The document provides an overview of examining the cardiovascular system in children. It discusses symptoms related to the CVS like chest pain, dyspnea, palpitations, and syncope. It also describes the modified Ross classification for heart failure in children. The examination involves taking a detailed history, general examination focusing on pallor, cyanosis, clubbing, edema, dysmorphic features, pulse, blood pressure, JVP. Inspection examines the chest wall shape, tracheal position, apical impulse and visible pulsations.

1. EXAMINATION OF
CARDIOVASCULAR
SYSTEM
- ANJANA.B.S.

2. HISTORY ; SYMPTOMS RELATED TO CVS
 Chest pain: ‘SOCRATES’ Pericarditis , Mitral valve prolapse, episodes of irritable
cry in ALCAPA….
 Dyspnoea: Breathlessness in cardiac disease –due to pulmonary congestion-left
heart failure.Tachypnoea-Cyanotic heart diseases,lesions causing low cardiac
output….suck-rest-suck cycle,head sweating.PND:Child wakes up from sleep
venospasm-REM-Pushes blood from areas of pooling to pulmonary circulation
 Modified Ross Classification for Heart failure in children
Class I Asymptomatic
Class II Mild tachypnoea or diaphoresis with feeding in infants,no growth
failure.Dyspnoea on exertion in older children.
Class III Marked tachypnoea.Marked dysnoea on exertion.Prolonged feeding
times with growth failure.
Class IV Symptoms such as tachypnoea,grunting,diaphoresis at rest.
 Palpitation: Sudden onset and cessation- supraventricular tachycardia.
 Syncope: Aortic outflow obstruction,PS,Heart block, tachyarrythmia.
 Squatting: Cyanotic heart diseases.

3. OTHER POINTS IN HISTORY
 Maternal history:Irradiation,drugs,alcohol etc during pregnancy,maternal
diabetes-high risk of CHD.Preterm birth – higher chance of
PDA.Consanguinity,maternal age, IUIs,Cardiotoxic drugs in child like
anthracycline,propranolol
 History of sudden death (hypertrophic cardiomyopathy) or CHD in family.
 Fever,rash(KD,Acute rheumatic fever),subcutaneous nodules,recurrent
LRIs,feeding history, lymphnode enlargement as in KD, SLE.
 Daily living activities

4. GENERAL EXAMINATION
 Pallour- in situations like AR,MR,Cardiac failure etc,feeding
difficulty,head sweating during feeding etc convey message of
fatigue in infants.
 Cyanosis

5.  CYANOSIS: Peripheral cyanosis- in conditions of circulatory stasis like shock,cold
extremities,CCF etc..lip can become blue due to cold..In central cyanosis,tongue &
mucous membrane of mouth and inside of lips become blue..Cyanosis of congenital
cyanotic heart diseases appear at birth in case of pulmonary or tricuspid
atresia,Severe PS with ASD whereas in TOF,cyanosis occurs after only by 2-6 months
 CLUBBING: Infective endocarditis and cyanotic heart diseases
 OEDEMA: Indicate cardiac failure..In rt heart failure, oedema in legs and liver
congestion..In left heart failure,pulmonary oedema.In small infants,rapid weight
gain,peri orbital oedema usually preceded by tachypnoea,dysnoea,hepatomegaly.
 Dysmorphic facies-Coronary stenosis ,Marfan syndrome-tall stature,pectus
excavatum..In coarctation of aorta, the upper part may be well developed..Cleft
palate – 20% chance of heart disease
 PULSE: Rate,rhythm,character,volume,peripheral pulses and any radiofemoral delay
 BP
 JVP: Pulsations-in rt internal jugular vein at the lower neck,just lateral to
clavicular end of sternocleidomastoid muscles.

6. Large fused cv waves – tricuspid regurgitation
Non pulsatile JVP - Superior venacaval obstruction

7. INSPECTION:

8. Shape and symmetry of chest wall
Normal-bilaterally symmetrical,AP diameter to transverse diameter 5:7
Funnel shaped chest- Marfan syndrome,Pigeon shaped chest- Rickets
Precordial bulge: Chronic cardiomegaly
Tracheal position: Central or shifted
Apical Impulse: 4th intercostal space,just lateral to the mid clavicular line
Other visible pulsations
Supra sternal pulsations: Aortic regurgitation,coarctation of aorta
Epigastric pulsations: Right ventricular hypertrophy
Hepatic pulsations: Tricuspid regurgitation
Dilated veins,Scars.

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