Congenital heart disease physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]
Physical Examination
Pulse
- Tachycardia may be present
Respiratory Rate
- Tachypnea may be present
Eyes
Chest
- Wheezing may be present
Heart
Inspection
- Precordial bulge may be present
Palpation
- Thrill due to outflow tract obstruction or a restrictive ventricular septal defect
- Increased apical activity suggestive of left ventricular volume or pressure overload
Auscultation
- A single second heart sound occurs in the following conditions:
- Aortic atresia
- Pulmonary atresia
- Truncus arteriosus
- Conditions with pulmonary hypertension
- Widely or fixed split S2 occurs with atrial septal defect
- Early systolic clicks, which occur with semilunar valve stenosis, bicuspid aortic valve, and truncus arteriosus.
- Mid-systolic clicks, which are heard with mitral valve prolapse and with ebstein's anomaly of the tricuspid valve.
- An S3 gallop, which, in infants, can result from ventricular dysfunction
- Murmurs
- Atrial septal defect: Systolic murmur heard best at the left upper sternal border
- Ventricular septal defect: Holosytolic murmur heard best at the left upper sternal border
- Patent ductus arteriosus: Machinery murmur heard best in the left infraclavicular region
- Tetralogy of fallot: A harsh systolic ejection murmur best heard at the left sternal border is usually present.
- Persistent truncus arteriosus: Systole ejection murmur is heard at the left sternal border
- Transposition of the great vessels: The murmur of a large PDA in d-TGA, is usually systolic, seldom continuos, due to the almost exclusive flow during systole from the aorta to the pulmonary artery. Systolic murmurs are absent in neonates unless a subpulmonic stenosis is present
- Total anomalous pulmonary venous connection: Systolic ejection murmur is heard at left upper sternal border. Diastolic murmur due to tricuspid regurgitation is also heard.
Abdomen
- Hepatomegaly often occurs in patient with congestive heart failure.
Extremities
- Skeletal abnormalities, especially those of the hand and arm, are often associated with cardiac malformations.