Ans. is 'c' i.e., Assessment of child for the presence of hea disease o The assessment of a child for the absence or presence of Hea disease can be done with the help of some guidelines suggested by NADA and are called NADA's criteria. NADA's Criteria o Either one major or two minor criteria are necessary for indicating the presence of hea disease. A) Major Criteria 1) Systolic murmur of grade III or more. The systolic murmur is classified into : ? a) Ejection systolic murmur b) Pansystolic murmur Pansystolic murmur is always abnormal no matter what is its intesity. Only three lesions produce pansystolic murmur --> i)VSD ii) MR iii) TR Ejection systolic murmur on the other hand may be organic or functional. If ejection systolic murmur is associated with thrill, it is always organic. If ejection systolic murmur is more than grade III intensity --) It is organic. Grade III or less ejection systolic murmur of a functional type may be heard in anemia or high fever in otherwise normal children. 2) Diastolic murmur Presence of diastolic murmur always indicates the presence of organic hea disease. There are two exceptions. i) Severe hypeension --> Reduction of BP may cause an AR murmur to disappear. ii) Anemia --> May result in delayed diastolic murmur across the tricuspid and mitral area. 3) Cyanosis Central cyanosis indicates presence of hea disease if lung disease has been excluded. 4) CHF Presence of CHF indicates presence of hea disease except in neonates and infants who get CHF from causes such as hypoglycemia and anemia. B) Minor criteria 1) Systolic murmur less than grade III in intensity. 2) Abnormal second hea sound Abnormal S2 always indicates presence of hea disease. It has been included as a minor criterian only because auscultation is an individual and subjective finding. 3) Abnormal ECG Main value of ECG lies in determining the : ? i) Mean QRS axis ii) Right or left atrial hyperophy iii) Right or left ventricular hyperophy 4) Abnormal X-ray If there is cardiomegaly in a good inspiratory film, it is highly suggestive for the presence of hea disease. 5) Abnormal BP