Pediatric Chest Pain:

Epidemiology:

• Mostly no identifable cause vs. muscle pain vs. GI
• Mostly Non-Cardiac

Differential Diagnosis:

• Cardiac à HOCM v. prolonged QTc v. WPW v. anomalous coronary artery v. SVT v. perimyocarditis
• Pulmonary à pneumothorax v. pneumomediastinum v. pneumonia v. asthma v. aspirated foreign body v. PE (rarely)
• GI à reflux, foreign body
• Chest wall à trauma, costochondritis.
• Heme à sickle cell crisis, acute chest syndrome

Use HPI and Phycial exam to guide need for EKG, CXR, Labs

•  May not need any diagnostics!

Red flags = palpitations, syncope, exertional, abnormal exam/ vitals, family history of sudden death at a young age, Kawaski’s history

 References:

Selbst SM1. Approach to the child with chest pain. Pediatr Clin North Am. 2010 Dec;57(6):1221-34

https://www.uptodate.com/contents/nontraumatic-chest-pain-in-children-and-adolescents-approach-and-initial-management?source=search_result&search=pediatric%20chest%20pain&selectedTitle=1~150#H372756498​