Goal to distinguish<unk>  (benign)<unk>  from clinically significant pathology
Red flag features that may point to pathology, not<unk><unk> :
Poor weight gain: check height and weight- left-to-right can cause decrease in weight, but are usually symptomatic
Color - cyanosis of hands, feet, perioral on exertion
Feeding - fatigue or short feeding times for infants- perspiring, grunting, coughing, tachycardia while feeding. Severe CHF may show at rest deep breathing with dyspnea with distress
Enlarged heart (ie ASD) can cause bulging of chest
Older kids - activity causing dyspnea/cyanosis- keeping up with peers, grunting, coughing, tired from stairs. syncope/presyncope, fatigue, palpitations/angina can occur with hypertrophic cardiomyopathy
Yet older - Aortic valve with rheumatic fever, myocarditis (history of URI), endocarditis (IV drug use)
Pregnancy history - Maternal diabetes (ASD, coarctation of the aorta, cardiomyopathies), CMV, Coxsackie B5, warfarin, AEDs use, EtOH (ASD,VSD), prematurity (PDA)
Worry when - family history of [[HCM]]/sudden death and prominent apical thrust (indicates LVH)
Poor weight gain: check height and weight- left-to-right can cause decrease in weight, but are usually symptomatic
Color - cyanosis of hands, feet, perioral on exertion
Feeding - fatigue or short feeding times for infants- perspiring, grunting, coughing, tachycardia while feeding. Severe CHF may show at rest deep breathing with dyspnea with distress
Enlarged heart (ie ASD) can cause bulging of chest
Older kids - activity causing dyspnea/cyanosis- keeping up with peers, grunting, coughing, tired from stairs. syncope/presyncope, fatigue, palpitations/angina can occur with hypertrophic cardiomyopathy
Yet older - Aortic valve with rheumatic fever, myocarditis (history of URI), endocarditis (IV drug use)
Pregnancy history - Maternal diabetes (ASD, coarctation of the aorta, cardiomyopathies), CMV, Coxsackie B5, warfarin, AEDs use, EtOH (ASD,VSD), prematurity (PDA)
Worry when - family history of [[HCM]]/sudden death and prominent apical thrust (indicates LVH)
Innocent pediatric murmurs
Mitral stenosis
Stone heart
Mitral regurgitation
Anomalous coronary arteries
Mitral valve prolapse
Arrhythmogenic right ventricular dysplasia
Aortic stenosis