Chest Pain in Children and Adolescents

Abstract

1. Surendranath R. Veeram Reddy, MD* 2. Harinder R. Singh, MD* 1. *Division of Cardiology, The Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Mich After completing this article, readers should be able to: 1. Enumerate the most common causes of chest pain in pediatric patients. 2. Differentiate cardiac chest pain from that of noncardiac cause. 3. Describe the detailed evaluation of a pediatric patient who has chest pain. 4. Screen and identify patients who require a referral to a pediatric cardiologist or other specialist. 5. Explain the management of the common causes of pediatric chest pain. ### Case 1 During an annual physical examination, a 12-year-old girl complains of intermittent chest pain for the past 5 days that localizes to the left upper sternal border. The pain is sharp and stabbing, is 5/10 in intensity, increases with deep breathing, and lasts for less than 1 minute. The patient has no history of fever, cough, exercise intolerance, palpitations, dizziness, or syncope. On physical examination, the young girl is in no pain or distress and has normal vital signs for her age. Examination of her chest reveals no signs of inflammation over the sternum or rib cage. Palpation elicits mild-to-moderate tenderness over the left second and third costochondral junctions. The patient reports that the pain during the physical examination is similar to the chest pain she has experienced for the past 5 days. A detailed cardiovascular and other organ system examination yields normal results. What is the most likely cause of this patient's chest pain? What will you recommend for this patient? Does she need to see a pediatric cardiologist? ### Case 2 A 17-year-old boy is playing soccer on a Saturday afternoon and has a syncopal event on the field. He regains consciousness within a few seconds, does not require resuscitation, and is taken to the emergency department. The patient informs the physician that he developed sudden midsternal chest pain and lightheadedness prior to passing out. His vital signs are normal for age, and he is …