Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain

Drossner, David; Hirsh, Daniel A.; Sturm, James T.; Mahle, William T.; Goo, David J.; Massey, R U; Simon, Harold K.

doi:10.1016/j.ajem.2010.01.011

Cited by 85 publications

(90 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…71 In a study of 4436 patients presenting to a pediatric emergency department with chest pain, 24 had a confirmed cardiac origin, of whom 4 were diagnosed with myocarditis. 72 A recent study 27 of pediatric patients presenting with myocarditis and a chest pain/myocardial infarction pattern found that all had elevations of cardiac troponin I (peak range, 6.54-64.59 ng/mL) in the presence of normal values of erythrocyte sedimentation rate and C-reactive protein. Echocardiograms demonstrated a mild reduction in left ventricular function in 57% of the patients, and 5 of 6 patients demonstrated cMRI findings consistent with myocarditis.…”

Section: Chest Pain/myocardial Infarctionmentioning

confidence: 99%

Diagnosis and Treatment of Myocarditis in Children in the Current Era

2014

View full text Add to dashboard Cite

Section: Chest Pain/myocardial Infarctionmentioning

confidence: 99%

Diagnosis and Treatment of Myocarditis in Children in the Current Era

2014

View full text Add to dashboard Cite

“…By previous reports, most pediatric patients with chest pain caused by myocarditis, pericarditis, pulmonary embolism, or cardiomyopathy present to the emergency department. 1,3,14 The outpatient cardiology department is the setting where rare congenital coronary anomalies are typically identified. Specifying echocardiography as the diagnostic test of choice is based on its ability to identify coronary anomalies.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] This low incidence has been documented in the emergency setting as well as ambulatory care. 14 Many previous reports on pediatric chest pain have been observational and lack guideline recommendation. We have designed and reported on a quality improvement tool termed Standardized Clinical Assessment and Management Plans (SCAMPs), which guides care of patients with a single presenting symptom or condition according to an algorithm designed by clinicians that improves outcomes, narrows practice variability, and reduces unnecessary testing.…”

mentioning

confidence: 99%

Regional Implementation of a Pediatric Cardiology Chest Pain Guideline Using SCAMPs Methodology

et al. 2013

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES: Chest pain is a complaint for which children are frequently evaluated. Cardiac causes are rarely found despite expenditure of considerable time and resources. We describe validation throughout New England of a clinical guideline for cost-effective evaluation of pediatric patients first seen by a cardiologist for chest pain using a unique methodology termed the Standardized Clinical Assessment and Management Plans (SCAMPs). METHODS: A total of 1016 ambulatory patients, ages 7 to 21 years initially seen for chest pain at Boston Children’s Hospital (BCH) or the New England Congenital Cardiology Association (NECCA) practices, were evaluated by using a SCAMPs chest pain guideline. Findings were analyzed for diagnostic elements, patterns of care, and compliance with the guideline. Results from the NECCA practices were compared with those of Boston Children’s Hospital, a regional core academic center. RESULTS: Two patients had chest pain due to a cardiac etiology, 1 with pericarditis and 1 with an anomalous coronary artery origin. Testing performed outside of guideline recommendations demonstrated only incidental findings. Patients returning for persistent symptoms did not have cardiac disease. The pattern of care for the NECCA practices and BCH differed minimally. CONCLUSIONS: By using SCAMPs methodology, we have demonstrated that chest pain in children is rarely caused by heart disease and can be evaluated in the ambulatory setting efficiently and effectively using minimal resources. The methodology can be implemented regionally across a wide range of clinical practice settings and its approach can overcome a number of barriers that often limit clinical practice guideline implementation.

show abstract

“…Chest pain is a common complaint in children and adolescents presenting to ED, but only 0.6% of cases have an underlying cardiac etiology. 17 The risk of cardiac etiology to chest pain is significantly greater in the setting of an abnormal ECG and warrants serial troponin evaluation. The troponin assay has been documented as a useful screening tool for the evaluation of acute coronary syndrome in adults.…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction Induced by Concurrent Use of Adderall and Alcohol in an Adolescent

Sharma¹,

Castro²,

Chatterjee³

et al. 2013

Pediatric Emergency Care

View full text Add to dashboard Cite

Adderall (amphetamine, dextroamphetamine mixed salts), a widely prescribed stimulant for the treatment of attention-deficit/hyperactivity disorder in children and adolescents, is considered safe with due precautions. Nonmedical use of Adderall is prevalent and rising in high school and college students. Use of prescribed Adderall without intention to overdose as a cause of myocardial infarction is extremely rare, and to our knowledge, only 3 cases have been reported in the pediatric literature. We report a case of acute myocardial infarction in an adolescent without cardiovascular risk factors who took the total prescribed daily dose of Adderall one time while consuming alcohol. The sporadic use of Adderall with alcohol creates a potentially dangerous situation with serious cardiovascular adverse effects. We should have a high degree of suspicion for children and adolescents on stimulant therapy who present with chest pain and an abnormal electrocardiogram in the pediatric emergency department, and there is a need to evaluate them for myocardial ischemia and infarction.

show abstract

Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain

Cited by 85 publications

References 12 publications

Diagnosis and Treatment of Myocarditis in Children in the Current Era

Diagnosis and Treatment of Myocarditis in Children in the Current Era

Regional Implementation of a Pediatric Cardiology Chest Pain Guideline Using SCAMPs Methodology

Acute Myocardial Infarction Induced by Concurrent Use of Adderall and Alcohol in an Adolescent

Contact Info

Product

Resources

About