Chest Pain Evaluation

Chest Pain

Chest pain in a very common symptom that children and adults experience. Chest pain can be present in children with a normal heart. Unfortunately, chest pain can also be a symptom in those with congenital heart disease or with there is a rhythm problem - in these cases, chest pain can be benign or can be very dangerous.

Chest Pain Q & A 

What causes chest pain in young patients?

Chest pain are a frequent symptom in healthy children. The majority of young patients with chest pain do NOT have cardiac causes. Examples of non-cardiac chest pain include:
· Asthma
· Pneumothorax
· Muscle strain
· Rib and/or joint inflammation
· Chest wall injury from trauma
· Heartburn
· Anxiety
· Vocal cord dysfunction

Alternatively there are several cardiac causes of chest pain in young patients that can be worrisome. Many of these causes are very dangerous and can potentially cause sudden death. A few examples of cardiac chest pain include:
· Congenital coronary artery anomalies
· Heart muscle diseases (cardiomyopathy)
· Heart valve obstruction or dysfunction
· Abnormal heart rhythm
· Infection of the heart

What are the symptoms of cardiac chest pain?

There are several symptoms of cardiac chest pain that should be concerning. These symptoms include:
· Pain triggered usually during exercise or intense physical activity
· Pain that radiates to the left shoulder / left arm / neck or back
· Pain that worsened by leaning forward or backward
· Unexplained breathing difficulties
· Unexplained loss of consciousness
· Unexplained heart racing

How do we evaluate for chest pain? 

To screen for cardiac chest pain, the pediatric cardiologist will obtain a detailed history to characterize the pain as well as associated symptoms, perform a comprehensive cardiac examination, and order an electrocardiogram (ECG) as the first level of evaluation. If the initial screening reveals concerning elements to the chest pain, additional evaluation such as an echocardiogram or heart rhythm monitor can be performed. 

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