My child is complaining of chest pain. Does he have a heart problem?
Child chest pain or more precisely chest pain is a common symptom in the pediatric population.
It is one of the most common causes of visits to emergency departments, approximately 6 out of 1000 visits. It causes intense anxiety in both the patient and the parental environment. This is because it is intertwined with the corresponding symptom in adults, where the heart usually suffers and is associated with an increased risk of sudden death. However, in the pediatric population with chest pain, the presence of heart disease is rare. The rate ranges from 0.6-1%.
Usually, the origin of chest pain in children and adolescents is idiopathic (no etiology is found) in 53%. The next possible cause is the musculoskeletal system at 29% due to pain in the ribs, cartilage or muscles and the respiratory system at 9% due to severe cough, bronchospasm, pneumonia, etc.
We should not forget the psychogenic causes of chest pain especially in adolescence (1-9%), followed by the gastrointestinal system due to gastroesophageal reflux, esophagitis or ulcer (7%), various other diseases such as tumors of the wall or mediastinum (4-11%) and finally the cardiovascular system at a rate of 1% due to coronary artery disease, arrhythmia, inflammatory disease and structural diseases. The most common cause of cardiac chest pain in the pediatric population is myocarditis and pericarditis.
In the majority of patients, the individual along with the family history and the detailed evaluation of the symptoms together with the clinical examination are sufficient to exclude an underlying serious condition that may be the cause of the chest pain as well as to refer the patient to the appropriate subspecialty for further testing, if deemed necessary.
More specifically, questions that must be answered in the initial assessment of the symptom of thoracalgia are whether there has been any injury or intense athletic activity, how long has the pain been, is it related to eating or exercise, is it continuous or intermittent, is there a position of the body that aggravates or relieves it, has the patient already received any medication.
Subsequently, and with regard to the patient’s personal and family history, the existence of pre-existing heart disease, Kawasaki disease, the existence of a serious lipid disorder or blood clotting disorders in the same or 1st degree relatives, the history of sudden deaths in young people <35 years of age, the occurrence of coronary artery disease in young people under 45 years of age, connective tissue diseases, hereditary structural or arrhythmic syndromes or the use of cocaine or amphetamines, are elements of the patient’s history that constitute red flags and raise suspicion of a potentially cardiac origin of the chest pain.
Regarding symptomatology, chest pain of cardiac origin is usually located in the center of the chest and may radiate to the neck, left shoulder blade and left upper limb. It is often a crushing pain or described as an intense feeling of heaviness, and may be associated with sweating, nausea or pallor.
The association with exercise, the onset a few 24 hours after a viral illness and the gradual worsening, the worsening when lying down and the improvement when standing up, the combination with complete loss of consciousness or a pre-syncope episode or with palpitations, are elements that argue in favor of a cardiac origin of the chest pain.
Various other characteristics of chest pain also refer to diseases of other systems, e.g. the respiratory system (pain related to breathing, after intense coughing, in the upper part of the chest) or the gastrointestinal system (pain in the middle of the chest wall, associated with eating) as well as to its psychogenic origin.
A thorough clinical examination of the heart, lungs and chest wall completes the assessment of the pediatric patient or adolescent and either the diagnosis is made or, depending on the findings, an indication for further specialized testing with chest X-ray, electrocardiogram, echocardiogram, cardiac enzyme testing arises.
The final diagnosis determines whether, by which specialty, and with what frequency, follow-up is needed. In some patients who have not been diagnosed, chest pain recurs and can affect quality of life. In this case, follow-up is recommended, which stops when the symptoms disappear
In any case, it is very important to inform and educate parents regarding the frequency of chest pain in children, as well as to reassure both the patient and his or her parents regarding his or her safety and the mostly benign course of the condition, always in collaboration with the pediatrician or the specialist doctor as the case may be.
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