Chest pain resident survival guide (pediatrics)
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 |
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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 pediatrics is idiopathic and the second cause is musculoskeletal. Although there are high worries among parents about the cardiac origin of chest pain in pediatrics, it consists 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 disease, acute pulmonary embolism, tamponade
- Abdominal aorta dissection with propagation to thoracic aorta
- Perforated peptic ulcer
- Air leak syndrome such as Pneunomothorax, 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 | |
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Musculoscletal origin | |
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Respiratory origin |
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Gastrointestinal origin |
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Cardiac origin | |
Psychogenic origin | |
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Ideopathic |
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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 sternal chest pain, exercised induced chest pain, persistent tachycardia, hypotension, gallop rhythm, syncope | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pulmonary | Hemoptysia, dyspnea, rales,cyanosis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical examination | Gastrointestinal | Hematemesis,hematochezia, melena | |||||||||||||||||||||||||||||||||||||||||||||||||||||
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%) |
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Respiratory (9.3%) | |
Musculoskeletal (8.8%) | |
Cardiac (3.8%) | |
Gastrointestinal (2.9%) | |
Psychiatric (1.4%) |
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- Quickly evaluate cardiac examination in pediatrics presented with chest pain and syncope.
- Arrhythmia leading chest pain in children include: paroxismal 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.
Don'ts
- The content in this section is in bullet points.