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Pediatric chest pain Full Text
The Clinical Advisor, 10/20/2010
The three most common complaints referred to pediatric cardiology are heart murmur, chest pain, and palpitations. While approximately 3%–4% of chest pain in pediatric patients is cardiac in origin (ischemic, inflammatory, or arrhythmogenic), most chest pain in this population is noncardiac (20% musculoskeletal, 15%–20% pulmonary, 5% GI, 10% psychiatric, 15%–20% miscellaneous, and 25% idiopathic). Benign chest pain is typically sporadic, unpredictable, and nonreproducible unless associated with musculoskeletal tenderness. Findings that indicate need for further exploration and testing include visceral pain (may be severe; a sensation of crushing or pressure; or radiating, often associated with shortness of breath), pain associated with exercise, history of associated symptoms (nausea, palpitations, syncope), history of congenital findings, significant family history (sudden cardiac death or early CAD), or abnormalities on physical exam. The child described here is likely experiencing benign chest pain. One common cause is precordial catch syndrome, the etiology of which is unknown. It is important to refer those patients likely to benefit from further testing and to allay the fears of those not in danger.