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PEM RC Exam > Chest Pain > Flashcards

Chest Pain Flashcards

1
Q

How common is chest pain in peds?

A

Third most common complaint
After abdo pain and headache
0.3 - 0.6%

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2
Q

Peak age for pediatric chest pain

A

12-14 years

Half are < 12 years

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3
Q

Most common Dx for kids who present with chest pain

A

Idiopathic (45%)

  • MSK/chest wall strain - most common
  • MSK trauma - contusion/injury from direct trauma
  • Costochondritis (10-20%)
  • Other MSK conditions

Respiratory Causes

  • Asthma
  • Cough
  • Pneumonia

GI Disorders

  • GERD (7%)
  • Esophagitis
  • Esophageal FB

Psychogenic causes (stress related)

Cardiac Disease
- Myocarditis

Sickle cell disease

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4
Q

What is precordial catch syndrome?

A

Sporadic
Brief (< 5 min)
Left-sided chest pain
May recur frequently within a few hours
Then disappear for a several months
Associated with slouched posture and bending
Not associated with exercise
Relieved with a deep breath, a few shallow breaths or straightened posture
? pain arises from parietal pleura or pinched intercostal nerve

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5
Q

What is slipping rib syndrome?

A

Rare sprain disorder caused by trauma to the costal cartilage of the 8th, 9th or 10th ribs (which do not attach to the sternum)
Pain under the ribs on in the upper abdomen quadrants
Can hear a clicking or popping sound when they lift heavy objects, flex the trunk or walk
Causes by the rib hooking under the rib above and irritating the intercostal nerve

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6
Q

Describe how chest pain can arise from tetracycline ingestion?

A

It can cause acute esophagitis (pill-induced esophagitis)
Can be due to the pH of the drug - acidic, protective gel washes off and it becomes caustic in the esophagus
Dx made clinically
Often in teenagers on acne associated tetracycline medications

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7
Q

Signs of a pneumothorax causing chest pain

A 
Acute onset
Sharp chest pain
Associated with some degree of respiratory distress
Dyspnea
Pain worsened by inspiration
Radiates to the neck or abdomen
Tachycardia
Decreased breath sounds to one side
Can have a history of trauma or be spontaneous, after exercise or coughing
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8
Q

Conditions that increase the risk of “Spontaneous” pneumothorax (4)

A

Asthma
Cystic Fibrosis
Marfan’s syndrome
Cocaine users

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9
Q

How does hyperventilation cause chest pain?

A

Hyperventilation which can be due to stress can cause a hypocapnic alkalosis
Prolonged hyperventilation can lead to coronary vasoconstriction and chest pain
Can also cause stomach distention with aerophagia
Can be associated with lightheadedness, headache, and parasthesias

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10
Q

When to do an ECG for kids with chest pain?

A

History:

  • Acute onset of pain
  • Chest pain associated with exercise
  • Associated syncope, dizziness and palpitations
  • History of heart disease
  • History of condition that can affect the heart and lungs (Diabetes mellitus, Kawasaki disease, Marfan’s syndrome, asthma, anemia, SLE)
  • History of sickle cell disease
  • Use of cocaine
  • Trauma
  • FB ingestion
  • Fever

Abnormal PEx findings:

  • Respiratory distress
  • Decreased/abnormal breath sounds
  • Cardiac findings (murmur, rub, click, arrhythmia)
  • Fever
  • Trauma
  • Palpation of subcutaneous air
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11
Q

Why is acute onset of pain worrisome?

A

Sudden onset (within 48h of presentation) are more likely to have an organic cause

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12
Q

Name 4 conditions that have fever and chest pain

A

Myocarditis
Pericarditis
Endocarditis
Pneumonia

Key points for fever and chest pain

  1. Consider the above Dx
  2. Listen for decreased breath sounds (pneumonia)
  3. Listen for distant heart sounds (carditis)
  4. Obtain a CXR
  5. Consider ECG if pneumonia excluded
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13
Q

What cardiac conditions can cause chest pain in kids?

A 
Arrhythmia (SVT, ventricular tachycardia, PVCs, cocaine induced)
Infection (Myo, endo, pericarditis)
Structural abnormalities (Hypertrophic cardiomyopathy, aortic valve stenosis, anomalous coronary arteries)
Coronary artery disease [CAD, ischemia, infarction] (Kawasaki disease, longstanding diabetes mellitus, familial hypercholesterolemia, or lipidemia)
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14
Q

What pathology is concerning for patients with Marfan Syndrome and chest pain?

A

Rupture of aortic aneurysm (fatal)

Spontaneous pneumothorax

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15
Q

Why is chest pain preceded by exercise a concern?

A

Can be associated with sudden death
Pain due to myocarditis, CAD, hypertrophic cardiomyopathy is worsened by exertion
Exercise induced asthma is also worsened by exercise

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16
Q

What is Tietze’s syndrome?

A

Rare condition of unknown etiology that causes sternal chest pain
Can last for months
Can have tender spindle-shaped swelling at the sternochondral junctions on PEx

17
Q

Name causes of chest pain in kids with asthma

A 
Anxiety
Overuse of chest wall muscles from resp distress
Associated pneumonia
Diaphragmatic irritation
Pneumothorax
Pneumomediastinum
18
Q

Name a cutaneous syndrome that is associated with chest pain

A

Herpes zoster
Shingles can cause chest pain when the lesions involve a chest wall dermatome
the chest pain can precede the vesicular rash for days

19
Q

What is the “devil’s grip”?

A

Sharp paroxysmal pain in the abdomen or thorax
Called pleurodynia
Caused by coxsackie virus and can occur in mini-epidemics

20
Q

What are teenage females with SLE at risk for when experiencing chest pain?

A 
Pericarditis
Myocarditis
Endocarditis
Pneumonia
Pleural effusion
Myocardial ischemia - if they have renal disease or hypertension
21
Q

When do you consider PE for chest pain in kids?

A

In patients:

  • with minor trauma to a lower extremity (males)
  • with risk of increased clotting (Factor V Leiden) or hypercoagulable state (nephrotic syndrome)
  • teenage girls
  • obese
  • in 1st 6 months of starting OCP
  • recent abortion
  • DVT
  • SLE
22
Q

What are the causes of chest pain in kids with sickle cell disease?

A

Vaso-occlusive crisis
Acute chest syndrome
Pneumonia
Ischemia due to chronic anemia

23
Q

What are the types and associated symptoms of cocaine induced chest pain?

A

Cocaine-related myocardial infarction
Coronary vasospasm

Chest tightness
Palpitations
Pressure
N/V
Anxiety
Tachycardia
Tachypnea
Hypertension
If snorted - can develop pneumothorax or pneumomediastinum
24
Q

Chest pain factors that require a referral to cardiology

A

Associated with exercise (during or immediately after)
Associated with:
- Syncope
- Dizziness
- Palpitations
Child has a history of underlying cardiac disease/arrhythmia
Previous condition that subjects them to cardiac disease (diabetes, kawasaki, hypertension, marfan’s)
Family history of sudden death

PEM RC Exam (25 decks)

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