Cardiac exam Flashcards
Initial general inspection?
-Unwell or well
-Cyanosis
-Growth parameters
-Vitals
o BP
o Temperature
o RR (do yourself)
o Urinalysis
-Iatrogenic
o IVs
o O2
-Dysmorphology (Downs, Turners, Noonans, Williams, Marfan, Alagille)
-Skin: scars
o Median sternotomy (all open heart corrections)
o Thoractomy scar
R sided lesions: pulmonary artery banding, closed valvotomies
L sided lesions: CoA, closed valvotomies
Connecting lesions: PDA, shunt formation
TO fistula repair
Thoracic duct ligation
Vascular ring repair
o Thoracic surgery
o Groin (cardiac catheters)
What do you look for in hands/arms?
- Clubbed (look at feet as well): normal hands with clubbed feet = Eisenmenger’s with PDA
- SBE (splinter, Osler, Janeway)
- BP
- Antecubital fossa scars
What do you look for in the pulse assessment?
-DO upper and lower limb
-Rate
-Rhythm
-Volume
-Form – lift up to detect hyperdynamic pulsation (aortic incompetence)
-Radio‐radial and radio‐femoral delay (often in kids with CoA –> only decreased femoral volume)
-Absent or reduced left brachial pulse
o Post coarctation repair
o Post Blalock‐Taussig shunt (will also have L thoracotomy scar)
What do you look for on head assessment?
- JVP (in older child) –> look at 45 degrees (elevated in RVF)
- Eyes: pale conjunctivae, icteric, roth spots (if applicable)
- mouth: central cyanosis, oral dentition state
- carotids: correct place to assess for volume and form
Inspection of precordium?
- Scars
- Symmetry: left chest prominence (chronic RVH), right chest prominence (dextrocardia with chronic ventricular hypertrophy)
- Apical pulsation
Palpation of precordium?
- apex: site, nature
- then LLSE, LUSE, RUSE, supraclavicular
- heaves
- thrills (remember to feel in suprasternal notch)
- palpable P2 (closure of PV)
Auscultation of precordium?
Areas
Heart sounds (intensity, splitting)
Added sounds
Murmurs
o Onset
o Site maximum intensity
o Character
o Grade
o Radiation
o Clicks with R or L outflow track murmurs if valvular
Radiation murmurs
o Carotids (aortic)
o Supraclavicular – R = aortic stenosis, L = PDA
o Axilla (mitral) –> roll them away from you
o Back (peripheral pulmonary stenosis, CoA)
o Variation of murmurs: inspiration, expiration
Manoeuvres (if appropriate)
o increased murmur with Valsalva
- HOCM
- MVP (inc intensity and earlier click)
o decreased murmur with Valsalva –> innocent murmurs
o Sit forward will increase aortic regurgitation murmur
Lung exam?
Feel deep in axilla (for collaterals in CoA if suspected)
Auscultate @ bases
Sacral oedema
?Cough = Kartageners/PCD
Abdomen exam?
Hepatomegaly
o Pulsatile (TRR)
o Enlarged (RVF) –> measure
Splenomegaly (SBE)
Lower limb exam?
Pitting oedema
Complete exam by doing developmental and functional assessment
What extra things might you ask for in the cardiac exam
ECG CXR Echo results \+/‐ Chromosome testing Urinalysis / Temperature (SBE)
Outline the signposting for the summary
1) Diagnosis or DDx
Well or unwell
Growth
Vitals
Dysmorphology
Cyanotic or acyanotic
Previous surgery
Main +ve findings and –ve findings (periphery and chest)
2) Severity of underlying lesion (if said Dx)
3) Complications
4) CXR and ECG (if not sure, wait until these for Dx)
When might you see an anacrotic carotid pulse?
Aortic stenosis: small volume, slow upstroke
When might you see a plateaued carotid pulse?
Aortic stenosis: slow upstroke
When might you see a bisferiens carotid pulse?
- Aortic stenosis and AR
o Small volume
o Slow upstroke
o Collapsing
