Finding		Significance
Abnormal growth (height and weight plotted on growth chart)		Feeding difficulties may be a sign of cardiac disease in newborns and infants (decreased exercise capacity)
		Certain genetic disorders may increase risk of delayed growth and CHD
Abnormal vital signs (compared with age-adjusted norms)		Arrhythmia, tachycardia, hypoxia, and tachypnea may indicate underlying structural heart disease
		Blood pressure discrepancy between upper and lower limbs may indicate coarctation of the aorta (pressure gradient of > 20 mm Hg with low blood pressure in the lower extremities)
Adventitial breath sounds (e.g., wheezing, rales, ronchi, pleural rub)		Wheezing may be associated with cardiac asthma; rales may be associated with pulmonary congestion secondary to congestive heart failure
Chest contour signaling maldevelopment of the sternum15		Defective segmentation of the sternum may occur in children with CHD
Dysmorphic features		Certain genetic or congenital conditions increase risk of CHD
Cardiovascular findings
	Abnormal S2	Classic finding of wide split fixed S2 with atrial septal defects; abnormal S2 may be present in other types of CHD
	Capillary refill	Normal peripheral perfusion is less than 2 to 3 seconds; delay may indicate poor perfusion secondary to diminished cardiac output
	Displaced point of maximal impulse; precordial impulses (heaves, lifts, thrills)	Possible structural abnormality or ventricular enlargement
	Edema	Congestive heart failure
	Left-sided precordial bulge	Cardiac enlargement
	S3 or S4	Can indicate structural heart disease; S3 can be a normal finding but usually disappears when patient is upright
	Substernal heave	Right ventricular hypertension
	Systolic ejection click	Semilunar valvular stenosis
	Weak or absent femoral pulses	Coarctation of the aorta
Gastrointestinal findings
	Ascites	Congestive heart failure
	Hepatomegaly	Congestive heart failure
	Location of liver signals abdominal situs	High rate of CHD with abdominal situs