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Chest Pain in Children

Chest pain is the presenting complaint in 6 per 1,000 children who present to pediatric emergency departments or walk-in clinics. Young children are more likely to have a cardiorespiratory cause o n b f their pain, such as cough, asthma, pneumonia, or heart disease; adolescents are more likely to have pain associated with a psychogenic disturbance.

Differential Diagnosis of Chest Pain in Children

Cardiac Disease

Cardiac disease is a rare cause of chest pain in children. However, myocardial infarction can rarely result from anomalous coronary arteries, and there may be no warning of this condition. Some children will have a pansystolic, continuous, or mitral regurgitation murmur or gallop rhythm that suggests

Arrhythmias may cause palpitations or abnormalities on cardiac examination in some children. Supraventricular tachycardia is the most common arrhythmia, but premature ventricular beats or tachycardia also can cause episodes of brief, sharp chest pain.

Hypertrophic obstructive cardiomyopathy is an autosomal dominant structural disorder; therefore, there often is a family history of the condition. Children may have a murmur that may be audible when

Mitral valve prolapse may cause chest pain secondary to papillary muscle or endocardial ischemia. A midsystolic click and a 

Cardiac infections are uncommon causes of pediatric chest pain.

Pericarditis presents with sharp, stabbing pain that improves when the patient sits up and leans forward. The child usually is febrile; is in respiratory distress; and has a friction rub, distant heart sounds, neck vein distention, and pulsus paradoxus.

Myocarditis presents as mild pain that has been present for several days. After a few days of fever, vomiting and lightheadedness, the patient may develop pain or shortness of breath on exertion. Examina tion may reveal muffled heart sounds, fever, a gallop rhythm, or tachycardia. The patient also may have orthostatic changes in

Chest radiography will show

Cardiac Disorders Leading to Pediatric Chest Pain
Coronary Artery Disease--Ischemia/Infarction
Anomalous coronary arteries

      Coronary arteritis (Kawasaki disease)

      Long-standing diabetes mellitus

Arrhythmia
Supraventricular tachycardia

Ventricular tachycardia

Structural Abnormalities

      Hypertrophic cardiomyopathy

      Severe pulmonic stenosis

      Aortic valve stenosis

      Mitral valve prolapse

      Infection

Pericarditis

      Myocarditis

Musculoskeletal Pain

This is one of the most common diagnoses in children who have chest discomfort. Children frequently strain 

Trauma to the chest may result in a mild contusion or a rib fracture. The physical examination will reveal 

Costochondritis is common in children, and it is characterized by tenderness over the costochondral junctions with palpation. The pain is sharp and

Respiratory Conditions

Severe cough, asthma, or pneumonia may cause chest pain because of overuse of chest wall muscles.

Exercise-induced asthma may cause chest pain, which can be confirmed with a treadmill test.

Spontaneous pneumothorax or pneumomediastinum may occasionally cause