Chest pain (peds)

This page is for pediatric patients. For adult patients, see: chest pain

Background

• Common cause of presentation to the ED, especially in adolescents
• The majority of pediatric chest pain is benign and not cardiac in origin
• The main cause of cardiac chest pain in pediatrics is pericarditis
• Family history plays an important part screening for familial history of sudden death

Clinical Features

• Chest pain
• Physical exam
  • Listen for murmurs
  • Palpate
  • Compress rib cage

Differential Diagnosis

• Idiopathic (most common)
• Precordial catch syndrome
  • Sudden, intense pain with deep inspiration, self-resolving
  • Usually located to one finger point and the intercostal space (often at apex of heart)
• Musculoskeletal
  • Costochondritis, trauma
• Pulmonary
  • Pneumothorax
  • Pneumonia (Peds)
  • Pulmonary embolism
  • Aortic dissection
    • Uncommon but consider with history of connective tissue disease
• GI
  • Esophagitis
  • Esophageal spasm
  • Gastritis
• Psychosomatic
  • Panic attack
  • Anxiety
• Cardiac (1%)
  • Left-sided obstructive lesions
  • Dysrhythmias
  • HOCM
  • Pericarditis
  • Prinzmetal's angina (vasospasm)
  • MI
    • Rare, even post-Kawasaki
    • Consider coronary artery dissection
  • Mitral valve prolapse

Evaluation

• ECG
• CXR
• Consider echocardiography

See Also

• Chest pain