"Cardiac History and Exam" by Christina Ronai for OPENPediatrics

In this video, Dr. Chris Ronai outlines the approach to obtaining a cardiac history and physical exam when evaluating children for possible cardiac disease. Dr. Ronai describes features including the clinical history, clinical exam and auscultation of abnormal heart sounds.

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Hi, my name is Christina Ronai. I'm one of the Cardiology Fellows at Boston Children's Hospital and I'll be talking to you today about the cardiac history and physical exam when evaluating children for possible cardiac disease. Our objectives today are to understand the clinical history relevant to heart disease in children, recognize the features of the clinical exam in heart disease, understand the basics of auscultation and characterization of cardiac murmurs, and understand the features of pathologic versus benign murmurs.

Clinical History. From a history standpoint, there are three important categories: gestational and perinatal history, especially if evaluating an infant, postnatal and present history, and then family history. We're going to go through each of these. The gestational and perinatal history is really important when evaluating an infant. Specifically, you're going to want to ask about the maternal history. Were they healthy while they were pregnant? Did they receive prenatal care? And did they have regular ultrasounds during pregnancy? And if so, did those show anything of concern? When you're asking about maternal infections, you're referring mostly to the TORCH infections, but any infection is also important to note. Finally, you're going to ask if mom took any medications. Specifically, phenytoin, lithium, retinoic acid, and warfarin have all been associated with cardiac malformations. The postnatal and present history is our next category. Most importantly for infants and young children is are they growing along their growth curve? And if they're not growing along their growth curve, have they at least continued to consistently gain weight or have they been losing weight? Are they meeting their developmental milestones? Have there been any feeding problems? Is there any cyanosis? Decreased exercise tolerance. Specifically for young children, you're going to want to ask, as they run around on the playground, are they able to keep up with their peers or are they falling back? Have they ever fainted or felt as if they were about to faint? Have they ever experienced chest pain or palpitations? When you're asking about palpitations, I usually pose the question to children have they had any extra beats or skipped beats? The most important thing to remember when evaluating an infant is that feeding is really an exercise test for them. And if they are able to feed and grow, there's usually not a major cardiac issue. Family history. You're going to want to ask if anyone has ever been born with a heart problem. And that'll be your screening for family history of congenital heart disease. Has anyone passed away suddenly or from an unexplained cause? Often I will also ask about unexplained car accidents or drownings, because those can be indicative of electrical problems with the heart. Does anyone have hypertrophic or dilated cardiomyopathy? And does anyone in the family require a pacemaker or an implanted defibrillator?

Видео "Cardiac History and Exam" by Christina Ronai for OPENPediatrics канала OPENPediatrics