Pediatrics in Review
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(Pediatrics in Review. 1997;18:169-173.)
© 1997 American Academy of Pediatrics

Consultation with the Specialist: Chest Pain in Children

Steven M. Selbst, MD*
* Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Acting Division Chief, Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA.

   Case Presentation
 
A 15-year-old boy presents to the emergency department with chest pain for 1 week. The pain began as mild left chest discomfort when he was hit over the ribs while playing football. Three days ago he reported a headache, neck stiffness, and worsening chest pain, especially when walking. He described the pain as aching, stabbing, and much worse with exertion. The patient has had no fever or symptoms of an upper respiratory tract infection, but he complains of mild dizziness with standing. He vomited twice yesterday and now complains of nausea. His past medical history is noncontributory.

The physical examination reveals an alert, talkative, obese male. Vital signs are: temperature, 38.3°C (oral); pulse, 72 beats/min; respirations, 24 breaths/min; and blood pressure, 128/84 mm Hg. The heart rate increases to 96 beats/min with standing and 116 beats/min with walking. Examination of the head, eyes, ears, nose, and throat is unremarkable. The neck is mildly tender, and there is pain with flexion. The chest examination reveals mild tenderness over the sternum and no pain over the ribs. The cardiac rhythm is regular, and no murmur is appreciated. The lungs are clear, and the abdomen is soft and nontender, with no mass or organomegaly. Findings on the remainder of the physical examination are normal.

The chest radiograph shows clear lung fields, but the heart is enlarged slightly. Electrocardiography shows left axis deviation, normal sinus rhythm, possible right ventricular hypertrophy, and ST elevation in the inferolateral leads.

About 3 hours after arrival at the emergency department, the boy becomes unresponsive, is found to have a ventricular arrhythmia, and develops cardiac arrest. He cannot be resuscitated. An autopsy reveals evidence of myo-carditis.


   Introduction
 
Chest pain is a frequent complaint among children; it occurs in 6 in 1,000 who present to an urban pediatric emergency department or . . . [Full Text of this Article]






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