even in CHF • Usually indicates a cardiomyopthy

  13. Ejection Clicks • Early systolic, high frequency sounds • Occur shortly after S1 • Signify semilunar stenosis • Variable (louder on expiration) if pulmonary • Constant (don’t vary with respiration) if aortic

  14. Holosystolic Murmurs • Begin with or obliterate the first heart sound • Typical examples are VSD and MR

  15. Murmurs

  16. Systolic Ejection Murmurs • Most common of all murmurs • Begin after S1 • Originate in outflow tracts

  17. Decrescendo Diastolic • Loudest in early diastole • High pitch typical of aortic regurgitation • Low pitch typical of pulmonary regurgitation

  18. Diastolic Rumble • Usually increased flow across a normal mitral or tricuspid valve • Very low frequency and intensity • Generally the result of VSDs and ASDs

  19. Continuous Murmurs • Any murmur which continues through S2 • Vascular in origin • Patent ductus arteriosus and venous hum are the most common source

  20. Characteristics of Murmurs • Loudness (Grade 1 to 6) • Location • Radiation • Changes with respiration, position, valsalva • Pitch or frequency • Length

  21. Radiation of Murmurs • Aortic -RUSB to neck • Pulm-LUSB to lungs • VSD-LLSB • MR-Apex to axilla Ao Pa VSD MR M

  22. Innocent Murmurs • Grade I-II/VI (rarely III/VI) • Systolic (except venous hum) • Often vibratory • Change with respiration and position • Short • Unassociated with abnormal heart sounds • Characteristic age 3 to 12 years

  23. IS Tachypnea Tachycardia Hepatomegaly Cardiomegaly IS NOT Rales Peripheral edema Gallops Venous distension Congestive Heart Failure

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