Chest pain resident survival guide (pediatrics)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Synonyms and keywords:

Chest pain resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Life threatening cause 1
• Life threatening cause 2
• Life threatening cause 3

Common Causes

• Common cause 1
• Common cause 2
• Common cause 3
• Common cause 4
• Common cause 5

Causes of pediatric chest pain

Cardiac

Musculoskeletal ❑ Muscle pain from overuse Pectoralis major and minor muscle Intercostal muscle Latissimus dorsi muscle Serratus muscle Trapezius muscle ❑Thoracic outlet obstruction ❑Ankylosis spondylitis ❑Spondylolisthesis ❑Discitis ❑Herniated disc ❑Transverse myelitis ❑Costochondritis ❑Tietze syndrome ❑Cervical rib (C7) ❑Slipping rib ❑Precordial catch syndrome ❑Trauma ❑Child abuse ❑Fractured or contused clavicle or ribs ❑Xiphoidalgia ❑Osteomyelitis ❑Rhabdomyosarcoma ❑Myositis

Pulmonary: ❑Reactive airway disease ❑Pneumothorax ❑Pneumonia (viral, bacterial, mycobacterial, fungal) ❑Chronic cough ❑Pleural effusion ❑Pleurodynia ❑Pulmonary embolism ❑Foriegn body aspiration ❑Adenoma, carcinoma

Gastrointestinal: ❑Esophagitis ❑Esophagial diverticulum ❑Esophagial spasm ❑Esophageal rupture (boerhaave syndrome ❑Mallory weiss tear ❑Achalasia ❑Gastrointestinal reflex disease (GERD) ❑Gastritis ❑Peptic ulcer disease ❑Zollinger ellison syndrome ❑Hiatal hernia ❑Foreign body ingestion ❑Cholecystitis ❑Subdiaphragmatic abcess ❑Fitz-hugh-curtis syndrome ❑Pancreatis

Mediastinal tumors: ❑Hodgkin disease ❑T-cell lymphoma ❑Thymoma ❑Thymolipoma ❑Teratoma ❑Germ cell tumor ❑Liposarcoma

Breast disease: ❑Gynecomastia ❑Therarce ❑Mastitis ❑Adenocarcinoma

Ingestion: ❑Cocaine ❑Tobaco ❑Methamphetamine ❑Sympathomimetic decongestants

Psychiatric: ❑Somatoform disorder ❑Stress ❑Depression ❑Hyperventillation syndrome ❑Panic attack ❑Bulemia nervosa ❑Manchhausen syndrome

Congenital lesions: ❑ Aortic stenosis ❑ Aortic aneurysm with dissection ❑ Subaortic stenosis ❑ Supravalvular aortic stenosis ❑ Ruptured sinus of valsalva ❑ Coarctation of aorta ❑ Anomalous origin of coronary arteries from pulmonary artery ❑ Coronary artery ostial stenosis or atresia ❑ Left coronary artery arising from anterior cusp ❑ Congenital coronary artery aneurysm ❑ Coronary artery fistula ❑ Mitral valva prolapse ❑ Severe pulmonary stenosis ❑ Arrhythmogenic right ventricular dysplasia

Acquired lesions: ❑Dilated cardiomyopathy ❑Hypertrophic cardiomyopathy ❑Restrictive cardiomyopathy ❑Endocarditis ❑Kawasaki ❑Myocarditis ❑Rheumatic fever ❑Myocardial infarction ❑Coronary vasospasm ❑Accelerated atherosclerosis ❑Dissection of aorta aneurysm (marfan disease) ❑Pericarditis ( infection, inflammation, constriction) ❑Post pericardiothomy syndrome ❑Partial absent of the pericardium ❑Pulmonary hypertension (primary, secondary]] ❑Eisemenger syndrome ❑Takayaso arthritis ❑Cardiac tumor ❑Pericardial neoplasm ❑Cardiac transplant (rejected, accelerated atherosclerosis]]

Arrhythmia: ❑Premature atrial contraction ❑Atrial flutter ❑Atrial fibrillation ❑Supraventricular tachycardia ❑Premature ventricular contraction ❑Ventricular tachycardia

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Complete Diagnostic Approach

Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.

Chest pain associated different organs	Charactristics of chest pain
Musculoscletal origin	Chest wall tenderness
	Pain aggravated with inspiration
	Muscle pain with movement
	Tenderness on palpation of costochondral junction
Respiratory origin	Chest pain secondary to acute onset of cough
	Wheezing, coughing, asthma
Gastrointestinal origin	Chest pain associated with indigestion, heart burn, vomotting
	Evidence in endoscopy: gastrointestinal relex,gastritis,
Cardiac origin	Congenital heart disease
	Kawazaki
	Arrhythmia
Psychogenic origin	School problem
	Family troubles such as parents divorce
Ideopathic	No evidence of any organic etiology or any psychologic factors

Sharp

Dull

Undefined

Duration of chest pain

Charactristics of chest pain

Associated symptoms

Chest wall tenderness

Respiratory related

Squeezing

Symptoms associated with Chest pain in children and adolescence: ❑ Cough (23.4%) ❑ Dyspnea (11%) ❑ Abdominal pain (9.7%) ❑ Palpitation (9.7%) ❑ Respiratory related (9%) ❑ Dizziness (5.8%) ❑ Post nasal drip (4.4%) ❑ Fever (5.2%) ❑ Exercise induced (2.6%) ❑ Syncope (2.6%)

Cardiac

Underlying congenital or acquired heart disease, arrhythmia, crushing sternal chest pain, exercised induced chest pain, persistent tachycardia, hypotension, gallop rhythm, syncope

Pulmonary

Hemoptysia, dyspnea, rales,cyanosis

Physical examination

Gastrointestinal

Hematemesis,hematochezia, melena

Other

Febrile, psychosis, suisidal ideation

Evaluation of chest pain

Medical history, cardiac examination

Abnormal history or cardiac examination

Normal history and cardiac examination

Yes

NO

Febrile, acute onset symptoms

Palpitation, chest pain, positive family history

Yes

NO

NO

Yes

Myocarditis,pericarditis Fever, rub, gallop, abnormal vital sign, ill appearance

Refer to pediatric cardiologist

At rest chest pain, exersional chest pain

Refer to pediatric cardiologist

Exertional chest pain

At rest chest pain or reproducible on exam

Suspected asthma

Low likehood of cardiac chest pain

Yes

NO

Reassurance

Bronchodilator

Refer to pediatric cardiologist

Improvement

Keeping management

Refer to pediatric cardiologist

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.