Murtagh - Chest pain cont. in children and in elderly Flashcards
probability diagnosis of chest pain in children
musculoskeletal (chest wall pain)
- cough strain
- injury
- muscle strain
- costochondritis
- precordial Cath syndrome (stitch in side)
- asthma
most cases unknown cause
serious disorders not to be missed in the child with chest pain
vascular
- ischaemic pain (structural cardiac conditions)
- arrythmias (e.g. PSVT)
infection
- pericarditis
- myocarditis
- pneumonia
- herpes zoster
other
- pneumothorax
- POTS syndrome
pitfalls (often missed) in the child with chest pain
Kawasaki syndrome
breast disorders
cocaine inhalation
rare disorders in the child with chest pain
Bornholm disease
oesophagitis or gastric pain
is the child patient with chest pain trying to tell me something?
psychogenic cause is common including hyperventilation
stress, anxiety, depression
chest pain in children younger than 12
more likely to be a cardiorespiratory cause, such as cough, asthma, pneumonia or heart disease
chest pain in adolescents (>12)
more likely to be associated with a psychogenic disturbance
cardiac causes of chest pain in children
myocardial ischaemia is very rare but should be considered in any child with exercise induced chest pain, adolescents with long standing diabetes or children with sickle cell anaemia
precordial catch
stitch in the side
unilateral low chest pain lasts 30 seconds to 3 minutes typically with exercise
precordial catch is relieved by
straightening up and taking slow deep breaths followed by shallow breaths
causes of chest pain in the elderly
myocardial infarction and angina, dissecting aneurysm and ruptured aorta are an increasing manifestation with age
the elderly patient presenting with chest pain is mostly likely to have
angina or myocardial infarction
other important disorders to consider in the elderly patient with chest pain
herpes zoster
cough fracture of the rib
malignancy
pleurisy
pulmonary embolus
GORD
