Pediatric Cardiac Assessment

Cynthia Crews RN, MSN, CNELisa Minor, RN, MSN, Ed.D

Longwood University Nursing Faculty

Participants will be able to identify essential components of a pediatric cardiac assessment.

Participants will be able to demonstrate a cardiac assessment recognizing normal and abnormal assessment findings.

Participants will be able to identify common childhood conditions affecting the heart

Objectives

What tools are needed?

Overview of Heart

There are 4 chambers of the heart 2 Atria

(Right & Left) 2 Ventricles (Right & Left)

There are two sets of valves Atrioventricular

Mitral valve between the left atria & ventricle Tricuspid valve between the right atria &

ventricle Semilunar

Pulmonic valve (Rt ventricle and pulmonary artery)

Aortic valve (Lt. ventricle and aorta)

Overview of Heart

Assess: Level of alertness, activity, tone Vital Signs Pulses Respiratory effort Chest symmetry Cap refill (should be less than 3 secs)- prolonged

indicates poor cardiac output Clubbing Peripheral edema Color and temperature of extremities

Cardiac Assessment

Normal vital signs

Cardiac Assessment

Age (yr)Respiratory Rate

(breaths/min)Heart Rate (beats/min)

 

<1 30-60 100-160

SBP: 65-100

DBP: 45-65

1-2 24-40 90-150

SBP: 90-105

DBP: 55-70

2-5 22-34 80-140

SBP: 95-110

DBP: 60-75

6-12 18-30 70-120

SBP: 100-120

DBP: 60-75

>12 12-16 60-100

SBP: 110-135

DBP: 65 - 85

The diaphragm of the stethoscope is best used for hearing higher pitched sounds such as S1 and S2 and some murmurs

The bell is best used for hearing lower pitched sounds such as S3 and S4

What is the best way to auscultate?

Objective Assessment

Auscultation: Auscultate all areas with patient sitting,

leaning forward, supine, and on left side. Begin with the diaphragm and then the

bell in all 5 areas Describe rate, rhythm, duration of cycle,

timing, intensity, frequency, splitting or murmurs, and quality

Auscultation of the heart includes two main things:

Rate:

Rhythm ( S1 and S2) and listening for abnormal rhythms

Listening to Heart Sounds

Age (yr) Heart Rate (beats/min)

<1 100-160

1-2 90-150

2-5 80-140

6-12 70-120

>12 60-100

Listening to Heart Sounds

Listening to Heart Sounds

Listening to Heart Sounds

Extra Heart Sounds

S3 - Ventricular filling sound that occurs in early

diastole soft, low pitched Ken----tuc---ky (Lub – duppa) May be an early sign of heart failure

S4 Atrial gallop atria contraction in late diastole Soft, low pitched sound Tenn ---- es—see (daLub –dup) Seen w/ CAD or cardiomyopathy

Heart Murmurs:

A heart murmur describes an extra sound in addition to the "lub-dub." Sometimes these extra sounds are simply the sound of normal blood flow moving through a normal heart. Other times, a murmur may be a sign of a heart problem.

Extra Heart Sounds

Extra Heart Sounds

Murmurs: R/t disruption of flow Commonly caused by diseased valves Characteristics:

Timing: systolic or diastolic Intensity/Loudness: grades 1-6 Pitch: High, medium, or low Pattern : crescendo; decrescendo, or square Quaility: harsh, blowing, musical Location: anatomical lanmarks Radiation: sound transmitted in direction of

blood flow

Murmurs

Systolic Mid-systolic – pulmonary or aortic stenosis Pansystolic – mitral or tricuspid regurgitation Late systolic – mitral prolapse

Diastolic Early diastolic – aortic regurgitation Mid diastolic – mitral stenosis Late diastolic – mitral stenosis

Many children may have an innocent murmur that will resolve during school age years. 

Murmurs Grading

Grade I- barely audible Grade II – quiet but clearly audible Grade III – moderately loud Grade IV – loud Grade V – Very loud, thrill easily

palpable Grade VI – Very loud heard w/o

stethoscope, + thrill

An arrhythmia is an abnormal heart rhythm. It may feel like fluttering or a brief pause. It may be so brief that it doesn’t change your overall heart rate. Or it can cause the heart rate to be too slow or too fast. Some arrhythmias don’t cause any symptoms. Others can make you feel lightheaded or dizzy. There are two basic kinds of arrhythmias.

Bradycardia is when the heart rate is too slow — less than 60 beats per minute.

Tachycardia is when the heart rate is too fast — more than 100 beats per minute.

Cardiac Arrhythmias

dizziness fatigue lightheadedness weakness palpitations (a feeling of fluttering or

pounding in the chest) shortness of breath chest pain fainting

Arrhythmia Signs and Symptoms

Age Normal Range (Average) (bpm)

3-4 years 73-137 (108) 5-7 years 65-133 (100) 8-11 years 62-130 (91) 12-15 years 80-119 (85) > 16 years 60-100

Tachycardia and Bradycardia

Most common cardiac conditions that affect children are congenital heart defects which usually are detected in infancy therefore surgical or medical interventions will have usually resolved by the time the child enters school. 

The two major types of acquired heart disease in children are rheumatic heart disease and Kawasaki disease (World Heart Federation)

Common childhood conditions affecting the heart

Rheumatic Heart Disease: condition where heart muscle and valves are damaged due to rheumatic fever. 

Signs/Symptoms: Aortic or mitral valve abnormalities (murmurs) Shortness of breath with activity or at rest Joint pain and inflammation (migrates) Small, painless nodules beneath the skin Chest pain fatigue

Common childhood conditions affecting the heart

Kawasaki disease: fever, rash, swollen hands and feet, bloodshot eyes, swollen lymph nodes, strawberry appearance to tongue, acute inflammation of blood vessels.  Cause unknown thought to be r/t infection.  Higher incidence less than 5 and more common in boys.

Common childhood conditions affecting the heart

Acquired heart diseases are most often due to: Cardiomyopathy Infections (Rheumatic Fever) Autoimmune factors Genetic Factors Teratogens – 

Chest pain is rare in pediatrics: if a child experiences chest pain it is usually related to other conditions such as costacondritis; musculoskeletal discomforts; skin conditions, or pleural pain. 

Common childhood conditions affecting the heart

Video and then Practice Time

Discussion and Questions