Chest Pain Flashcards
Into what two categories should pediatric chest pain be divided in order to best guide diagnosis?
Acute-onset, severe vs chronic and recurrent
What is the most common cause of cardiac chest pain in children?
Pericarditis
Describe the typical presentation for pericarditis.
It is usually described as severe, substernal chest pain that is squeezing or tightening in character. The pain is worse with movement and exacerbated by breathing. Classically, the patient is leaning forward to alleviate the pain, does not want to lie down, and there is a pericardial friction rub on exam.
Which illicit drug can cause acute MI in adolescents?
Cocaine
What would be the typical presentation for a child presenting with myocardial infarction?
Pain is severe, pressure-like, and substernal. It can radiate to the neck or arms, is worse with exercise, and improves with rest. There may be signs of ischemia on EKG, as well as elevated cardiac enzymes.
What are the typical EKG changes associated with acute myocardial infarction?
ST-segment elevation and T-wave changes in the area of the affected myocardium, as well as reciprocal ST-segment depression in the corresponding opposite leads.
If a child presents with true acute myocardial infarction, what underlying conditions should one consider?
Cocaine use in the adolescent, familial hyperlipidemia, or a history of Kawasaki disease
What is the most likely cause of acute chest pain if arrhythmia is the underlying etiology?
Supraventricular tachycardia
An adolescent with Marfan syndrome presents with acute chest pain that is tearing and radiates to his back. What are you immediately concerned about?
Aortic dissection
How is the pain associated with aortic dissection usually described?
Sharp, tearing, and radiating to the neck or back.
Which conditions increase the risk for aortic dissection?
Marfan syndrome, Ehlers-Danlos syndrome, severe thoracic trauma.
What is the recommended diagnostic workup and management of suspected aortic dissection?
Aortic dissection can be visualized with MRI, CT, or transesophageal ECHO. Urgent surgical intervention is required.
What condition should be suspected in a patient who develops sudden, severe, unilateral chest pain accompanied by dyspnea?
Spontaneous pneumothorax
Which conditions increase the risk for developing a spontaneous pneumothorax?
Asthma, cystic fibrosis, Marfan syndrome, and trauma.
What are the typical physical exam findings for a spontaneous pneumothorax?
Diminished breath sounds and hyperresonant percussion on the affected side.
Which pathogen should be considered as a possible cause of severe chest pain in adolescents with HIV risk factors?
Pneumocystis
How might one distinguish the chest pain caused by angina from that caused by GERD?
Usually with GERD the pain has a strong correlation to meal-time and is aggravated with supine positioning.
What are three GI causes for acute pediatric chest pain?
GERD, esophageal spasm, and esophageal foreign body.
Which conditions may cause chest pain by irritating the diaphragm?
Lower lobe pneumonia, hepatic and splenic abscesses, and pancreatitis.
What is the most common cause of chest pain in children?
Musculoskeletal chest wall pain
What is the typical presentation of musculoskeletal chest wall pain?
The pain is usually localized, does not radiate, is reproducible with palpation, and can become worse with exercise.
What type of chest pain occurs over the rib/cartilage junction and is often reproducible with palpation over the area?
Costochondritis
What is the recommended treatment for musculoskeletal chest wall pain?
Reassurance and mild analgesics (Acetaminophen/NSAIDs)
What is Tietze syndrome?
Pain and swelling of the anterior chest wall, normally involving the 2nd or 3rd costochondral junction on one side. Pain and swelling come and go and can last months to years.
