Pediatric CVS Conditions and Clinical Diagnostic Guide

This app is a comprehensive collection of pediatric cardiovascular system (CVS) conditions, meticulously categorized with their specific clinical diagnostic findings. It serves as an invaluable resource for students and pediatricians, providing detailed insights into the presentation and evaluation of various heart-related conditions in children. Each condition is accompanied by a clear breakdown of key diagnostic signs, symptoms, and physical examination techniques.

Designed to enhance the clinical understanding of pediatric CVS conditions, the app enables users to systematically approach diagnosis and improve their clinical skills. Whether you are a medical student learning about cardiovascular diseases or a pediatrician refining your diagnostic accuracy, this app serves as a practical guide for day-to-day clinical practice.

Atrial Septal Defect (ASD)

Often asymptomatic in infancy and early childhood. Family history of congenital heart defects may be present.

Fixed splitting of S2 heart sound, systolic ejection murmur at upper left sternal border, right ventricular heave.

Ventricular Septal Defect (VSD)

May present with failure to thrive, recurrent respiratory infections, or heart failure symptoms in infancy.

Harsh holosystolic murmur best heard at left lower sternal border, hyperdynamic precordium, signs of pulmonary hypertension in large defects.

Patent Ductus Arteriosus (PDA)

Premature infants are at higher risk. May be asymptomatic or present with signs of heart failure.

Continuous "machinery" murmur best heard at left infraclavicular area, bounding peripheral pulses, wide pulse pressure.

Tetralogy of Fallot (TOF)

Cyanosis that worsens with crying or feeding, squatting behavior in older children, history of "tet spells".

Cyanosis, clubbing of fingers and toes, systolic ejection murmur at left sternal border, single S2 heart sound.

Coarctation of the Aorta

May present with heart failure in infancy or hypertension and headaches in older children.

Upper extremity hypertension, weak femoral pulses, systolic murmur best heard in the back, suprasternal notch thrill.

Transposition of the Great Arteries (TGA)

Severe cyanosis noted shortly after birth, not improving with oxygen administration.

Central cyanosis, tachypnea, single S2 heart sound, absence of significant murmur in simple TGA.

Hypoplastic Left Heart Syndrome (HLHS)

Rapid onset of symptoms in the first few days of life, including poor feeding, lethargy, and respiratory distress.

Cyanosis, tachypnea, weak pulses, single S2 heart sound, gallop rhythm, hepatomegaly.

Truncus Arteriosus

Symptoms of heart failure in early infancy, including poor feeding, sweating, and rapid breathing.

Single loud S2 heart sound, systolic ejection murmur, signs of pulmonary overcirculation, wide pulse pressure.

Atrioventricular Septal Defect (AVSD)

Associated with Down syndrome. May present with failure to thrive and recurrent respiratory infections.

Systolic murmur at left sternal border, fixed splitting of S2, signs of pulmonary hypertension in complete AVSD.

Pulmonary Stenosis

Often asymptomatic in mild cases. Severe cases may present with exercise intolerance or right-sided heart failure.

Systolic ejection murmur at left upper sternal border, ejection click, right ventricular heave in severe cases.

Ebstein's Anomaly

Variable presentation from fetal life to adulthood. Neonates may present with cyanosis and heart failure. Older children may have exercise intolerance, palpitations, or cyanosis. Family history of congenital heart disease or sudden cardiac death may be present.

Wide splitting of S1, systolic murmur of tricuspid regurgitation, cyanosis in severe cases. Chest X-ray may show cardiomegaly with a "box-shaped" heart. ECG often shows right bundle branch block and tall, broad P waves ("Himalayan" P waves).

Total Anomalous Pulmonary Venous Return (TAPVR)

Presents in early infancy with cyanosis and respiratory distress. Obstructed TAPVR presents more acutely with severe cyanosis and pulmonary edema. Unobstructed TAPVR may present later with failure to thrive and recurrent respiratory infections.

Tachypnea, cyanosis, increased right ventricular impulse. Systolic ejection murmur at left upper sternal border. In obstructed TAPVR, there may be signs of severe pulmonary hypertension and right heart failure. Chest X-ray may show "snowman" or "figure-8" appearance in supracardiac TAPVR.

Tricuspid Atresia

Presents in early infancy with cyanosis. Severity depends on associated lesions. History of poor feeding, failure to thrive, and increased fatigue with feeding may be present.

Central cyanosis, diminished right ventricular impulse, single S2 heart sound. Systolic murmur of VSD if present. Left ventricular heave due to volume overload. Clubbing in older children.

Pulmonary Atresia with Intact Ventricular Septum

Presents in the newborn period with severe cyanosis and signs of right heart failure. History of poor feeding, tachypnea, and irritability.

Central cyanosis, single S2 heart sound, systolic murmur of tricuspid regurgitation may be present. Right ventricular heave may be absent. Hepatomegaly and peripheral edema in severe cases.

Aortic Stenosis

Can be asymptomatic in mild cases. Severe cases may present with syncope, chest pain, or signs of left heart failure. Family history of bicuspid aortic valve or sudden cardiac death may be present.

Systolic ejection click followed by a crescendo-decrescendo systolic murmur at right upper sternal border. Murmur radiates to carotids. Narrow pulse pressure in severe cases. Left ventricular heave may be present.

Persistent Truncus Arteriosus

Presents in early infancy with signs of heart failure and mild cyanosis. History of poor feeding, failure to thrive, and increased respiratory effort with feeding.

Mild central cyanosis, bounding peripheral pulses, wide pulse pressure. Single S2 heart sound, systolic ejection murmur at left sternal border. Signs of pulmonary overcirculation and heart failure (tachypnea, hepatomegaly) develop over time.

Double Outlet Right Ventricle (DORV)

Presentation varies depending on associated lesions. May present with cyanosis, heart failure, or both. History of poor weight gain and increased respiratory effort may be present.

Cyanosis (variable), systolic murmur (character depends on associated VSD and outflow tract obstruction). Right ventricular heave, single or widely split S2 heart sound. Signs of heart failure may be present.

Interrupted Aortic Arch

Presents in early neonatal period as ductal-dependent lesion. History of poor feeding, tachypnea, and rapid deterioration when ductus arteriosus begins to close.

Differential cyanosis (lower body more cyanotic than upper), diminished or absent femoral pulses, systolic murmur at left sternal border. Signs of heart failure develop rapidly without intervention.

Cor Triatriatum

Presentation varies from infancy to adulthood depending on the degree of obstruction. May present with signs of pulmonary venous obstruction or mimic mitral stenosis. History of recurrent respiratory infections and exercise intolerance in older children.

Tachypnea, diastolic rumble at apex, signs of pulmonary hypertension in severe cases. Fixed splitting of S2 heart sound may be present. Right ventricular heave in advanced cases.

Single Ventricle Defects

Presents in early infancy with cyanosis and/or heart failure. History of poor feeding, failure to thrive, and increased work of breathing. Specific presentation depends on associated lesions.

Cyanosis, single S2 heart sound, systolic murmur (varies with associated lesions). Signs of heart failure may be present. Clubbing in older children.

Aortopulmonary Window

Presents in early infancy with signs of pulmonary overcirculation and heart failure. History of poor feeding, tachypnea, and failure to thrive. Often associated with other cardiac anomalies.

Bounding peripheral pulses, wide pulse pressure, continuous murmur at left upper sternal border. Signs of congestive heart failure including tachypnea, hepatomegaly, and poor perfusion may be present.

Pulmonary Atresia with Ventricular Septal Defect

Presents in neonatal period with severe cyanosis. History of rapid, shallow breathing and poor feeding. Cyanotic spells may occur, especially during crying or defecation.

Central cyanosis, single S2 heart sound, continuous murmur of collateral vessels may be heard in the back. Right ventricular heave may be present. Clubbing develops over time.

Partial Anomalous Pulmonary Venous Return

Often asymptomatic in childhood. May present with exercise intolerance or recurrent respiratory infections. Sometimes discovered incidentally on chest imaging.

Right ventricular heave, fixed splitting of S2 heart sound, systolic ejection murmur at left upper sternal border. Signs of right heart volume overload on ECG and chest X-ray.

Coronary Artery Anomalies

May be asymptomatic or present with exertional chest pain, syncope, or sudden cardiac death. Family history of sudden cardiac death in young individuals may be present.

Often no specific findings on physical exam. Exercise stress test may show ischemic changes. Definitive diagnosis requires imaging (CT angiography or cardiac catheterization).

Eisenmenger Syndrome

Late complication of unrepaired left-to-right shunts. Progressive cyanosis and exercise intolerance in older children or adolescents. History of known cardiac defect often present.

Central cyanosis, clubbing, differential cyanosis may be present. Loud, single S2 heart sound. Right ventricular heave. Murmur of pulmonary regurgitation may be present.

Heterotaxy Syndrome

Complex congenital anomaly affecting multiple organ systems. Cardiac manifestations vary widely. May present with cyanosis, heart failure, or arrhythmias. Associated non-cardiac anomalies often present.

Varies depending on specific cardiac lesions. May include dextrocardia, murmurs of septal defects, signs of outflow tract obstruction. Abdominal examination may reveal abnormal visceral situs.

Vascular Rings and Slings

May present with stridor, recurrent respiratory infections, or feeding difficulties. Symptoms often worsen with age. History of positional changes affecting breathing or swallowing may be present.

Inspiratory stridor, expiratory wheezing, suprasternal retractions. Rarely, may hear a bruit over the affected area. Cardiovascular exam often normal unless associated cardiac defects are present.

Kawasaki Disease

Acute febrile illness in young children. History of high fever for ≥5 days, rash, conjunctivitis, oral changes, cervical lymphadenopathy, and extremity changes. Risk of coronary artery aneurysms.

In acute phase: fever, polymorphous rash, bilateral non-exudative conjunctivitis, red cracked lips, strawberry tongue. In subacute phase: periungual desquamation. Cardiovascular findings may include tachycardia, gallop rhythm, and signs of myocarditis or pericarditis.

Marfan Syndrome

Genetic connective tissue disorder. Family history often present. Cardiovascular manifestations include aortic root dilation and mitral valve prolapse. May present with chest pain, palpitations, or syncope.

Tall stature, long limbs, arachnodactyly, pectus deformities. Cardiovascular exam may reveal mitral regurgitation murmur, aortic regurgitation murmur, or midsystolic click of mitral valve prolapse.

Williams Syndrome

Genetic disorder with characteristic facial features and developmental delay. Cardiovascular manifestations include supravalvular aortic stenosis and peripheral pulmonary stenosis. May present with failure to thrive or heart murmur.

Distinctive elfin facies. Cardiovascular exam may reveal systolic ejection murmur at right upper sternal border radiating to the back (supravalvular aortic stenosis) and/or systolic murmur at left upper sternal border (pulmonary stenosis). Hypertension may be present.

Dilated Cardiomyopathy

May be idiopathic or secondary to various causes (viral myocarditis, genetic disorders, metabolic diseases). Presents with signs of heart failure. History of recent viral illness, failure to thrive, or exercise intolerance may be present.

Tachycardia, tachypnea, hepatomegaly. Displaced apical impulse, S3 gallop rhythm. Mitral regurgitation murmur may be present. Signs of pulmonary edema in severe cases.

Hypertrophic Cardiomyopathy

Often familial. May be asymptomatic or present with exertional dyspnea, chest pain, palpitations, or syncope. Family history of sudden cardiac death may be present.

Harsh systolic ejection murmur at left lower sternal border that increases with Valsalva maneuver. Double apical impulse. S4 gallop may be present. Carotid pulse may have rapid upstroke and descent.

Restrictive Cardiomyopathy

Rare in children. May present with exercise intolerance, fatigue, or signs of right heart failure. History of systemic diseases (e.g., amyloidosis, sarcoidosis) may be present in older children.

Elevated jugular venous pressure with prominent y descent, hepatomegaly, peripheral edema. S3 or S4 gallop may be present. Auscultation may reveal regurgitant murmurs of mitral and tricuspid valves.

Left Ventricular Non-compaction

May be asymptomatic or present with heart failure, arrhythmias, or thromboembolic events. Family history of cardiomyopathy or sudden cardiac death may be present.

Signs of left ventricular dysfunction including displaced apical impulse, S3 gallop rhythm. Systolic murmur of mitral regurgitation may be present. Arrhythmias may be detected on examination or ECG.

Cardiac Tumors (e.g., Rhabdomyoma)

May be asymptomatic or present with heart failure, arrhythmias, or embolic phenomena. In infants, may be associated with tuberous sclerosis. Prenatal diagnosis on fetal echocardiography is common.

Varies depending on tumor location and size. May include murmurs, abnormal heart sounds, or signs of heart failure. Arrhythmias may be detected on examination or ECG.

Myocarditis

Often follows a viral illness. Presents with rapid onset of fatigue, dyspnea, chest pain, or signs of heart failure. Recent history of upper respiratory or gastrointestinal infection is common.

Tachycardia, tachypnea, hypotension in severe cases. S3 gallop rhythm, pericardial friction rub may be present. Signs of congestion including hepatomegaly and pulmonary rales in advanced cases.

Pericarditis

May be idiopathic, post-infectious, or associated with systemic diseases. Presents with chest pain (often positional), fever, and sometimes signs of tamponade. Recent viral illness or trauma history may be present.

Pericardial friction rub (best heard with patient leaning forward), distant heart sounds if effusion present. Signs of tamponade include tachycardia, hypotension, pulsus paradoxus, and elevated jugular venous pressure.

Long QT Syndrome

May be asymptomatic or present with syncope, seizures, or cardiac arrest. Often triggered by exercise, emotion, or auditory stimuli. Family history of sudden cardiac death or unexplained syncope may be present.

Often normal physical exam. Bradycardia may be present in some forms. Diagnosis primarily based on ECG findings and family history.

Wolff-Parkinson-White Syndrome

May be asymptomatic or present with palpitations, tachycardia, or syncope. Onset of symptoms often in adolescence or young adulthood. Family history may be present.

Often normal physical exam between episodes. During tachycardia episodes: rapid, regular pulse, and signs of hemodynamic compromise in severe cases. Diagnosis confirmed by ECG showing pre-excitation.

Pulmonary Hypertension

May be idiopathic or secondary to congenital heart disease, lung disease, or systemic disorders. Presents with progressive dyspnea, fatigue, syncope, or right heart failure.

Loud P2 component of S2 heart sound, right ventricular heave, systolic murmur of tricuspid regurgitation. In advanced cases: elevated jugular venous pressure, hepatomegaly, peripheral edema.

Rheumatic Heart Disease

Follows acute rheumatic fever. History of recurrent strep throat infections. May present with signs of valvular disease (most commonly mitral regurgitation or stenosis) years after initial infection.

Depends on affected valve(s). Mitral stenosis: diastolic rumble at apex. Mitral regurgitation: holosystolic murmur at apex. Aortic regurgitation: early diastolic murmur at left sternal border.

Endocarditis

Often subacute onset in children with underlying heart disease or indwelling central lines. Presents with fever, fatigue, weight loss, and sometimes embolic phenomena.

Fever, new or changed heart murmur, petechiae, splinter hemorrhages, Janeway lesions, Osler nodes. Splenomegaly may be present. Signs of heart failure if valvular destruction occurs.

Cardiac Effects of Systemic Diseases (e.g., Duchenne Muscular Dystrophy)

Cardiac involvement may be asymptomatic initially. In Duchenne's, cardiac symptoms often develop in second decade. History of muscle weakness, delayed motor milestones, and elevated CK levels.

Signs of dilated cardiomyopathy may develop over time: displaced apical impulse, S3 gallop, mitral regurgitation murmur. Arrhythmias may be detected on examination or ECG.

Postural Orthostatic Tachycardia Syndrome (POTS)

Presents with lightheadedness, palpitations, fatigue, and sometimes syncope upon standing. Symptoms worse in hot environments or after prolonged standing. Often affects adolescent females.

Normal examination when supine. Upon standing: significant increase in heart rate (≥30 bpm in children) without orthostatic hypotension. May see acrocyanosis of lower extremities.

Cardiac Manifestations of Genetic Syndromes (e.g., Noonan Syndrome)

Noonan syndrome presents with characteristic facial features, short stature, and various cardiac defects. Most common cardiac finding is pulmonary valve stenosis. May have history of feeding difficulties in infancy.

Short stature, webbed neck, wide-spaced eyes. Cardiac exam may reveal systolic ejection murmur of pulmonary stenosis, signs of hypertrophic cardiomyopathy, or other congenital defects.

Fontan Circulation Complications

History of single ventricle physiology with Fontan palliation. May present with exercise intolerance, fatigue, abdominal pain, or signs of protein-losing enteropathy. Thromboembolic events can occur.

Often cyanotic at baseline. Hepatomegaly, ascites, and peripheral edema may develop. Systolic murmur of AV valve regurgitation may be present. Venous congestion in neck veins and abdominal wall collaterals may be visible.

Cardiac Effects of Chemotherapy (e.g., Anthracycline-Induced Cardiomyopathy)

History of cancer treatment with cardiotoxic agents. May be asymptomatic initially or present with signs of heart failure. Risk increases with cumulative dose and time since treatment.

Signs of dilated cardiomyopathy: displaced apical impulse, S3 gallop, mitral regurgitation murmur. Tachycardia and signs of congestion (hepatomegaly, pulmonary rales) in advanced cases.

Congenital Coronary Artery Fistula

Often asymptomatic in childhood. May present with exertional chest pain, dyspnea, or heart failure symptoms. Sometimes discovered incidentally on echocardiography or due to heart murmur.

Continuous machinery-like murmur, best heard over the precordium. Location varies depending on fistula origin and drainage site. Rarely, signs of myocardial ischemia or heart failure may be present.

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)

Often presents in adolescence or young adulthood with palpitations, syncope, or cardiac arrest. Family history of sudden cardiac death may be present. Exercise can trigger symptoms.

Often normal physical exam. May have prominent jugular venous a-wave, widely split S2, or systolic murmur of tricuspid regurgitation. Ventricular arrhythmias may be detected on examination or ECG.

Systemic Lupus Erythematosus (SLE) with Cardiac Involvement

Multisystem autoimmune disease. Cardiac involvement can include pericarditis, myocarditis, or valvular disease. May present with chest pain, dyspnea, or signs of heart failure.

Pericardial friction rub if pericarditis present. Signs of myocarditis (tachycardia, S3 gallop) or valvulitis (most commonly mitral or aortic regurgitation murmurs) may be present. Other systemic findings of SLE often evident.