4.7 Chest Pain

Question 1

What is the first goal when a kids presents with chest pain

Answer 1

rule out cardiac causes

more commonly something else

Question 2

Which age group of peds presents most frequently for chest pain

Answer 2

young adolescents

Question 3

What is the most common cause of chest pain in kids

Answer 3

MSK

specifically r/t chest wall

originating in the chest wall or chest cage, is benign, and rarely requires any treatment.

Question 4

What is a common cause of chest wall pain in kids

Answer 4

coughing

Question 5

Chest wall pain occuring with exercise can indicate which condition

Answer 5

exercise-induced bronchospasm

Question 6

Chest pain that is vague and occurs over
many months in a variety of circumstances, particularly around
stressful events may be ___ in nature

Answer 6

psychogenic (anxiety or hyperventilation)

Question 7

Chest pain in kids assocaited with syncope, exertional dyspnea, or irregular rhythm should be red flags for ___

Answer 7

cardiac origin

Question 8

Descriptions of any burning, substernal pain that worsens with reclining or
with spicy foods indicates ___

Answer 8

GI etiology of chest pain

Question 9

Descriptions of Pain that is sharp or stabbing, lasting several seconds to
minutes, located over the midsternum or infranipple area, and occurring with nonexertion or deep inspirations indicates ___

Answer 9

MSK chest pain

Question 10

Chest pain that awakens the patient is more likely ___ in nature than psychological

Answer 10

organic

Question 11

On physical exam point tenderness of costochondral joints that is worse with activity or deep breaths suggests which?

2

Answer 11

costochondritis
Tietze syndrome - rare, benign condition that causes inflammation of the cartilage in the upper ribs, where they attach to the breastbone

The costochondral joints are the joints between the ribs and costal cartilage in the front of the rib cage. They are hyaline cartilaginous joints (i.e. synchondrosis or primary cartilagenous joint). Each rib has a depression shaped like a cup that the costal cartilage articulates with.

Question 12

What is typical of costochondritis

Answer 12

pain with activity or deep breathing that is reproducible on palpation

Question 13

Tenderness and swelling found in pectoral and shoulder carriage muscles can be due to ___

Answer 13

overuse (excessive weight lifting, video gaming)

Question 14

When chest pain has no clear etiology, the child appears well, and all aspects of the evaluation are normal what is the most important treatment

Answer 14

reassurance

Question 15

Who should be referred to peds cardiology

3

Answer 15

• chest pain that worsens with exercise or suggests angina,
• positive findings on examination, ECG, or chest radiograph
• a concerning personal or family history.

Question 16

What is first line treatment for MSK/costocondritis

2

Answer 16

NSAIDs and rest

Question 17

What does brief sharp pain localized on left side of chest that is relieved by deep breathing indicate

Answer 17

Precordial catch syndrome

Medical experts aren’t sure what causes precordial catch syndrome. But they think it may be due to pinched nerves or muscle spasms in the lining around your lungs (pleura) or in your ribs or cartilage.

Question 18

What is slipping rib syndrome

Answer 18

can cause chest pain-

when a inferior false rib slips under adjacent rib

use hooking method under lower costal margin and lift anteriorly - if you hear a click this is likely the dx