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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The first question on general inspection should be: is there evidence of dysmorphology? A number of dysmorphic syndromes are closely associated with specific heart lesions, and their presence lends a strong clue.

From here the hands are inspected:

  • is there clubbing - first seen in the thumbs
  • cyanosis may be apparent from the nail beds, as may anaemia

Inspection of face:

  • central cyanosis may be seen in the lips, or more convincingly the tongue
  • the teeth should be inspected for caries, which are a risk factor for infective endocarditis

Inspection of the neck is only useful in the older child - for example in teenagers. Features are similar to the adult cardiovascular examination.

Inspection of the chest:

  • a careful examination should be made for scars:
    • lateral thoracotomy scars might imply Blalock Taussig shunting in tetralogy of Fallot, or on the left might imply pulmonary artery banding.
    • midline scars are usually associated with intracardiac surgery
  • Harrison's sulcus is rarely a cardiological sign, but may be seen in chronic pulmonary hypertension with reduced lung compliance.

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