Paediatric-History taking & Physical examination of heart failure

Paediatric-History taking & Physical examination of heart failureCreated OnApril 27, 2020Last Updated OnApril 27, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of heart failure < All Topics Table of Contents History taking: Infants: Tachypnoea Easy fatigability Irritability Feeding difficulty Poor suck, prolonged time to feed, sweating during feed Poor weight gain (failure to thrive) May result in delayed motor milestones Young children: Gastrointestinal symptoms (abdominal pain, nausea, vomiting, and poor appetite) Failure to thrive Easy fatigability Recurrent or chronic cough with wheezing These symptoms may be mistaken for common childhood illnesses such as gastroenteritis, reflux, asthma, or even behavioural issues Older children: Exercise intolerance  Anorexia Abdominal pain  Wheezing  Dyspnoea  Oedema  Palpitations Chest pain Syncope Physical examination: Depends on the cardiac output, and degree of volume overload and pulmonary congestion, and/or systemic venous congestion Poor weight gain or ‘faltering growth’ Tachycardia: Defined as the presence of a heart rate value greater than expected for age (remember that in paediatrics, heart rate varies with age!) It is a response to decreased cardiac output in patients with depressed myocardial contractility Poor perfusion A result of diminished cardiac output is manifested by cool peripheries, decreased capillary refill, decreased peripheral pulses, and lowered systemic blood pressure Gallop rhythm S3 gallop may be present in children with diminished cardiac output or volume overload Pulmonary congestion Tachypnoea Most common finding of pulmonary congestion (normal respiratory rate varies with age!) Chest retractions Use of accessory respiratory muscles In infants, grunting with nasal flaring Ausculatory findings, include wheezing and rales, are more commonly seen in older children as compared with infants Systemic congestion: Hepatomegaly Ascites and splenomegaly may be present in severe right heart failure Jugular venous distension (not generally observed in infants and young children) Peripheral oedema Other findings – Other findings may suggest an underlying...

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