Analysis of clinical characteristics and causes of chest pain in children and adolescents

Abstract

PurposeChest pain is common in children and adolescents and is a reason for referral to pediatric cardiologists. Although most cases of chest pain in these age groups are benign and do not require treatment, timely diagnosis is important not to miss life-threatening diseases requiring prompt treatment. We investigated certain clinical characteristics that may be useful in the diagnosis of such critical diseases.MethodsPatient medical records between July 2006 and September 2013 were retrospectively examined. We included 517 patients who presented with chest pain to the Department of Pediatrics at Kyung Hee University Hospital in Gangdong.ResultsMost cases of chest pain were idiopathic in origin (73.6%), followed by cases with respiratory (9.3%), musculoskeletal (8.8%), cardiac (3.8%), gastrointestinal (2.9%), and psychiatric (1.4%) causes. In 6 patients (1.2%) with air-leak syndrome including pneumothorax or pneumomediastinum, the pain was abrupt, continuous, and lasted for a short period of 1-2 days after onset in the older adolescents. Of the patients with cardiac pain, 13 had cardiac arrhythmias (65.0%), 6 had congenital heart diseases (30%), and 1 had coronary aneurysms caused by Kawasaki disease (5.0%). One patient with atrial flutter had only symptoms of syncope and chest pain.ConclusionThe abrupt, continuous chest pain of a short duration in the older children was characteristic of air-leak syndrome. In patients with pneumomediastinum, radiological diagnosis was difficult without careful examination. Combined syncope should not be neglected and further cardiac workup is essential in such patients.

Aetiological evaluation of chest pain in childhood and adolescence

“…1,2 The most common causes of chest pain in children are non-cardiac and include musculoskeletal and idiopathic origins, and cardiac diseases are found in the aetiology of chest pain in a small portion of the cases ranging from less than 1 to 10%. [3][4][5][6] Careful evaluation of medical history, and physical examination should be performed due to high mortality of cardiac-related chest pain in cases without rapid diagnosis and treatment. 3,5,7 However, there is a controversy about determining which child could be affected by a serious organic disease and which tests could be performed for an exact diagnosis.…”

“…[3][4][5][6] Careful evaluation of medical history, and physical examination should be performed due to high mortality of cardiac-related chest pain in cases without rapid diagnosis and treatment. 3,5,7 However, there is a controversy about determining which child could be affected by a serious organic disease and which tests could be performed for an exact diagnosis. 4 Aetiology of chest pain may show considerable variability based on the diagnostic approaches.…”

Anomalous origin of the left coronary artery from the right aortic sinus: probably benign variant associated with a subpulmonic intramyocardial course – a case report

“…The coronary artery took a caudal course below the right ventricular outflow tract. In the absence of signs of myocardial ischemia and since the episodes of chest pain had the characteristics of idiopathic chest pain [6] we decided to monitor the patient in the first decade without invasive diagnosis. When she was referred again at the age of 12 years she still had short episodes of chest pain but otherwise she was asymptomatic.…”

“…Furthermore the CT-scan revealed that the anomalous left coronary artery had neither a slit like opening nor an acute angle of take-off from the aorta which have been identified as possible risk factors for myocardial ischemia in patients with interarterial course [7]. Since the episodes of chest pain had the characteristics of idiopathic chest pain [6] and since prophylactic surgery appeared not justified in the absence of documented ischemia we opted for a conservative approach without restriction of exercise or sports activities and recommended annual follow-up visits [2]. During a follow-up of 2 years the patient remained asymptomatic.…”

Could there be any relationship between nutritional deficiencies and idiopathic chest pain in children?

“…On the other hand, chest pain is one of the main causes of recurrent referral to pediatric emergency and pediatric cardiology departments and the most common etiology is still unknown and called as'idiopathic' with a percentage of 21-59 % [12]. Different studies were made to enlight this unknown etiology to this date [13][14][15][16]. However, there has been no published studies that evaluated the relationship between idiopathic chest pain and nutritional deficiencies according to our knowledge.…”