SCMC Evaluation of CHd by History Taking 1. Infants 2. Chilldren 1)Murmur 1)Murmur 2)Symptoms of CHF 2)Symptoms of CHF feeding difficult exercise Intolerance, low weight gain, dyspnea on exertion, frequent URI tachypnea, tachycardia, palpitation sweating, anxiety, 3)Syncope, chest pain irritability, frequent URI 4)Symptoms of Hypoxemia 3)Symptoms of hypoxemia cyanosis, squatting, cyanosis, hypoxic spell hypoxic spell, clubbing
Evaluation of CHD by History Taking 1. Infants 1) Murmur 2) Symptoms of CHF feeding difficulty low weight gain, tachypnea, tachycardia, sweating, anxiety, irritability, frequent URI 3) Symptoms of hypoxemia cyanosis, hypoxic spell 2. Children 1) Murmur 2) Symptoms of CHF exercise intolerance, dyspnea on exertion, frequent URI, palpitation 3) Syncope, chest pain 4) Symptoms of Hypoxemia cyanosis, squatting, hypoxic spell,clubbing
SCMC Physical examination Inspection: general appearance, nutrition, syndrome?, facial morphology, jugular venous pulse, respiratorypattern, rate, chest retraction, alae nasi flaring, dyspnea, precordialbulging cyanosis, clubbing Palpation: apical pulse, precordial activity, thrill, arterial pulse, location and size of liver and spleen Auscultation: S, S,, abnormalsounds murmur o Please do not pull out stethoscope before you observe patients carefully
Physical Examination ⚫ Inspection : general appearance, nutrition, syndrome?, facial morphology, jugular venous pulse, respiratory pattern, rate, chest retraction, alae nasi flaring, dyspnea, precordial bulging, cyanosis, clubbing ⚫ Palpation: apical pulse, precordial activity, thrill, arterial pulse, location and size of liver and spleen ⚫ Auscultation: S1 , S2 , abnormal sounds, murmur ⚫ Please do not pull out stethoscope before you observe patients carefully
SCMC Physical Exam ● Vitals HR, BP(including 4 extremities)RR, Pulse OX o Respiratory Assessment Tachypnea, flaring Cvanosis e Acrocyanosis vs Central Cyanosis
Physical Exam ⚫ Vitals – HR, BP (including 4 extremities) RR, Pulse Ox ⚫ Respiratory Assessment – Tachypnea, flaring – Cyanosis ⚫ Acrocyanosis vs. Central Cyanosis
What make in infant cyanosed? ScMC mixture of systemic venous and pulmonary venous blood o mixture causes ejection of desaturated blood to the body o Obstruction to pulmonary blood flow o obstruction still requires admixture
What make in infant cyanosed? ⚫ mixture of systemic venous and pulmonary venous blood ⚫ mixture causes ejection of desaturated blood to the body ⚫ Obstruction to pulmonary blood flow ⚫ obstruction still requires admixture
SCMC Physical Exam ● Cardiovas| ar exam Arterial exam o Pulses, capillary refill Venous exam e Jugular venous pulse, palpation of liver Precordial exam e Precordial bulge, substernal thrust, apical heave shift of apical impulse, thrills
Physical Exam ⚫ Cardiovascular Exam – Arterial exam ⚫ Pulses, capillary refill – Venous exam ⚫ Jugular venous pulse, palpation of liver – Precordial exam ⚫ Precordial bulge, substernal thrust, apical heave, shift of apical impulse, thrills