Pediatric emergency medicine trisk 1073 1073
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Pulmonary embolus
Pulmonary venoocclusive
disease
Tumor (chest wall, chest, or
mediastinum)
Miscellaneous Drug ingestion/overdose
(especially cocaine)
Sickle cell crisis
Cholecystitis
Pulmonary infarction,
hypertension, cardiovascular
collapse
Pulmonary hypertension
Airway compromise,
progression of tumor
Arrhythmia, cardiomyopathy,
shock
Pulmonary infarction or
hypertension
Sepsis, peritonitis
Anomalous coronary arteries which originate from the opposite sinus and
traverse between the great vessels usually present with sudden death but can also
cause chest pain with intense exercise. Pain is thought to be related to inadequate
coronary perfusion via either compression of the great vessels, relative ostial
stenosis, or both. The history is the key to this significant disease as the physical
examination is usually normal.
Hypertrophic cardiomyopathy is the most common cardiac cause of sudden
death, which is likely due to ventricular dysrhythmias, yet chest pain is not a
common feature. This disease follows an autosomal dominant pattern of
inheritance; however, spontaneous mutations may occur. Patients often have a
systolic murmur which becomes more intense with standing or a Valsalva
maneuver. Chest pain can also occur with severe obstruction from aortic stenosis
which is likely to be discovered by the pathologic murmur on physical
examination. The patient with chest pain that has onset with or worsening with
exertion should be evaluated for these conditions.
Arrhythmias are not uncommon and children usually present with palpitations
or a combination of chest pain and palpitations. Symptoms of heart pounding may
occur with instantaneous initiation and termination whereas other children have
been reported to abruptly stop an activity. Most arrhythmias are benign, such as
premature atrial and ventricular contractions; however, children may present with
signs of shock, congestive heart failure, or syncope secondary to supraventricular
or ventricular tachycardia. Physical examination is often normal in the absence of
active arrhythmias but long-term effects can lead to cardiomyopathy. Dilated
cardiomyopathy presents with chest discomfort, fatigue, exercise intolerance,
