Recently, there has been an increase in pathologies in children associated with the cardiovascular system. With early detection of the disease, the percentage of recovery is much higher. One of the effective methods for determining the performance of the main organ in the body is percussion. Consider the algorithm for determining the boundaries of the heart in children, the causes of deviations from the norm, as well as what diseases they indicate and how to prevent them.
Features of the cardiovascular system of the child
The heart muscle in a child has its own anatomical features, depending on age. For example, at birth, heart weight is only 0.8% of the total weight of the baby (22 g), in adults - 0.4%. The ventricles (right and left) are almost identical in mass, the wall thickness is only 5 mm. By the year the heart mass doubles, by 3 years - three times, by six years - 11 times. The load on the left ventricle grows with age, its wall thickness reaches 10 mm by the age of 14, and the right one is only 6 mm.
As they mature, tissue maturation, connective tissue densification and proliferation of arteries, through which blood supply occurs, also occurs. Until the age of 12, the aorta in a child has already a pulmonary artery, then the lumens become the same, and the borders of the heart in children are formed up to 15 years. With age, the volume of blood flow also increases.
There are also differences in the anatomical location of the heart in children and adults:
- In babies, the heart is higher; as it grows older, it sinks. This is primarily due to the structure of the diaphragm.
- At birth, the baby's heart resembles a ball. During the first years of life, it moves inside the cell and gradually descends.
- There is also a difference in heart rate, in babies the pulse is more frequent than in adults, because the heart muscle contracts faster and the metabolism is intense.
How is the study of the work of the heart in children
Before determining the boundaries of the heart in children, it is necessary to examine the main organ for performance. The first indicator is the heart rate. It should be symmetrical on both hands. The characteristics of the pulse also include properties such as rhythm, tension, filling, size and shape.
At the same time, it is taken into account that heart rate indicators can be individual. Depending on age, there are certain norms, deviations from which can be within 20%. If the pulse is more frequent - there is tachycardia, a slowed heart rate indicates bradycardia. Heart rate is calculated per minute in between physical activities. Rhythm is when it is measured at certain intervals.
Deviations from normal indications can be caused by various diseases, not even related to the organs of the cardiovascular system. But this is an occasion to see a doctor. You can determine the work of the heart using a one-time cardiogram or with the measurement of indicators throughout the day to notice how and when the state of the heart muscle changes.
Features of the location of the heart in children by age
There are indicators of the work of the heart muscle that determine the normal development of the child. This primarily relates to the size and location of the heart, which is due to the anatomical structure of both children and adults.
Determining the boundaries of the heart in children allows you to evaluate the functionality of the organ, as well as identify possible pathologies in its development. Distinguish the boundaries of relative and absolute dullness of the heart by age:
- up to two years, the organ is located 2 cm from the left nipple line, above at the level of the second rib;
- by seven years - 1 cm from the left nipple line, and above in the region of the 2nd intercostal space;
- to 12 years - at the level of the left nipple line and the third rib.
The boundaries of the absolute dullness of the main organ, regardless of age, look like this: the right side is located at the level of the left sternal line, up to two years at the level of the 3rd rib, up to seven years - of the 3rd intercostal space, by 12 years old - at the level of 4- th ribs.
The knowledge gained about the location of the heart, depending on age, allows you to listen to the organ with a stethoscope and evaluate the work of its components. This physical diagnostic method is called auscultation of the heart and is carried out at 5 different points:
- The mitral valve is audible in the apical region.
- Aortic valve - in the 2nd intercostal space on the right side.
- Pulmonary valve - in the 2nd intercostal space on the left side,
- Tricuspid valve - at the base of the xiphoid process of the sternum.
- The aortic valve is at the Botkin-Erba point (4 intercostal space to the left of the sternum).
When evaluating auscultation, you can evaluate the work of the heart by the following indicators:
- volume, clarity and purity of tones;
- rhythm;
- tone ratio;
- the presence or absence of noise.
Healthy children hear loud, clear and rhythmic tones, no noise. If noise is present, this indicates a pathology that is examined for localization, intensity and duration.
Methods for determining the boundaries of the heart in children
Using the method of percussion, you can determine the size, position and configuration of the heart in both children and adults. It can be carried out in a vertical and horizontal position. There are also direct percussion, which determines the size and configuration of the organ in babies and indirect - used in adolescents.
Percussion of the borders of the heart in children, the basic rules:
- Absolute borders of the heart are determined by the quietest percussion, relative - quiet.
- A research method is carried out along the intercostal space, moving from the lungs to the heart (pulmonary sound is clearer, then goes blunt), while the finger moves parallel to the border of the heart, which is determined in advance.
- The absolute border is determined by the inner edge of the finger, the relative - by the outer.
- In the ortho-sagittal plane, percussion defines the left border of relative cardiac dullness.
- The procedure is carried out in a certain sequence.
The determination of the boundaries of the heart in children by percussion is carried out according to the following sequence:
- the height of the diaphragm is determined;
- the right border is determined one edge above (4th intercostal space), then the left border;
- the apical impulse is found by palpation and the left border of the organ is determined by this intercostal space (4 or 5).
Relative and absolute boundaries of the heart in a child
Considering the size, configuration and location of the heart, it is worth noting that its boundaries depend on age. For example, the boundaries of the heart in a 5-year-old child are as follows: the upper border is at the level of the 2nd intercostal space, the right border is 1 cm from the right sternum line, and the left one is 1 cm from the left sternum line.
Up to two years, the baby’s organ is 2 cm from the sternal lines, then it moves and increases in size. Its configuration also changes - from a round ball it turns into a cavity of a convex shape, similar to a heart.
Reasons for Border Offsets
Perhaps a shift in the boundaries of the heart in children, which does not depend on natural processes, that is, age, but is associated with pathology. Here, experts determine not only the angle of displacement, but also its direction.
What does the nature of the displacement of the borders of the heart indicate?
- A shift to the right side indicates cardiac or extracardial causes - it may indicate hypertrophy of the right heart (atrial septal defect). It can also be a consequence of pneumothorax, chronic pneumonia, bronchial asthma or whooping cough.
- Left shift - indicates left ventricular hypertrophy, mitral valve insufficiency or an increase in the right side of the heart can also be the result of sepsis, infectious diseases and right-sided exudative pleurisy.
- Upward shift - can cause hypertrophy or dilatation of both ventricles (stenosis and mitral valve insufficiency), carditis, cardiomyopathy, fibroelastosis.
- Displacement in all directions occurs with exudative pleurisy, hyperthyroidism and hypothyroidism.
Clarifying the diagnosis, relying on knowledge of the boundaries of the heart in children by age, can be done by listening to the organ. It should be remembered that with flatulence, ascites, tumors, an increase in the size of absolute dullness is observed, with emphysema, pneumothorax, enteroptosis - a decrease.
What are the norms and deviations in the heart rate in children?
The indicators of the main organ can be estimated by other factors, if the borders of the heart in children are normal. First of all, the baby’s heartbeat is examined, that is, its frequency (heart rate). Normal indicators of newborn babies are 100-160 bpm / min, children under 10 years old - 700-120 bpm, up to 12 years old - 60-100 bpm.
At the same time, sinus arrhythmia, that is, irregular heart rhythms (slowdown and acceleration), is considered quite normal for children. It can be detected using an ECG and it does not cause anxiety. Doctors are guided by the average indicators of the heartbeat of children, depending on age.
Normal indicators of heart rate in children by age:
- 1 month - 140 bpm (deviations from the norm, non-disturbing from 110 to 170 bpm);
- 12 months - 130 bpm (100-170 bpm);
- 3 years - 105 bpm (85-130 bpm);
- 5 years - 95 beats / min (in the absence of a displacement of the borders of the heart in a child of 5 years, the pulse can range from 75 to 125 beats / min);
- 8 years - 90 bpm (70–115 bpm);
- 10 years - 85 bpm (65–110 bpm);
- 12 years - 80 bpm (60–105 bpm);
- 15 years - the heartbeat is almost like that of an adult and is 75 beats / min (fluctuations from 55 to 110 beats / min are considered normal).
A rapid heartbeat in its normal location can be caused by the baby's psychoemotional state (crying). But the slow should alert. This may indicate congenital problems that led to rhythm disturbance. Adolescents may have bradycardia, that is, a slowdown in heart rate. Most often, it is observed in those who are actively involved in sports.
It is worthwhile to consult a doctor if a child’s heart rhythm is less than 50 beats / min, long-term interruptions in the heart rhythm (it should work without stopping) or a sharp acceleration of heart rate for no reason.
What affects the change in heart rate?
Determining the boundaries of the heart in children 5 years old (especially before school) is an important indicator that determines the absence of pathologies. An equally important criterion for evaluating an organ is the pulse rate. But what can lead to changes in heart rate, that is, slow down or speed it up?
Physiological factors can contribute to bradycardia: increased physical activity, prolonged sleep, cooling the body, taking sedatives. It is also worth noting that it may indicate other disorders: poisoning, ulcer, stroke, traumatic brain injury, high blood pressure, tumor, nervous system disease, heart failure, anemia, hyperthyroidism and heart disease.
Heart rate indicators in a child can vary for a number of reasons:
- disturbances in cardiac activity;
- lack of oxygen in the lungs;
- decrease in oxygen in the blood and pathology of the organ.
As a rule, such indicators are far from the norm of the child by age, therefore, they require constant monitoring.
Prevention
A normal heartbeat and the correct location of the heart within the normal range ensures a good supply of blood to vital organs, especially the brain. In order to protect the child from heart problems, there are preventive measures:
- Sports (about half an hour a day) - it can even be a walk in the fresh air.
- Lack of stress and overstrain. Avoid situations where the baby may be afraid).
- Normalization of weight due to diet. Food for the child should be varied and consist of age-appropriate vitamins and minerals.
- Rest and good sleep.
Exercise such as running, swimming, and cycling affects a good heart function.