Chest pain in children – Cardiology Basics

Chest pain in children – Cardiology Basics

Even though chest pain in children is a common symptom, unlike in adults it is seldom due to heart disease. Most often the cause of chest pain in children is not a major life threatening disease. Still chest pain can cause restriction of activities, absence from school and cause of anxiety to children and their parents.

A good history and physical examination can give a lot of information to exclude any potentially serious condition causing chest pain, though it is rare. Costochondritis is a common cause of chest pain in adolescent and preadolescent girls. It can be caused by viral illness or due to frequent coughing due to respiratory illness. It can be identified by localised tenderness at costochondral joint.

Injury to muscles and bones of the chest can be a cause of chest pain in children, but this cause is usually obvious from the history. But this can also occur following the lifting of heavy objects, frequent coughing or a lot of aerobic exercise.

Stress or anxiety is also a common cause of chest pain though it may be difficult to elucidate because the cause of stress may not be obvious. Exam related stress and other usual causes of stress have to be thought of. Stress can also cause worsening of chest pain due to another cause. Hence other causes have to be excluded before attributing a sole etiological role for stress.

Pleurisy is another important cause of chest pain which characteristically increases on inspiration and has a catching nature. Sometimes chest pain can occur due to pleural effusion which can be preceded by pleurisy. But in this case shortness of breath is usually a prominent associated symptom.

Reflux esophagitis can also cause chest pain. This causes a burning type of chest pain felt in the center of the chest. In adults this can be mistaken for coronary artery disease.

Though rare, some cardiac causes of chest pain in children are worth noting. Pericarditis can cause chest pain in children. It causes a sharp pain which may be relieved by sitting and leaning forwards. Fever may be associated with pericarditis. Odynophagia may be associated with pericarditis as the food bolus presses on the inflamed pericardium behind the left atrium.

Presence of a pericardial rub makes diagnosis easy, though it may be evanescent sometimes. Most cases of pericarditis are self-limited but can rarely become a serious problem leading to pericardial effusion and cardiac tamponade.

Abnormalities of the coronary arteries can occur as a congenital anomaly or secondary to conditions like Kawasaki disease. Kawasaki disease can cause coronary aneurysms and myocardial infarction in children as late sequelae.

Hypertrophic cardiomyopathy is an autosomal dominant disorder which could be a cause of chest pain in children. Mitral valve prolapse can also cause chest pain, more often in adolescent females. Most often it is only a minor abnormality though rarely it can cause significant mitral regurgitation.

Another rare cause of chest pain could be an aneurysm of aorta. This is quite rare in children and can occur in Marfan syndrome.

Rarely a tachyarrhythmia may also be felt as a chest discomfort by some children. This ECG shows supraventricular tachycardia with right bundle branch block pattern. Wolff-Parkinson-White syndrome is an important cause of supraventricular tachycardia in children.