Chest Pain

Chapter 23 Chest Pain



Norman B. Berman




ETIOLOGY



What Are the Most Common Causes of Chest Pain?


Cardiac causes of chest pain are rare in children. Atherosclerotic coronary artery disease is essentially nonexistent in otherwise healthy children. Most chest pain in children originates in the chest wall, not in the heart. Despite this, parents often seek medical attention for a child who has chest pain because they are concerned about a “heart attack” or that the child is at risk for sudden death. These concerns are often prompted by recent events in the family or in the news.



What Are the Noncardiac Causes of Chest Pain?


Precordial catch is the term given to a chest pain that is common in adolescents. The pain is described as sharp, brief, and occurring sporadically, unassociated with exertion. One of the most characteristic features of this type of chest pain is the exacerbation by deep inspiration. Costochondritis is a less common chest wall pain that is due to inflammation of the costochondral joint. This pain is characterized by tenderness to palpation over the sternum and is typically much longer lasting than the precordial catch pain. Gastroesophageal reflux and other gastrointestinal causes are less common, as are pulmonary causes such as asthma or pneumothorax.



What Are the Cardiac Causes of Chest Pain?



Structural cardiac causes of chest pain


Hypertrophic cardiomyopathy and congenital coronary artery anomalies are the most common causes of sudden cardiac death in children and, as such, must always be considered in a child presenting with chest pain. Congenital heart defects are unlikely to cause chest pain, with the exception of severe aortic stenosis. Cardiac chest pain is uncommon but possible in children with repaired congenital heart defects.



Acquired cardiac causes of chest pain


Pericarditis is an uncommon but important cardiac cause of chest pain. Pericarditis causes a pericardial effusion to develop and thus can lead to cardiac tamponade. Pericarditis typically presents acutely with severe persistent chest pain. There is often an associated fever and respiratory symptoms.


Myocarditis is also uncommon. It often presents with signs of congestive heart failure because it impairs ventricular function. Myocarditis can cause anginal chest pain and should be considered in a patient with signs of congestive heart failure and chest pain.


Kawasaki disease is a fairly common disorder of unknown etiology. Kawasaki disease typically presents with prolonged fever (> 5 days) and other signs of vasculitis. Coronary artery aneurysms develop in up to 20% of patients with Kawasaki disease who are not treated with intravenous immunoglobulin. Aneurysms place the child at risk for myocardial ischemia and infarction, with accompanying chest pain.


Tachyarrhythmias generally do not cause chest pain, but some young children will describe their palpitations as chest pain.

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Jun 19, 2016 | Posted by in PEDIATRICS | Comments Off on Chest Pain

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