the cardiovascular exam in infants and children l.
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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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heart rate
Heart Rate
  • Most labile of the vital signs
  • Wide variations are normal
  • Sensitive to multiple stimuli
blood pressure
Blood Pressure
  • Blood pressure increases with age
  • Use appropriate cuff
  • Repeat if abnormal
respiratory rate
Respiratory Rate
  • Sensitive but non-specific for CHF
  • Most reliable while asleep
  • Minimal dyspnea with heart failure
  • Growth (linear growth is spared)
  • Color (cyanosis, pallor)
  • Respiratory effort
  • Precordial bulge
  • Apical impulse
  • Pulses (upper and lower)
  • Precordial activity
  • Thrills
  • Liver edge
  • Perfusion
  • Skin temperature
  • Use your own stethoscope
  • Insist on quiet surroundings
  • Be methodical
  • Be patient
  • Come back and listen again
  • Don’t get discouraged
heart sounds
Heart Sounds
  • S1- closure of AV valves
  • Increased in ASDs
  • Obscured by holosystolic murmurs
  • Variable in complete heart block
heart sounds10
Heart Sounds
  • S2- closure of semilunar valves
  • Increased P2 if increased pulmonary artery pressure
  • Fixed splitting in ASDs
heart sounds11
Heart Sounds
  • S3- rapid filling of ventricles
  • Normal sound in children
  • Usually in ages 3 to 16
heart sounds12
Heart Sounds
  • S4- atrial contraction
  • Uncommon in children, even in CHF
  • Usually indicates a cardiomyopthy
ejection clicks
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
holosystolic murmurs
Holosystolic Murmurs
  • Begin with or obliterate the first heart sound
  • Typical examples are VSD and MR
systolic ejection murmurs
Systolic Ejection Murmurs
  • Most common of all murmurs
  • Begin after S1
  • Originate in outflow tracts
decrescendo diastolic
Decrescendo Diastolic
  • Loudest in early diastole
  • High pitch typical of aortic regurgitation
  • Low pitch typical of pulmonary regurgitation
diastolic rumble
Diastolic Rumble
  • Usually increased flow across a normal mitral or tricuspid valve
  • Very low frequency and intensity
  • Generally the result of VSDs and ASDs
continuous murmurs
Continuous Murmurs
  • Any murmur which continues through S2
  • Vascular in origin
  • Patent ductus arteriosus and venous hum are the most common source
characteristics of murmurs
Characteristics of Murmurs
  • Loudness (Grade 1 to 6)
  • Location
  • Radiation
  • Changes with respiration, position, valsalva
  • Pitch or frequency
  • Length
radiation of murmurs
Radiation of Murmurs
  • Aortic -RUSB to neck
  • Pulm-LUSB to lungs
  • MR-Apex to axilla






innocent murmurs
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
congestive heart failure







Peripheral edema


Venous distension

Congestive Heart Failure