Chest Pain Flashcards
What is the average age of presentation for pediatric chest pain?
13 years
What are the top 3 most common causes of pediatric chest pain?
- Trauma/muscle strain of chest wall
- Costochondritis
- Respiratory illness with cough
What percentage of chest pain is cardiac in nature?
< 5 %
Describe chest pain due to costochondritis
- 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
How to diagnose costochondritis?
*
What is the natural history of costochondritis?
- Benign condition
- Pain may persist several months
What is Tietze’s syndrome?
- Rare form of costochondritis
- Large, tender, fusiform, nonsuppurative swelling at costochondral junction
- Usually affects upper ribs, especially second and third costochondral junctions
List a differential for pediatric chest pain
- Idiopathic
- Costochondritis
- MSK strain
- Respiratory: lung pathology, pleural irritation, pneumothorax
- Exercise induced asthma
- GERD
- Precordial catch
- Slipping rib syndrome
- Mastalgia
- Pleurodynia
- PE
- Hyperventilation
What is slipping rib syndrome?
- 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
What percentage of pediatric chest pain is cardiac in origin?
0-5%
List the cardiac causes of chest pain
- Myocardial ischemia associated with obstructive congenital heart disease
- Mitral valve prolapse
- Cardiomyopathy
- Coronary artery disease
- Cocaine abuse
- Aortic dissection/aneurysm
- Pericarditis
- Myocarditis
- Arrythmias
What is the cause of chest pain with severe obstructive lesions?
- Increased myocardial oxygen demands from tachycardia and increased pressure work on the ventricle
- Pain usually associated with exercise and anginal pain
What percentage of patients with mitral valve prolapse experience chest pain?
20%
Describe chest pain associated with mitral valve prolapse
- Vague, non exertional chest pain of short duration located at the apex without a constant relationship to emotion or effort
How does cocaine cause chest pain?
- 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
