The document outlines a comprehensive approach to conducting a cardiovascular physical examination in pediatric patients. It details the steps involved, including taking vital signs, assessing growth parameters, and performing relevant systemic and chest examinations. Additionally, it emphasizes building a rapport with the patient and their guardian to gain the child's trust.

1. Mays Yousuf; Medical student; Al-Quds university; Palestine.
Cardiovascular physical examination for pediatrics
Start by introducingyourself and your examiner to the patient; take permission, maintain privacy, and
washyour hands.Make sure to buildagood relationshipbetweenyouandthe patientand their mother
so that you get the trust of the child.
1. Targeted exam:
a. Vital signs:
1. Heart rate.
2. Respiratory rate.
3. Blood pressure.
4. O2 saturation.
b. Growth parameters and interpret using growth charts:
1. Weight.
2. Height.
3. Head circumference.
c. General appearance:
1. The patient’slookingwell/ill/BMI,lyingcomfortably in bed/in pain, conscious /drowsy,
is attached to a nasal cannula/monitor/etc…
2. The patient is pale /cyanosed/sweating.
3. There are(not) Dysmorphic features/ fetal alcoholic syndrome/marfanoid features.
4. Seems to be responsive and is maintaining an eye to eye contact.
5. Tachypneic/ using his accessory muscles/ nasal flaring…
2. Relevant systemic examination:
a. EYES: RED REFLEX/corneal clouding/pallor/jaundice/xanthelsma/heterochromia/albinism.
b. MOUTH: central cyanosis/dentition.
c. Malar rash for SLE or mitral stenosis.
d. NECK: use of accessory muscles/tracheal tug/ thyroid.
e. HAND:temp/pallor/cyanosis/clubbing/Osler/janeway lesions/splinter hemorrhage/palmar
erythema/simian crease/polydactaly/sweating and tremor/CRT/PULSE; rate, rhythm,
character, volume/radio-radial delay/femoral pulses/collapsing pulse.
f. BLOOD PRESSURE.

2. 3. Chest examination:
a. Inspection:
1. Symmetry with respiration; the pattern of respiration.
2. Shape; pectus carinatum and bulging due to cardiomegaly.
3. Respiratory distress: recession and Harrison sulcus.
4. Scars/deformity/ dilated veins/skin pigmentation/ pacemakers/ pulsation.
5. Delayed or precocious puberty as a sign of poor growth.
b. Palpation:
1. Apex beat, and locate it; put your finger tips in the anterior axillary line.
2. Parasternal heave for RVH, and apex heave for LVH.
3. Thrills with your fingertips at the 4 valvular areas and in the supra-sternal notch.
4. Hyperactive precordium in VSD.
5. BE AWARE OF DEXTROCARDIA.
c. Percussion: usually of limited value in young children.
d. Auscultation:
1. In the fourvalvularareas,sub-clavicle,erb’sspace,and inter-scapular with the bell and the
diaphragm. ANDre-locate thrillsforgrading. Describe the character,systolic/diastolic, point
of maximumintensity.Determineradiationtothe axillaand the carotid, and inter-scapular.
2. Auscultate bruit over carotids/femoral/ and renal arteries.
3. Auscultate both lung bases for crackles. You may percuss for pleural effusion.
6. Abdominal examination:
a. Palpate for hepatomegaly, and splenomegaly for infective endocarditis. Describe the
edge, surface, and consistency of the liver, and do the liver span.
b. Check for ascites by shifting dullness and fluid thrill.
7. Others:
a. Sacral and LL edema.
b. Ask for: Blood pressure/ophthalmoscope/temperature/urine dipstick/CXR/ECG/Echo.