Module 5: (b) Chest Pain & Syncope Flashcards
1
Q
Chest Pain in Children?
-Info
A
- Common and almost NEVER cardiac, even in children w/ known heart disease
- Causes much anxiety w/ parents, coaches, and teachers
- Best tools for evaluation are cheap:
- Thorough history
- Good physical exam
- +/- EKG if additional reassurance needed
- Echo, treadmill, NOT generally needed
2
Q
Chest Pain in Children
-Non-Cardiac Causes
A
- Musculoskeletal
- Pulmonary — Asthma, pneumothorax, pleurodynia
- Gastroesophageal — Esophagitis, PUD, Esophageal foreign body
3
Q
Chest Pain in Children
-Cardiac Causes
A
- Coronary Ischemia
- Coronary anomalies
- Kawasaki dz
- Ventricular hypertrophy
- Cocaine - Pericardial Pain — Pericarditis, trauma
- Aortic dissection — Marfan Syndrome
4
Q
Pericarditis info
A
- Inflammation of pericardial sac
- Normally <30 ml’s of fluid in adult
- Accumulation of fluid may impair filling of the left ventricle and lower cardiac output (cardiac tamponade) - Multiple etiologies
- Infectious vs. Non-infectious
5
Q
Pericarditis Clinical Presentation
A
- Chest pain — Worse w/ inspiration, supine position and better when leaning forward
- Dyspnea — often worse when supine
- Jugular venous distension
- Pericardial friction rub — Often not present if effusion is large — Often 3 components
6
Q
Chest Pain
-Reassuring features in the history
A
- Occurence at rest or with activity
- Nonspecific or variable description
- New exercise routines using chest muscles
- Pain on the right side of the chest
- Brief sharp pain lasting seconds
- Dull pain lasting hours
- Association w/ psychological stress
- Relatives or acquaintances w/ recent heart problems or death
7
Q
Chest Pain
-Concerning Feature in History
A
- Syncope w/ chest pain
- Tachycardia preceding chest pain
- Reproducible left sided chest pain w/ strenuous exercise
- Known left sided obstruction, arrhythmias or coronary disease
- Fam Hx of sudden death, marfan, hypertrophic obstructive cardiomyopathy
8
Q
Chest Pain - Physical Findings
A
- Reassuring Physical Findings
- Lack of significant murmur
- Tenderness at costochondral margins - Concerning physical findings
- Ejection murmur at URSB
- HOCM, AS
- Other loud murmurs — AS, PS
- Clicks, rubs — AS, PS, MVP, Pericarditis, hemopericardium
9
Q
Chest Pain Evaluation
A
- History, History, History
- PE — Murmurs and Reproducibility of pain
- Labs
- Usually NONE needed
- Sometimes EKG
- Rarely treadmill test
- Rarely echocardiogram
10
Q
Chest Pain — Pearls
A
- The vast majority of chest pain in children and adolescents is NON CARDIAC, even in pt’s with known heart disease
- Hx is your BEST tool
- Be positive and reassuring
11
Q
SYNCOPE NEXT SLIDES
A
SYNCOPE NEXT SLIDES
12
Q
Syncope in Children - Info
A
- Common and Generally does NOT reflect cardiac disease
- Vasovagal, neurocardiogenic, conversion reaction, & rarely seizure - May reflect cardiac disease
- Arrhythmias — SVT, VT, AV block, Sinus node dysfunction
- Coronary disease — Anomalous coronaries, Kawasaki
- Limited Cardiac Output — AS, PS, HCM, Pulmonary HTN
13
Q
Evaluation of Syncope — Hx, Hx, Hx
A
- Circumstances — Precipitating events, exercise, relation to meals
- Position (Standing (MOST COMMON), sitting, lying)
- Premonitory signs — Palpitaitons, visual changes, sounds, vertigo
- Characteristics of the event
- Duration of unconsiousness, seizure activity
- Incontinence
- Injuries from falling
14
Q
Evaluation of Syncope - PE and Labs
A
- Physical Exam
- Orthostatic VS’s HR and BP
- Murmurs — Right sternal border and louder with standing = Hypertrophic cardiomyopathy
- Second heart sound - Lab Data (Often NOT needed)
- EKG if question of arhythmias
- Treadmill if exercise induced
- Echo if question of structural heart disease
15
Q
Wolff-Parkinson-White
A
- Delta waves in Sinus rhythm
- None in SVT
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