PE22.{7-8,11} | Cardiovascular Examination Workflow — Summary & Reflection

KEY TAKEAWAYS

The paediatric cardiovascular examination requires both technical skill and empathic communication. Vital signs must be measured with age-appropriate technique and interpreted against normative reference ranges — heart rate, respiratory rate, and blood pressure all vary substantially by age. The systematic CVS examination (IPPA) includes precordial inspection for bulge and visible pulsations, palpation of the apex beat (4th ICS in children <7 years), thrills, and parasternal heave, followed by percussion for cardiac dullness, and auscultation across the precordium, axillae, neck, and back. The femoral pulses must always be palpated and compared with radial — radio-femoral delay indicates coarctation. JVP is most useful in older children; hepatojugular reflux is preferred. Murmurs are graded 1–6 (Levine) — Grade 4+ have a thrill and are always pathological; diastolic murmurs are never innocent. Still's murmur is the most common innocent murmur. Communication with children and parents requires age-appropriate explanation, active listening, and care to balance reassurance with clinical accuracy.

REFLECT

Think back to the case in the hook — the 5-year-old girl with a soft midsystolic murmur at the left sternal border. You now have the knowledge to recognise this as likely innocent. But reflect on the interaction: how would you have told the mother, who was visibly anxious, that her child's murmur is probably benign — without either dismissing her concern or alarming her unnecessarily? What words would you choose? And more broadly: when you encounter a child with confirmed congenital heart disease in clinical practice — a child who may need surgery, who may have limited activities, whose parents carry significant emotional burden — what habits of empathic communication will you cultivate to make each encounter supportive? Consider one concrete step you will take to improve your ability to communicate difficult cardiovascular diagnoses to paediatric patients and their families.