NEWBORNS AND INFANTS

Details of pregnancy: Maternal exposure to teratogens Smoking during pregnancy Congenital infections Use of illicit drugs Age of the mother

Family history: Family history of relatives/siblings, born with heart defects Presence/ absence of syndromes associated with CHD (Marfan syndrome, Holt-Oram syndrome, long-QT syndrome)

Perinatal history: Complications? (toxemia, birth asphyxia, fetal distress, low birth weight) Infants Apgar score?

Time at which sign & symptoms begin: Commonly, murmurs neonatal period Newborn with CHD asymptomatic at birth perinatal changes completed the defect present, e.g: 2wks of life ductal-dependent left-sided obstructive lesions present 4wks of life significant L-R shunt lesions

Time at which sign & symptoms begin: Commonly, murmurs neonatal period
Newborn : asymptomatic Perinatal changes completed Symptomatic physiologic defect present

2wks of life ductal-dependent left-sided

obstructive lesions present 4wks of life significant L-R shunt lesions

 Feeding

history : Frequency? Amount? Length of time to finish? Fall asleep during feeding? Presence of Cyanosis? Breathing patterns Growth and development Activity level? Fatigue easily? Syncope

CHILD AND ADOLESCENTS

Chest pain : location, quality, timing of the pain, referred pain, and what relieves pain. Associated with exersice? Chest pounding? Past medical history Previous hospitalization Previous operation Immunizations status Symptoms of poor growth

 Social

history : eating and exersice habit School performance Keeping up with peers History of tobacco and illicit drugs

CARDIAC PHYSICAL EXAMINATION

Vital sign

Auscultation
CARDIAC P.E

Inspection

Percussion

Palpation

Heart rate

Temperature

Vital sign
Blood pressure

Respiratory rate

Inspection
General Appearance
Comfort? Fussy? Well nourished? Dysmorphic? Breathing patterns? Edema? Chest wall surgical scars (right thoracotomy? Midline sternotomy? Left thoracotomy?) Childs color

Visible pulsation? A left parasternal bulge?

Point of maximal impulse?

Neck veins distention?

Palpation
Pulse

rate on upper and lower extremities : regularity and quality Capillary refill time Chest : palpated on PMI, precordial activity and thrills Abdomen Back : scoliosis?

Percussion
To

evaluate the total span of liver Pulmonary consolidation? Effusion? Hyperinflation? Liver enlargement?

Auscultation
Heart sound? (S1, S2, S3, S4, Clicks) Heart murmurs : intensity, loudness, timing, location, transmission, and quality Systolic murmurs ejection murmurs and S1Coincident murmurs Diastolic murmurs early/mid/late-diastolic murmurs Continuous murmurs

Innocent Murmurs Stills Murmurs Pulmonary flow murmur of childhood Pulmonary flow murmur of Infancy Venous hum murmur

SUMMARY

An accurate history can be obtained by establishing a relationship with the patient and parents. Detailed history taking includes: pregnancy, family history, previous history, perinatal, and social history Physical examination is important in establishing the diagnosis. It consists of vital sign, inspection, palpation, percussion, and auscultation.