Chest pain in children

Jump to navigation Jump to search


Siren.gif

Resident
Survival
Guide

WikiDoc Resources for Chest pain in children

Articles

Most recent articles on Chest pain in children

Most cited articles on Chest pain in children

Review articles on Chest pain in children

Articles on Chest pain in children in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Chest pain in children

Images of Chest pain in children

Photos of Chest pain in children

Podcasts & MP3s on Chest pain in children

Videos on Chest pain in children

Evidence Based Medicine

Cochrane Collaboration on Chest pain in children

Bandolier on Chest pain in children

TRIP on Chest pain in children

Clinical Trials

Ongoing Trials on Chest pain in children at Clinical Trials.gov

Trial results on Chest pain in children

Clinical Trials on Chest pain in children at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Chest pain in children

NICE Guidance on Chest pain in children

NHS PRODIGY Guidance

FDA on Chest pain in children

CDC on Chest pain in children

Books

Books on Chest pain in children

News

Chest pain in children in the news

Be alerted to news on Chest pain in children

News trends on Chest pain in children

Commentary

Blogs on Chest pain in children

Definitions

Definitions of Chest pain in children

Patient Resources / Community

Patient resources on Chest pain in children

Discussion groups on Chest pain in children

Patient Handouts on Chest pain in children

Directions to Hospitals Treating Chest pain in children

Risk calculators and risk factors for Chest pain in children

Healthcare Provider Resources

Symptoms of Chest pain in children

Causes & Risk Factors for Chest pain in children

Diagnostic studies for Chest pain in children

Treatment of Chest pain in children

Continuing Medical Education (CME)

CME Programs on Chest pain in children

International

Chest pain in children en Espanol

Chest pain in children en Francais

Business

Chest pain in children in the Marketplace

Patents on Chest pain in children

Experimental / Informatics

List of terms related to Chest pain in children

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mitra Chitsazan, M.D.[2]

Synonyms and Keywords: Chest pain in kids, pediatric chest pain

Overview

Chest pain is a common symptom in children and adolescents. Despite causing considerable concerns and anxiety in patients and their families, most cases have benign and non-cardiac etiologies. A throughout history and physical examination can reveal diagnoses in the majority of patients, necessitating laboratory testing and imaging studies only in a small subset of patients.

Historical Perspective

There is limited evidence on the historical perspective of chest pain in children.

Classification

There is no established system for the classification of chest pain in the pediatric population.

Pathophysiology

Causes

The most common causes of chest pain in children include musculoskeletal, respiratory, psychogenic, and idiopathic. A comprehensive list of causes of chest pain in children is presented in the table below: [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]

Causes of pediatric chest pain
Musculoskeletal
  • Muscle overuse/strain
Respiratory
  • Severe and/or chronic Cough
  • Foreign body
Psychogenic
Gastrointestinal
Cardiac
Miscellaneous
  • Tumors (chest wall/mediastinal)
Idiopathic

For a complete list of causes of chest pain in children click here.

Differentiating pediatric chest pain from other Diseases

Epidemiology and Demographics

  • Chest pain accounts for 0.3%-0.6% of emergency department visits, 15% of outpatient visits, and 5.2% of cardiology consultations in the pediatric population. [24] [25]
  • In children and adolescents aged 10-21 years, chest pain has been reported to cause ≥ 650,000 annual pediatric cardiologist visits. [24]

Risk factors

Common risk factors in the development of chest pain in children include: [1][2][3][4][5][6][7][8][9][10][11][12][26][27][28][16][29][18]

Screening

There is insufficient evidence to recommend routine screening for chest pain in children.

Natural History, Complications and Prognosis

  • Most cases of chest pain in children are benign, and cardiac causes have been identified in less than 1% of children with chest pain. [24] [30]
  • Despite having benign etiologies, chest pain in children may contribute to school absences, activity restrictions, and significant anxiety in children and their families.
  • The complications of chest pain in children depend on the underlying etiology.

Diagnosis

Diagnostic Study of Choice

History and symptoms

  • A detailed history is of crucial importance when assessing a child with chest pain as it can help to make a definitive diagnosis in the majority of pediatric patients with chest pain. [1][31][32][30]
  • Particular attention should be paid to the nature of the pain, its characteristics, and associated symptoms.
  • Younger children may interpret a wide range of symptoms and even unpleasant sensations in their chest wall as chest pain. A thorough history may help differentiate true chest pain from these unusual sensations.
  • The important characteristics of chest pain that can help to differentiate the underlying etiology are as follows:
Musculoskeletal
  • Usually well-localized
  • Associated with chest wall tenderness, i.e., reproducible with palpation or gentle pressure
  • Worse with movement, coughing, and inspiration
Respiratory
Psychogenic
Gastrointestinal
Cardiac
Other important clues in making the diagnosis of chest pain in children include:

Physical Examination

Laboratory Findings

Electrocardiogram

An electrocardiogram (ECG) should be obtained if there is a clinical suspicion of cardiac disease based upon history orphysical examination findings. [1]

X-ray

Echocardiography or Ultrasound

CT scan

MRI

Other Diagnostic Studies

*For an algorithmic guide on the diagnosis of chest pain in children, click here.

Treatment

Medical Therapy

*For a complete guide on the algorithmic approach to the treatment of chest pain in children, click here.

Surgery

Surgical intervention may be indicated in patients with: [34] [35] [36] [37]

Primary Prevention

There are no established measures for the primary prevention of chest pain in children.

Secondary Prevention

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Friedman KG, Alexander ME (September 2013). "Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease". J Pediatr. 163 (3): 896–901.e1–3. doi:10.1016/j.jpeds.2013.05.001. PMC 3982288. PMID 23769502.
  2. 2.0 2.1 2.2 Aeschlimann A, Kahn MF (1990). "Tietze's syndrome: a critical review". Clin Exp Rheumatol. 8 (4): 407–12. PMID 1697801.
  3. 3.0 3.1 3.2 Heinz, George J. (1977). "Slipping Rib Syndrome". JAMA. 237 (8): 794. doi:10.1001/jama.1977.03270350054023. ISSN 0098-7484.
  4. 4.0 4.1 4.2 Selbst SM (June 1985). "Chest pain in children". Pediatrics. 75 (6): 1068–70. PMID 4000782.
  5. 5.0 5.1 5.2 Howell, John M. (1992). "Xiphodynia: A report of three cases". The Journal of Emergency Medicine. 10 (4): 435–438. doi:10.1016/0736-4679(92)90272-U. ISSN 0736-4679.
  6. 6.0 6.1 6.2 Pickering, D (1981). "Precordial catch syndrome". Archives of Disease in Childhood. 56 (5): 401–403. doi:10.1136/adc.56.5.401. ISSN 0003-9888.
  7. 7.0 7.1 7.2 Wiens L, Sabath R, Ewing L, Gowdamarajan R, Portnoy J, Scagliotti D (September 1992). "Chest pain in otherwise healthy children and adolescents is frequently caused by exercise-induced asthma". Pediatrics. 90 (3): 350–3. PMID 1518687.
  8. 8.0 8.1 8.2 Evangelista, Juli-anne K.; Parsons, Marytheresa; Renneburg, Anne K. (2000). "Chest pain in children: diagnosis through history and physical examination". Journal of Pediatric Health Care. 14 (1): 3–8. doi:10.1016/S0891-5245(00)70037-X. ISSN 0891-5245.
  9. 9.0 9.1 9.2 Barth, Charles W.; Roberts, William C. (1986). "Left main coronary artery originating from the right sinus of valsalva and coursing between the aorta and pulmonary trunk". Journal of the American College of Cardiology. 7 (2): 366–373. doi:10.1016/S0735-1097(86)80507-1. ISSN 0735-1097.
  10. 10.0 10.1 10.2 Lipsitz, Joshua D.; Masia, Carrie; Apfel, Howard; Marans, Zvi; Gur, Merav; Dent, Heather; Fyer, Abby J. (2005). "Noncardiac chest pain and psychopathology in children and adolescents". Journal of Psychosomatic Research. 59 (3): 185–188. doi:10.1016/j.jpsychores.2005.05.004. ISSN 0022-3999.
  11. 11.0 11.1 11.2 Lee, Jennifer L.; Gilleland, Jordan; Campbell, Robert M.; Simpson, Patricia; Johnson, Gregory L.; Dooley, Kenneth J.; Blount, Ronald L. (2013). "Health care utilization and psychosocial factors in pediatric noncardiac chest pain". Health Psychology. 32 (3): 320–327. doi:10.1037/a0027806. ISSN 1930-7810.
  12. 12.0 12.1 12.2 Selbst SM (January 1990). "Chest pain in children". Am Fam Physician. 41 (1): 179–86. PMID 2403723.
  13. . doi:10.7759/2Fcureus.3690. Missing or empty |title= (help)
  14. . doi:10.2147/2FOAEM.S29942. Missing or empty |title= (help)
  15. . doi:10.1007/2Fs00383-011-2874-8. Missing or empty |title= (help)
  16. 16.0 16.1 16.2 Chun JH, Kim TH, Han MY, Kim NY, Yoon KL (November 2015). "Analysis of clinical characteristics and causes of chest pain in children and adolescents". Korean J Pediatr. 58 (11): 440–5. doi:10.3345/kjp.2015.58.11.440. PMC 4675925. PMID 26692880.
  17. . doi:10.1161/2FCIRCULATIONAHA.113.006702. Missing or empty |title= (help)
  18. 18.0 18.1 18.2 Swap, Clifford J. (2005). "Value and Limitations of Chest Pain History in the Evaluation of Patients With Suspected Acute Coronary Syndromes". JAMA. 294 (20): 2623. doi:10.1001/jama.294.20.2623. ISSN 0098-7484.
  19. Kane DA, Fulton DR, Saleeb S, Zhou J, Lock JE, Geggel RL (2010). "Needles in hay: chest pain as the presenting symptom in children with serious underlying cardiac pathology". Congenit Heart Dis. 5 (4): 366–73. doi:10.1111/j.1747-0803.2010.00436.x. PMID 20653703.
  20. . doi:10.7759/2Fcureus.3690. Missing or empty |title= (help)
  21. . doi:10.2147/2FOAEM.S29942. Missing or empty |title= (help)
  22. . doi:10.1007/2Fs00383-011-2874-8. Missing or empty |title= (help)
  23. . doi:10.1161/2FCIRCULATIONAHA.113.006702. Missing or empty |title= (help)
  24. 24.0 24.1 24.2 Yeh TK, Yeh J (2015). "Chest Pain in Pediatrics". Pediatr Ann. 44 (12): e274–8. doi:10.3928/00904481-20151110-01. PMID 26678235.
  25. Selbst SM (2010). "Approach to the child with chest pain". Pediatr Clin North Am. 57 (6): 1221–34. doi:10.1016/j.pcl.2010.09.003. PMID 21111115.
  26. . doi:10.7759/2Fcureus.3690. Missing or empty |title= (help)
  27. . doi:10.2147/2FOAEM.S29942. Missing or empty |title= (help)
  28. . doi:10.1007/2Fs00383-011-2874-8. Missing or empty |title= (help)
  29. . doi:10.1161/2FCIRCULATIONAHA.113.006702. Missing or empty |title= (help)
  30. 30.0 30.1 30.2 30.3 Collins SA, Griksaitis MJ, Legg JP (2014). "15-minute consultation: a structured approach to the assessment of chest pain in a child". Arch Dis Child Educ Pract Ed. 99 (4): 122–6. doi:10.1136/archdischild-2013-303919. PMID 24301714.
  31. . doi:10.3345/2Fkjp.2015.58.11.440. Missing or empty |title= (help)
  32. Ives, A.; Daubeney, P. E. F.; Balfour-Lynn, I. M. (2010). "Recurrent chest pain in the well child". Archives of Disease in Childhood. 95 (8): 649–654. doi:10.1136/adc.2008.155309. ISSN 0003-9888.
  33. . doi:10.1136/2Fadc.63.12.1457. Missing or empty |title= (help)
  34. Govindarajan KK (2018). "Esophageal perforation in children: etiology and management, with special reference to endoscopic esophageal perforation". Korean J Pediatr. 61 (6): 175–179. doi:10.3345/kjp.2018.61.6.175. PMC 6021361. PMID 29963100.
  35. Fikar CR (2006). "Acute aortic dissection in children and adolescents: diagnostic and after-event follow-up obligation to the patient and family". Clin Cardiol. 29 (9): 383–6. doi:10.1002/clc.4960290903. PMC 6654457 Check |pmc= value (help). PMID 17007168.
  36. Williams K, Baumann L, Grabowski J, Lautz TB (2019). "Current Practice in the Management of Spontaneous Pneumothorax in Children". J Laparoendosc Adv Surg Tech A. 29 (4): 551–556. doi:10.1089/lap.2018.0629. PMID 30592692.
  37. Pogorelić Z, Gudelj R, Bjelanović D, Jukić M, Elezović Baloević S, Glumac S; et al. (2020). "Management of the Pediatric Spontaneous Pneumothorax: The Role of Video-Assisted Thoracoscopic Surgery". J Laparoendosc Adv Surg Tech A. 30 (5): 569–575. doi:10.1089/lap.2019.0742. PMID 32167851 Check |pmid= value (help).
  38. Research Committee of the Japanese Society of Pediatric Cardiology. Cardiac Surgery Committee for Development of Guidelines for Medical Treatment of Acute Kawasaki Disease (2014). "Guidelines for medical treatment of acute Kawasaki disease: report of the Research Committee of the Japanese Society of Pediatric Cardiology and Cardiac Surgery (2012 revised version)". Pediatr Int. 56 (2): 135–58. doi:10.1111/ped.12317. PMID 24730626.
  39. Alvarez O, Yovetich NA, Scott JP, Owen W, Miller ST, Schultz W; et al. (2013). "Pain and other non-neurological adverse events in children with sickle cell anemia and previous stroke who received hydroxyurea and phlebotomy or chronic transfusions and chelation: results from the SWiTCH clinical trial". Am J Hematol. 88 (11): 932–8. doi:10.1002/ajh.23547. PMC 4631259. PMID 23861242.
  40. Niihara Y, Miller ST, Kanter J, Lanzkron S, Smith WR, Hsu LL; et al. (2018). "A Phase 3 Trial of l-Glutamine in Sickle Cell Disease". N Engl J Med. 379 (3): 226–235. doi:10.1056/NEJMoa1715971. PMID 30021096.