Chest Pain Flashcards

1
Q

What is the average age of presentation for pediatric chest pain?

A

13 years

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2
Q

What are the top 3 most common causes of pediatric chest pain?

A
  • Trauma/muscle strain of chest wall
  • Costochondritis
  • Respiratory illness with cough
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3
Q

What percentage of chest pain is cardiac in nature?

A

< 5 %

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4
Q

Describe chest pain due to costochondritis

A
  • More common in girls than boys
  • Sharp, anterior chest pain
  • Usually unilateral, occasionally bilateral
  • Exaggerated by physical activity or breathing
  • Radiation to chest, back, abdomen
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5
Q

How to diagnose costochondritis?

A

*

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6
Q

What is the natural history of costochondritis?

A
  • Benign condition
  • Pain may persist several months
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7
Q

What is Tietze’s syndrome?

A
  • Rare form of costochondritis
  • Large, tender, fusiform, nonsuppurative swelling at costochondral junction
  • Usually affects upper ribs, especially second and third costochondral junctions
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8
Q

List a differential for pediatric chest pain

A
  • Idiopathic
  • Costochondritis
  • MSK strain
  • Respiratory: lung pathology, pleural irritation, pneumothorax
  • Exercise induced asthma
  • GERD
  • Precordial catch
  • Slipping rib syndrome
  • Mastalgia
  • Pleurodynia
  • PE
  • Hyperventilation
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9
Q

What is slipping rib syndrome?

A
  • Excess mobility of 8th-10th ribs which do not directly insert into sternum
  • Ligaments holding ribs to upper ribs are weak
  • Pain when ribs slip down
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10
Q

What percentage of pediatric chest pain is cardiac in origin?

A

0-5%

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11
Q

List the cardiac causes of chest pain

A
  • Myocardial ischemia associated with obstructive congenital heart disease
  • Mitral valve prolapse
  • Cardiomyopathy
  • Coronary artery disease
  • Cocaine abuse
  • Aortic dissection/aneurysm
  • Pericarditis
  • Myocarditis
  • Arrythmias
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12
Q

What is the cause of chest pain with severe obstructive lesions?

A
  • Increased myocardial oxygen demands from tachycardia and increased pressure work on the ventricle
  • Pain usually associated with exercise and anginal pain
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13
Q

What percentage of patients with mitral valve prolapse experience chest pain?

A

20%

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14
Q

Describe chest pain associated with mitral valve prolapse

A
  • Vague, non exertional chest pain of short duration located at the apex without a constant relationship to emotion or effort
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15
Q

How does cocaine cause chest pain?

A
  • Blocks reuptake of norepinephrine in the CNS and peripheral nervous system
  • Increased sympathetic output and catecholamines causes coronary vasoconstriction
  • Cocaine activates platelets, increases endothelin production and decreases NO production
  • Increases HR, increases BP, increases myocardial O2 consumption
  • Can cause anginal pain, arrythmias, infarction and sudden death
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16
Q

Which children are at risk for aortic dissection or aneurysm?

A
  • Turner’s
  • Marfan’s
  • Noonan’s
17
Q

Describe chest pain due to pericarditis

A
  • Sharp stabbing precordial pain worsens with lying down and improves when sitting up and leaning forward
18
Q

What physical exam findings are consistent with pericarditis?

A
  • Distant heart sounds
  • Neck vein distenstion
  • Friction rub
  • Paradoxical pulse
19
Q

Describe classic ECG findings associated with pericarditis

A
  • Low QRS voltages
  • ST-T wave changes
20
Q

When to refer chest pain to cardiology?

A
  • Chest pain triggered or worsened by physical activity
  • Chest pain associated with dizziness, syncope, palpitations
  • Abnormal cardiac exam, ECG, CXR
    • FHx cardiomyopathy, long QT syndrome, sudden unexpected death
  • Highly anxious family - otherwise will just keep presenting with same issues
21
Q

What is the management of costochondritis?

A
  • Reassurance
  • NSAIDs
  • Limit backpack weight
  • Avoid physical activities requiring shoulder girdle use
22
Q
A