Pediatric emergency medicine trisk 1086 1086
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condition is not suspected, ordering unnecessary tests may actually increase a
patient’s or parent’s concern that true pathology exists. Definitive ongoing
management requires referral to a primary care physician.
SUMMARY
Chest pain in children is a relatively uncommon sign of serious disease, but often
has great importance to the patient or family. Most cases can be diagnosed by the
emergency physician from the history and physical examination alone. Most all
cardiac causes of chest pain can be diagnosed from the full history, physical
examination, and EKG. Selective use of chest radiography and labs including
troponin may be warranted in specific cases. The physician should always
consider drug-induced chest pain and other life-threatening conditions. Patients
with a history of exercise-induced chest pain, palpitations and/or syncope,
medical history of underlying cardiopulmonary condition, suspected Kawasaki
disease, collagen vascular disease, connective tissue disorders, hyperlipidemia,
malignancy, thrombophilia, myopathies, history of drug use, oral contraceptive
and cigarette use, and family history of sudden death, early coronary artery
disease, cardiomyopathy, hypercholesterolemia, hypercoagulability disorders,
hyperlipidemia, and pulmonary hypertension appear to be at higher risk of
cardiovascular disease and warrant cardiology evaluation. Psychogenic chest pain
is a common occurrence and may be chronic or related to an acute stressful event.
The possibility of cardiac disease needs to be addressed directly by the examining
physician to alleviate fully the patient’s (or family’s) anxiety. The most common
causes of organic chest pain are musculoskeletal (traumatic or inflammatory) and
infectious disorders, usually self-limited or easily treated diseases. Occasionally,
serious abdominal, pulmonary, or cardiac problems require immediate attention.
Suggested Readings and Key References
Angoff GH, Kane DA, Giddins N, et al. Regional implementation of pediatric
cardiology chest pain guideline using SCAMP methodology. Pediatrics
2013;132:e1010–e1017.
Brown JL, Hirsh DA, Mahle WT. Use of troponin as a screen for chest pain in the
pediatric emergency department. Pediatr Cardiol 2012;33:337–342.
Cava JR, Sayger PL. Chest pain in children and adolescents. Pediatr Clin North
Am 2004;51:1553–1568.
Dalal A, Czosek RJ, Kovach J, et al. Clinical presentation of pediatric patients at
risk for sudden cardiac arrest. J Pediatr 2016;177:191–196.
