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.