Chest Pain in Children

Question 1

What are some serious causes of chest pain in children? What features can you use to differentiate these causes?

Answer 1

• pericarditis:
  
  • positional (sitting up/leaning forward helps)
  • pericardial rub
  • arrhythmia
  • ST elevation ‘saddle-shaped’
• aortic dissection: CTD
  
  • differential limb BPs, CXR findings of widened mediastinum and defiated trachea.
• Pulmonary embolus (hypercoagulable state)
  
  • tachypnoea, tachycardia, hypoxia, non specific ST and T waves in anterior leads (S1Q3T3)

Question 2

What are some non-serious causes of chest pain in children?

Answer 2

• musculoskeletal strain
• respiratory infections
• upper GI or biliary
• anxiety/idiopathic

Question 3

What is the management for a child with chest pain? What tests would you order?

Answer 3

• RF for cardiac disease?
  
  • first episode, radiation, Hx of cardiac/clotting/Kawasaki/DM, cocaine use, BP changes
  • order ECG and CXR, consider troponin
• RF for pulmonary embolus?
  
  • immobility, hypercoagulability, haemoptysis, neoplasms, CVC
  • order CXR - consider ECG/V-Q scans
• psychological cause?
  
  • hyperventilation, social withdrawal, drug/alcohol use, lowered affect.
• reproducible with palpation = musculoskeletal
• psychosomatic - reassure and refer