Chest pain resident survival guide (pediatrics): Difference between revisions
(→Do's) |
|||
Line 432: | Line 432: | ||
* Think about [[pneumothorax]] among young adult [[male]] presented with [[tachypnea]], persistent [[pleuritic chest pain]] for 1-2 days and take a [[chest-X-ray]] for evaluation of [[air leak syndrome]]. | * Think about [[pneumothorax]] among young adult [[male]] presented with [[tachypnea]], persistent [[pleuritic chest pain]] for 1-2 days and take a [[chest-X-ray]] for evaluation of [[air leak syndrome]]. | ||
* If the [[CXR]] is undiagnostic for evaluation of pneumomediastinum, [[chest]] CT-scan is considered. | * If the [[CXR]] is undiagnostic for evaluation of pneumomediastinum, [[chest]] CT-scan is considered. | ||
* In [[patients]] with [[chest pain]] and [[hypoxia]], [[pulmonary embolism]] should be considered. | |||
* In [[children]], acute [[chest]] syndrome can be the manifestation of [[sickle cell anemia]]. | |||
==Don'ts== | ==Don'ts== |
Revision as of 21:16, 19 February 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Synonyms and keywords:
Chest pain resident survival guide (pediatrics) Microchapters |
---|
Overview |
Causes |
FIRE |
Diagnosis |
Treatment |
Do's |
Don'ts |
Overview
Chest pain is the second cardiac symptom after cardiac murmur that is referred to a pediatric cardiologist for evaluation. the most common cause of chest pain in children is idiopathic and the second cause is musculoskeletal. Although there are high worries among parents about the cardiac origin of chest pain in children, it consists in low percentage the causes of chest pain. Evaluation of chest pain includes assessments of the respiratory system, gastrointestinal system, cardiac diseases and psychologic factors.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Cardiac causes such as life-threatening arrhythmia, acute coronary syndrome, acute pulmonary embolism, tamponade
- Abdominal aorta dissection with propagation to thoracic aorta
- Perforated peptic ulcer
- Air leak syndrome such as Pneumothorax, pneumomediastinum
Common Causes
FIRE: Focused Initial Rapid Evaluation
Complete Diagnostic Approach
Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.
Charactristics of chest pain | |
---|---|
Musculoscletal origin |
|
| |
| |
Respiratory origin |
|
Gastrointestinal origin |
|
| |
Cardiac origin | |
Psychogenic origin | |
| |
Ideopathic |
|
Sharp | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dull | Undefined | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Duration of chest pain | Charactristics of chest pain | Associated symptoms | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Chest wall tenderness | Respiratory related | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Squeezing | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Symptoms associated with Chest pain in children and adolescence: ❑ Cough (23.4%) ❑ Dyspnea (11%) ❑ Abdominal pain (9.7%) ❑ Palpitation (9.7%) ❑ Respiratory related (9%) ❑ Dizziness (5.8%) ❑ Post nasal drip (4.4%) ❑ Fever (5.2%) ❑ Exercise induced (2.6%) ❑ Syncope (2.6%) | |||||||||||||||||||||
Cardiac | Underlying congenital or acquired heart disease, arrhythmia, crushing chest pain, exercised induced chest pain, persistent tachycardia, hypotension, gallop rhythm, syncope, pericardial rub | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pulmonary | Hemoptysia, tachypnea, rales,cyanosis, wheeze, pleural rub | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical examination | Gastrointestinal | Hematemesis,hematochezia, melena, epigastric tenderness, organomegaly, trauma | |||||||||||||||||||||||||||||||||||||||||||||||||||||
musculoskeletal | Chest Trauma, chest bruising, chest asymmetry, chest localised swelling, chest localized tenderness, crepitus on palpation, arm limited range of motion | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Other | Febrile, psychosis, suisidal ideation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Evaluation of chest pain | |||||||||||||||||||||||||||||||||||||||||||||
Medical history, cardiac examination | |||||||||||||||||||||||||||||||||||||||||||||
Abnormal history or cardiac examination | Normal history and cardiac examination | ||||||||||||||||||||||||||||||||||||||||||||
Yes | NO | ||||||||||||||||||||||||||||||||||||||||||||
Febrile, acute onset symptoms | Palpitation, chest pain, positive family history | ||||||||||||||||||||||||||||||||||||||||||||
Yes | NO | NO | Yes | ||||||||||||||||||||||||||||||||||||||||||
Refer to pediatric cardiologist | At rest chest pain, exersional chest pain | Refer to pediatric cardiologist | |||||||||||||||||||||||||||||||||||||||||||
Exertional chest pain | At rest chest pain or reproducible on exam | ||||||||||||||||||||||||||||||||||||||||||||
Suspected asthma | Low likehood of cardiac chest pain | ||||||||||||||||||||||||||||||||||||||||||||
Yes | NO | Reassurance | |||||||||||||||||||||||||||||||||||||||||||
Bronchodilator | Refer to pediatric cardiologist | ||||||||||||||||||||||||||||||||||||||||||||
Improvement | |||||||||||||||||||||||||||||||||||||||||||||
Keeping management | Refer to pediatric cardiologist | ||||||||||||||||||||||||||||||||||||||||||||
Causes of sharp chest pain |
Aspect |
Ideopathic (73.6%) |
|
Respiratory (9.3%) | |
Musculoskeletal (8.8%) | |
Cardiac (3.8%) | |
Gastrointestinal (2.9%) | |
Psychiatric (1.4%) |
Cardiac origin |
---|
History of acquired or congenital cardiac disease |
Exertional syncope |
Exertional chest pain |
Hypercoagulable state |
Hypercholesterolemic state |
Family history of sudden death under 35 years of age |
Family history of premature coronary artery disease |
Inheritted arrhythmia in the first relative |
ICD implantation |
Connective tissue disorders |
Using cocaine,amphetamine |
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Cardiac causes such as IHD, pericarditis, tamponade, arrhythmia | Treatment of underlying causes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Musculoskeletal | Reassurance, rest,analgesic, antiinflammatory agent (NSAID), warmcompression | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment of pediatric chest pain | Pulmonary disease ( bronchitis, asthma, pleurisy, pleural effusion, pneumonia, empyema, bronchiectasis, lung abscess, | antibiotic therapy, bronchodilator therapy | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Gastrointestinal such as GERD, gastritis | Antiacid, H.pilory eradication | {{{ }}} | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Psychologic | Cognitive behavior therapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- Quickly evaluate cardiac examination in pediatrics presented with chest pain and syncope.
- Arrhythmia leading chest pain in children include: paroxysmal supraventricular tachycardia (PSVT), premature ventricular contraction (PVC), atrial flutter, mobitz type2 block ,atrial tachycardia, atrial premature contraction.
- Think about pneumothorax among young adult male presented with tachypnea, persistent pleuritic chest pain for 1-2 days and take a chest-X-ray for evaluation of air leak syndrome.
- If the CXR is undiagnostic for evaluation of pneumomediastinum, chest CT-scan is considered.
- In patients with chest pain and hypoxia, pulmonary embolism should be considered.
- In children, acute chest syndrome can be the manifestation of sickle cell anemia.
Don'ts
- The content in this section is in bullet points.