Clinical History and Physical Examination

The clinical history can provide information about the diagnosis, severity, and etiology of cardiac conditions in pediatric-age patients. Together with careful physical diagnosis, they are key to the diagnostic approach and management of these neonates, infants, and children. In this chapter, particular attention is devoted to the common childhood symptom of chest pain. Much of the chapter discusses cardiac auscultation. Normal and abnormal heart sounds are described, including their origins, where known, their normal features, and meaning of variations from normal. The origins of heart murmurs are discussed. The important features of murmurs to be identified on examination are presented. Heart murmurs are classified and related to hemodynamics. Since functional murmurs are so prevalent in childhood, details of each type and the differential from significant murmurs are emphasized. Finally, information about other organ systems that might also have abnormal findings is presented.