- Chest pain is a common complaint in children and causes significant anxiety to families who often worry that it is associated with the heart as it might be in older patients.
- Chest pain in children is rarely caused by the heart (<1%) and is most commonly musculoskeletal, idiopathic or respiratory in origin
Chest Pain
General information
Initial management
- Consider key differentials:
- costochondritis,
- precordial catch,
- musculoskeletal and respiratory pain
- Assess for cardiac risk factors;
- Past or current history of congenital cardiac disease
- Cardiac-type pain (central, crushing chest pain with radiation to left arm and jaw) or exertional syncope
- Hypercoagulable or hypercholesterolaemic state
- Family history of sudden death < 35 years, cardiac arrhythmia e.g. Brugada syndrome, Long QT, or young onset ischaemic heart disease
- Connective tissue disorders
- Implantable cardiac defibrillator in situ
- History of cocaine or amphetamine use
- Consider 12 lead ECG (use adult positions).
Who to refer
Refer to paediatrics if:
Same day referral if
- Cardiac risk factors are present (see above)
- Exercise induced dizziness
- Abnormal ECG
- Abnormal cardiac examination
Same day referral if
- Cardiac –type chest pain
- Exertional collapse
- TRUE Cyanosis i.e. documented low oxygen saturations
Who not to refer
Sharp, intermittent chest pains lasting seconds and worse on inspiration (pathognomic of precordial catch)
How to refer
Same day phone on-call paediatric registrar Ninewells
Outpatient referrals via SCI Gateway/Paediatrics (will be vetted and directed to paediatric cardiology).
Outpatient referrals via SCI Gateway/Paediatrics (will be vetted and directed to paediatric cardiology).