Do a full adult cardiac examination with the following additional components.

General

• Dysmorphic features 
  • Down’s, Williams and DiGeorge syndromes associated with congenital heart disease
  • Turner syndrome associated with AS
  • Noonan syndrome associated with PS
• Work of breathing
• Colour (pallor, cyanosis, mottling) 
• Alertness and interest in surroundings
• Nutritional status

	<1 year	1-2 years	2-5 years	5-12 years	>12 years
Resp rate	30-40	25-35	25-30	20-25	15-20
Heart rate	110-160	100-150	95-140	80-120	60-100

Auscultation

• Also auscultate in the following areas:
  • Left interscapular area (systolic murmur = coarctation of the aorta)
  • Left infraclavicular area (systolic murmur = coarctation of the aorta; continuous machinery-like murmur = patent ductus arteriosus)

To complete

• Observations including blood pressure
• Preductal (right hand) and postductal (left hand or either foot) oxygen saturations to assess for critical congenital heart disease (both should be ≥95%)
• Growth charts

Learn about the clinical features of congenital heart disease

Try some viva questions you may be asked