Chest Pain in Pediatric Patients

One hundred and twenty-three patients (72 males and 51 females) with the chief complaint of chest pain, seen at our department during the five-year period from January 1982 to December 1986, were studied regarding their past medical history, physical findings, results of diagnostic tests, and prognosis. The ages of the subjects ranged from 3 to 16 years (mean 11.7 years) in boys and 3 to 20 years (mean 10.9 years) in girls, constituting 0.54% of the total number of the mean annual outpatients. Of these 123, 80 patients (65%) had chest pain lasting over one month, and 91 patients (74%) had a short time of duration of pain which improved within a few seconds to five minutes. In nine (7%) of the 123 patients, the pain was considered to be related to cardiovascular lesions and in 82 patients (67%) as being idiopathic chest pain. Chest pain in children is rarely due to serious primary cardiovascular diseases.     

Chest Pain: Characteristics of Children/Adolescents

Chest pain (CP) in children/adolescents is a common referral for the pediatric cardiologist. A group of 263 patients (141 males/122 females, mean age = 13.4 years, range = 5-22 years) with the primary complaint of CP underwent evaluation in the cardiac stress lab at Children's Hospital of Wisconsin. Echocardiograms at rest were obtained in 70% of patients with no significant cardiac abnormalities identified. Endurance time (EXT) and oxygen consumption (VO(2)/kg) were below predicted in 26% and 46%, respectively. Reactive airway disease (RAD) as a preexisting condition was reported in 19% of patients, but abnormal resting pulmonary function (PFTs) were found in 26% (n = 68), with 48/68 never having the diagnosis of RAD. At risk of overweight (BMI >85th percentile), was seen in 28% of the cohort, with 16% identified as being overweight (BMI >95th percentile). A significant difference in RAD (p < 0.01) was seen in African Americans (AA) and decreased EXT (p = 0.01) was seen in Hispanics (H). VO(2)/kg was significantly reduced in both AA and H (p < 0.01). These results identify both racial and age-related differences in the etiology of CP in children. Most importantly, true cardiac pathology is extremely rare. AOW, deconditioning, and respiratory compromise play important roles in CP. The need for comprehensive cardiopulmonary monitoring is emphasized by these findings.     

Methacholine Inhalation Challenge in Children with Idiopathic Chest Pain

Bronchial reactivity to inhaled methacholine (MCH) was evaluated in 32 patients with 'idiopathic' chest pain. Each pain was recurrent in nature. The incidence of cases with a provocative concentration causing a 20% fall in the forced expiratory volume in 1 sec (PC₂₀) of 10 mg/ml or less was 62.5% (20 cases), while it was only 11.1% (three cases) in 27 healthy controls. Seventeen patients had no personal history of allergic diseases, elevated serum lgE level or positive house dust mite-specific IgE antibody. Among these 17, eight (47.1%) had a PC₂₀ of 10 mg/ml or less, the incidence of which was also higher than that of the healthy controls. During the challenge, eight patients complained of chest pain similar to that experienced before. The present results indicate that bronchial hyper-reactivity is an important cause of 'idiopathic' chest pain. Patients with unexplained chest pain should be considered for inhalation challenge.     

Managing the Grandparent with Chest Pain: Advice for Emergency Pediatricians

The etiology of acute undifferentiated chest pain in a grandparent may be difficult to establish, even for a specialist in adult emergency care or internal medicine. Faced with such a patient, the emergency pediatrician should focus on measures that provide a foundation for excluding life-threatening illness and optimizing outcome. Such measures, as discussed in this paper, should be well within the capability of all emergency pediatricians.

Assessment of Acute Pain in Children

Pain assessment is an important component of emergency department care. Children present unique challenges to assessing pain due to their constantly changing developmental ability to understand concepts, communicate verbally, and use common pain severity rating scales. Pain severity in young and noncommunicating cognitively impaired children is rated using behavioral scales. School-aged children use faces scales to self-report pain severity, whereas older preteens and adolescents can use the verbal numeric rating scale. There are numerous other important aspects of the pain experience to assess other than severity, such as location, mechanism, neuropathology, onset, provokers and palliaters, quality, radiation, and timing.     

Acute Chest Syndrome in Children with Sickle Cell Anemia

Vaso-occlusive crisis is the most common cause of morbidity in patients with sickle cell anemia (SCA). Those patients are frequently admitted with chest signs and symptoms suggesting an infective process. The term acute chest syndrome (ACS) is used to describe those chest episodes in SCA patients, and it is postulated that a primary bone vaso-occlusive crisis may be the cause of the acute chest syndrome in SCA patients. In this study we report 52 episodes of ACS in a group of 22 children with SCA. Chest pain, fever, and leukocytosis were a constant clinical finding. The hematological, radiological, and bacteriological studies are reported. There is a constant and significant fall in hemoglobin levels from 88 ± 10 g/L (8.8 ± 1.0 g/dl) to 68 ± 15 g/L (6.8 ± 5 g/dl). Unilateral or bilateral pulmonary basal infiltrations were found in 50 episodes. Pleural effusion was noticed in 60 episodes, and it was bilateral in three. No significant bacteriological findings were present.     

心脏疾病相关性胸痛的早期识别与处理

胸痛已成为近年来儿童就诊的常见症状,由于引起胸痛的原因很多,大部分患儿难以寻找出明确的病因。通过相关检查及长期随访研究表明,仅极少部分患儿胸痛为心源性疾病所致,心脏科医师的任务是如何通过病史、体格检查及相应的辅助检查及时、有效地筛查出可能危及患儿生命的心脏疾病相关性胸痛,消除患儿及父母的焦虑,并针对不同的病因做出正确的处理。     

Left Atrial Myxoma in a Child with Unique Presentation: Chest Pain

We present a 16-year-old girl who presented with chest pain. Given her obesity and positive family history, she was felt to have atherosclerotic heart disease. However, an echocardiogram showed an atrial myxoma, which prompted surgical excision. This case supports the routine use of echocardiography and widened differential diagnosis when presented with pediatric chest pain.     

A Teenage Girl with Acute Back Pain

Initially, when presented with a child with back pain, it is important to consider a broad and complete differential diagnosis because back pain in children is often the sign of a pathological process. The red flags to be aware of when evaluating a child with back pain are acute or progressive back pain, limitation of activity, any neurologic signs or symptoms, and pain unresponsive to anti-inflammatory drugs. Malignancy is an important consideration in children with back pain, and evidence of at least 2 abnormal cell lines on a complete blood count requires evaluation for an oncologic process. Although rare, back pain may be the initial and only manifestation of leukemia.     

小儿急性腹痛诊断

急腹症一般指腹痛为主的外科情况，病理条件以局部性器质性病变为主的病种：就诊主诉包括突然发生的腹痛、呕吐、腹胀、排便排气异常。     

Exercise-Induced Intraventricular Obstruction in a Child with Near Syncope and Chest Pain During Exercise

We report the case of a 10-year-old girl with two episodes of light-headedness and chest pain during exercise. She had an unremarkable clinical record, physical examination, ECG, and echocardiogram. Noninvasive ischemia tests were positive, but coronary angiography was normal. Exercise stress echocardiogram revealed an exercise-induced intra-left-ventricular obstruction with a peak gradient of 78 mmHg and replicated her symptoms. After starting beta-blocker therapy her clinical status improved and no residual obstruction was detected. The authors review this unsuspected clinical condition, seldom reported in the adult population and, to our knowledge, never before in a child.