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Limited Utility of Exercise Stress Tests in the Evaluation of Children with Chest Pain
Congenital Heart Disease, 08/09/2012
Clinical Article
Kyle WB et al. – In children referred to pediatric cardiology clinic for chest pain, exercise stress test (EST) has a low yield in identifying cardiac abnormalities.
Methods- Retrospective chart review over a 14–month period.
- Cardiology clinic at an academic children's hospital.
- Two hundred three pediatric patients who presented to a pediatric cardiologist and had an EST for chest pain.
- Correlate EST results with echocardiographic findings and the patient's ultimate diagnosis.
- Retrospective review of patients who presented to cardiology clinic for chest pain, analysis of medical records, EST, echocardiograms, and other downstream testing.
- Of 433 patients who presented to a pediatric cardiologist for chest pain, 203 (47%) had an EST performed. One hundred seventy–six (87%) patients did not have a prior diagnosis of congenital heart disease and made up the study population.
- Mean age was 13.2 ± 3 years.
- Of the patients who had an EST, 139 (79%) had chest pain with exercise.
- Echocardiography was performed in 124 (70%) of the patients who had an EST.
- Of patients undergoing echocardiography, 17/124 (14%) had abnormalities, but none of the abnormalities found were thought to contribute to the patients’ chest pain.
- There were only four (2%) abnormal EST, and none were thought to be diagnostic for the patients’ symptoms of chest pain.
- The most common diagnoses were musculoskeletal chest pain in 34 patients (19%) and reactive airway disease in 27 patients (15%).