Chest pain (peds)

Background

• Common cause of presentation to the ED, especially in adolescents
• The majority of pediatric chest pain is benign and not cardiac in origin
• The main cause of cardiac chest pain in pediatrics is pericarditis
• Family history plays an important part screening for familial history of sudden death

Differential Diagnosis

• Idiopathic (most common)
• Precordial catch syndrome
  • Sudden, intense pain with deep inspiration, self-resolving
• Musculoskeletal
  • Costochondritis, trauma
• Pulmonary
  • Pneumothorax
• GI
  • Esophagitis
• Psychosomatic
• Cardiac (1%)
  • Left-sided obstructive lesions
  • Dysrhythmias
  • HOCM
  • Pericarditis
  • Prinzmetal's angina (vasospasm)
  • MI
    • Rare, even post-Kawasaki
  • Mitral valve prolapse

Evaluation

• Physical exam
  • Listen for murmurs
  • Palpate
  • Compress rib cage
• ECG
• CXR
• Consider echo

See Also

• Chest pain