Paediatric Cardiovascular Examination: Structured Guide for
Medical Students
1. Preparation and Introduction
Wash hands and wear PPE if necessary.
Introduce yourself to the child and parents:
“Hello, my name is [Name], I am a [Role].”
Confirm the child’s identity: name and date of birth.
Explain the examination:
“Today, I’d like to examine your child’s heart. I will observe, feel the
pulse, and listen to their chest with my stethoscope.”
Obtain consent:
“Are you happy for me to proceed with the examination?”
2. General Inspection
Observe the child in their environment (e.g., waiting room, hospital
bed):
o Appearance & behaviour: alertness, activity, interaction.
o Signs: cyanosis, pallor, shortness of breath, oedema, rashes.
o Nutritional status: weight for age and height.
o Syndromic features: stature, facial features (e.g., Marfan,
Down’s syndrome).
3. Observe Surrounding Equipment and Medications
Equipment: oxygen (mask, nasal prongs), mobility aids.
Medications: anticoagulants, diuretics, antihypertensives.
4. Hands Inspection and Palpation
Inspect for:
o Colour (pallor, cyanosis)
o Xanthomata (hyperlipidaemia)
o Arachnodactyly (Marfan syndrome)
o Absent thumbs (Holt-Oram syndrome)
o Finger clubbing (cyanotic heart disease, endocarditis)
o Signs of endocarditis: splinter haemorrhages, Janeway lesions,
Osler’s nodes.
Palpate:
o Temperature (warm vs cool hands)
o Capillary refill time (normal <2 seconds)
Medical Students
1. Preparation and Introduction
Wash hands and wear PPE if necessary.
Introduce yourself to the child and parents:
“Hello, my name is [Name], I am a [Role].”
Confirm the child’s identity: name and date of birth.
Explain the examination:
“Today, I’d like to examine your child’s heart. I will observe, feel the
pulse, and listen to their chest with my stethoscope.”
Obtain consent:
“Are you happy for me to proceed with the examination?”
2. General Inspection
Observe the child in their environment (e.g., waiting room, hospital
bed):
o Appearance & behaviour: alertness, activity, interaction.
o Signs: cyanosis, pallor, shortness of breath, oedema, rashes.
o Nutritional status: weight for age and height.
o Syndromic features: stature, facial features (e.g., Marfan,
Down’s syndrome).
3. Observe Surrounding Equipment and Medications
Equipment: oxygen (mask, nasal prongs), mobility aids.
Medications: anticoagulants, diuretics, antihypertensives.
4. Hands Inspection and Palpation
Inspect for:
o Colour (pallor, cyanosis)
o Xanthomata (hyperlipidaemia)
o Arachnodactyly (Marfan syndrome)
o Absent thumbs (Holt-Oram syndrome)
o Finger clubbing (cyanotic heart disease, endocarditis)
o Signs of endocarditis: splinter haemorrhages, Janeway lesions,
Osler’s nodes.
Palpate:
o Temperature (warm vs cool hands)
o Capillary refill time (normal <2 seconds)
