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

Abstract

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.

Unrecognized scoliosis as the cause of chest pain: A case report

“…Бол у грудима код деце и адолесцената је симптом који је и код деце и код родитеља узрок изразитог страха, због честе повезаности са животно угрожавајућим срчаним обољењем [1]. Бол у грудима код деце ретко је повезан са тешким срчаним обољењем, а најчешће је мишићно-скелетног порекла [1,2,3]. Код највећег броја деце и адолесцената са болом у грудима некардијалног порекла, у последње време, дијагностикује се неки облик мишићно-скелетног поремећаја [4,5].…”

“…Chest pain in children and adolescents is a symptom that causes extreme fear both in the child and in their parents, as they frequently tend to associate it with life-threatening heart disease [1]. Chest pain in children is rarely associated with severe heart disease, and is most often musculoskeletal [1,2,3]. In recent times, most children and adolescents with chest pain of non-cardiac origin are diagnosed with some form of musculoskeletal disorder [4,5].…”

Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department

“…Chest pain in children and adolescents could be divided into the following etiologies: musculoskeletal, idiopathic, pulmonary, gastrointestinal, psychogenic, cardiac, or miscellaneous causes [ 1 , 2 , 9 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Due to varying classifications of the causes of chest pain in different articles and the lack of uniformity in diagnostic definitions among these articles, the exact proportion of chest pain in children and adolescents varies from study to study.…”

“…Due to varying classifications of the causes of chest pain in different articles and the lack of uniformity in diagnostic definitions among these articles, the exact proportion of chest pain in children and adolescents varies from study to study. However, it is clear that cardiac chest pain is relatively rare in the pediatric population, accounting for 0.6–8.0% [ 1 , 2 , 9 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

“…However, chest pain in the pediatric population is generally a benign disease, with the most common cause being musculoskeletal pain, which can be identified simply with detailed history-taking and physical examination [ 1 , 3 , 4 , 7 , 8 ]. Cardiac chest pains in children, on the other hand, are rare, accounting for 0.3–8.0% of all children and adolescents with chest pain ( Table 1 ) [ 1 , 2 , 4 , 7 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Several studies have noted that many examinations performed in the emergency department have limited diagnostic value [ 1 , 2 , 4 , 9 , 20 , 21 ].…”