Pediatric Cardiology
Domain focus
Pediatric Cardiology tests murmur triage, cyanosis, heart failure, syncope and acquired heart disease such as Kawasaki. The exam favours bedside findings and physiology over rare eponyms.
Core rules
- Innocent murmurs are soft, systolic, non-radiating, without clicks, and occur in a thriving child with normal pulses and second heart sound.
- Pathologic features: diastolic or pansystolic murmur, loud harsh murmur, click, cyanosis, failure to thrive, abnormal pulses or blood pressure.
- Duct-dependent lesions worsen when the ductus closes; start prostaglandin E1 and arrange urgent echocardiography.
- A hyperoxia test helps distinguish cyanotic congenital heart disease from lung disease.
- In heart failure, look for tachypnoea, poor feeding, sweating and hepatomegaly.
Worked example
A 2-week-old presents with poor feeding, tachypnoea and weak femoral pulses. Blood pressure is higher in the right arm than in the leg. This suggests coarctation of the aorta. Start prostaglandin E1, obtain echocardiography and transfer to a cardiac centre. Use oxygen cautiously because high oxygen may close the ductus.
Traps
Calling every murmur innocent without checking pulses and blood pressure; missing Kawasaki disease in prolonged fever; attributing cyanosis to sepsis without a hyperoxia test; ignoring a long QT interval on ECG.