The Causes of Chest Pain in Children and the Criteria for Targeted Myocardial Enzyme Testing in Identifying the Causes of Chest Pain in Children

Chen, Li; Duan, Hongzhou; Li, Xiaoyan; Yang, Zuozhen; Ji, Meng; Sun, Kangtai; Jin, Mei

doi:10.3389/fcvm.2021.582129

Cited by 15 publications

(20 citation statements)

References 20 publications

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“…Chest pain is a common symptom in children, and the visit rate of chest pain as the first complaint in pediatric outpatient is gradually increasing ( 10 , 18 ). Since there is not enough relevant knowledge about the common causes of children’s chest pain, most parents believe that their child’s chest pain should be caused by cardiac diseases and may be life-threatening.…”

Section: Discussionmentioning

confidence: 99%

“…Until now, children with myocarditis, pericarditis, large ventricular septal defect, anomalous origin of the coronary artery, cardiomyopathy, pulmonary arterial hypertension, aortic dissection, moderate or severe left ventricular outflow tract obstruction, pulmonary embolism or arrhythmia were thought to have cardiac chest pain ( 1 – 5 , 11 – 16 ). According to our previous study, we enrolled suspected myocarditis as cardiac chest pain in children ( 10 , 17 ). Based on criteria that were applied in retrospect, chest pain was divided into cardiac or non-cardiac ( 1 – 5 , 13 – 17 ).…”

Section: Methodsmentioning

confidence: 99%

“…To date, few studies have reported the disease spectrum of chest pain in children who are referred to cardiology clinics ( 1 , 6 ). Studies have estimated that cardiac chest pain in children range from 1 to 8% ( 7 – 10 ). In the existing studies, the number of subjects was small.…”

Section: Introductionmentioning

confidence: 99%

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The Etiology of Chest Pain in Children Admitted to Cardiology Clinics and the Use Echocardiography to Screen for Cardiac Chest Pain in Children

Chen

Duan

et al. 2022

Front. Pediatr.

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AimsChest pain is a common disease in children. Most cardiac specialists use echocardiography to evaluate the etiology of and screen for children’s cardiac chest pain. We analyzed the etiology and echocardiography results of children with chest pain in pediatric cardiology clinics, clarified the disease spectrum and evaluated the diagnostic value of echocardiography in screening cardiac chest pain in children.Methods and ResultsThe clinical data of children with chest pain aged younger than 18 years who admitted to the pediatric cardiology clinic of Beijing Anzhen Hospital between 2005 and 2019 were analyzed. The patients were divided into three groups, including the preschool group, the school-age group and the adolescent group. Total 3,477 children were enrolled in this study. 232 (6.7%) patients were caused by cardiac diseases and chest pain was of non-cardiac origin in 3,245 patients (93.3%). The incidence of non-cardiac chest pain in the adolescent group was significantly lower than the other two groups, respectively (91.4 vs. 94.9 vs. 94.3%, P < 0.05). In the preschool group, most of the patients were girls (51.4%), while in the school-age group and the adolescent group, most of the patients were boys (P < 0.05). Among the children (n = 3,205) who underwent echocardiography, 108 children had positive results, and 3,097 children had negative results. Among the 108 positive results, 10 cases of cardiac diseases were related to chest pain. The sensitivity, specificity of echocardiography in the diagnosis of cardiac chest pain were 6.7, and 96.9%, while the positive predictive value and negative predictive value was 12.96 and 93.67%, respectively.ConclusionIn children with chest pain who are admitted to pediatric cardiology clinics, chest pain is mostly benign and rarely due to cardiac diseases. The use of echocardiography in evaluating cardiac chest pain in children is of little diagnostic value and leads to excess costs for patients and the health care system.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The Etiology of Chest Pain in Children Admitted to Cardiology Clinics and the Use Echocardiography to Screen for Cardiac Chest Pain in Children

Chen

Duan

et al. 2022

Front. Pediatr.

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“…Cardiac causes were excluded in the present study, which have been considered the main causes by parents and pediatricians. Chen et al [23] reported on 7,251 children with chest pain and only 8.0% was of cardiac origin. Possible respiratory-system problems were also excluded, such as pharyngitis, allergic rhinitis, adenoidal or tonsillar hypertrophy, pneumonia, pleura effusion, and bronchiolitis obliterans.…”

Section: Discussion/conclusionmentioning

confidence: 99%

The Use of Exercise Challenge Testing and Fractional Exhaled Nitric Oxide in Diagnosis of Chest Tightness Variant Asthma in Children

Feng

Zhang

Ya-zhen

et al. 2022

Int Arch Allergy Immunol

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Background: Chest tightness variant asthma (CTVA) in children presents with chest tightness as the sole manifestation. Diagnostic tests are needed given the lack of typical asthma symptoms. The present study aimed to investigate the diagnostic value of exercise challenge testing (ECT) and fractional exhaled nitric oxide (FeNO) in pediatric CTVA. Methods: We included 98 children aged 6–13 years with chest tightness as the sole symptom for >4 weeks. All subjects underwent FeNO measurement, spirometry and ECT, and received 4-week budesonide/formoterol treatment. According to treatment responses, children were categorized into CTVA (n = 12) and non-CTVA (n = 86) groups. Differences in clinical characteristics and FeNO, spirometry, and ECT results were compared between the two groups. The FeNO and ECT diagnostic performances were determined using receiver operating characteristic (ROC) curve analysis. Results: Children with CTVA exhibited significantly higher Mycoplasma pneumoniae IgG, total IgE, and FeNO values; greater post-ECT forced expiratory volume in 1 s (FEV1) fall; and more frequent sensitization to mites and pets than those without CTVA. Further logistic regression revealed that higher FEV1 fall (OR, 1.39; 95% CI: 1.11–1.74; p = 0.004) and higher FeNO values (OR, 1.04; 95% CI: 1.01–1.08; p = 0.014) were risk factors associated with CTVA. FEV1 fall and FeNO had similar areas under the ROC curve (AUCs) (0.79 vs. 0.78; p = 0.924), and their optimal CTVA-prediction cutoff values were 9.9% and 15.0 ppb, respectively. The AUC of FEV1 fall and FeNO combination was higher at 0.86 (95% CI: 0.78–0.93); however, no difference was observed using the single test (p > 0.05). Their combination exhibited a relatively higher sensitivity than that of FEV1 fall alone (0.75 vs. 0.67) and higher positive predictive value than that of FeNO alone (0.60 vs. 0.29). Conclusion: CTVA is a cause of unexplained recurrent chest tightness in children. FeNO ≥15.0 ppb and post-ECT FEV1 fall ≥9.9% are diagnostically valuable for CTVA in children, with their combination potentially contributing to greater diagnostic accuracy.

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“…On the other hand, non-emergent cardiac factors contributing to chest pain encompass valvular, infectious, or inflammatory conditions. Interestingly, a Study by Chen L et al aimed to investigate the causes of chest pain in Chinese children and found that causes of chest pain in 7,251 children who visited the hospital during a 15-year period; 53.0% of the cases were idiopathic, 29.1% were related to Musculoskeletal diseases, 9.1% were related to respiratory diseases, 8.0% were cardiac, 0.6% were related to gastrointestinal diseases, 0.16% were related to mental diseases, and 0.04% were related to other conditions [ 1 ]. Nevertheless, according to this study, idiopathic chest pain was the most common cause of chest pain [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Chest pain in pediatric patients in the emergency department- Presentation, risk factors and outcomes-A systematic review and meta-analysis

Alsabri,

Elshanbary,

Nourelden

et al. 2024

PLoS ONE

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Objective This study aimed to assess and determine the presentation, risk factors, and outcomes of pediatric patients who were admitted for cardiac-related chest pain. Background Although chest pain is common in children, most cases are due to non-cardiac etiology. The risk of misdiagnosis and the pressure of potentially adverse outcomes can lead to unnecessary diagnostic testing and overall poorer patient experiences. Additionally, this can lead to a depletion of resources that could be better allocated towards patients who are truly suffering from cardiac-related pathology. Methods This review was conducted per PRISMA guidelines. This systematic review used several databases including MEDLINE, Embase, Scopus, and Web of Science to obtain its articles for review. Results A total of 6,520 articles were identified, and 11 articles were included in the study. 2.5% of our study population was found to have cardiac-related chest pain (prevalence = 0.025, 95% CI [0.013, 0.038]). The most commonly reported location of pain was retrosternal chest pain. 97.5% of the study population had a non-cardiac cause of chest pain, with musculoskeletal pain being identified as the most common cause (prevalence = 0.357, 95% CI [0.202, 0.512]), followed by idiopathic (prevalence = 0.352, 95% CI [0.258, 0.446]) and then gastrointestinal causes (prevalence = 0.053, 95% CI [0.039, 0.067]). Conclusions The overwhelming majority of pediatric chest pain cases stem from benign origins. This comprehensive analysis found musculoskeletal pain as the predominant culprit behind chest discomfort in children. Scrutinizing our study cohort revealed that retrosternal chest pain stands as the unequivocal epicenter of this affliction. Thorough evaluation of pediatric patients manifesting with chest pain is paramount for the delivery of unparalleled care, especially in the context of potential cardiac risks in the emergency department.

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The Causes of Chest Pain in Children and the Criteria for Targeted Myocardial Enzyme Testing in Identifying the Causes of Chest Pain in Children

Cited by 15 publications

References 20 publications

The Etiology of Chest Pain in Children Admitted to Cardiology Clinics and the Use Echocardiography to Screen for Cardiac Chest Pain in Children

The Etiology of Chest Pain in Children Admitted to Cardiology Clinics and the Use Echocardiography to Screen for Cardiac Chest Pain in Children

The Use of Exercise Challenge Testing and Fractional Exhaled Nitric Oxide in Diagnosis of Chest Tightness Variant Asthma in Children

Chest pain in pediatric patients in the emergency department- Presentation, risk factors and outcomes-A systematic review and meta-analysis

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