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Chest pain in pediatric patients presenting to a cardiac clinic
Insights
Pediatric chest pain is rarely caused by heart disease, even with congenital anomalies. Most cases are idiopathic and tend to resolve over time, indicating a benign prognosis for childhood chest pain.
Area of Science:
- Pediatric Cardiology
- Clinical Medicine
Background:
- Chest pain is a common presenting complaint in pediatric patients.
- The etiology of pediatric chest pain is often unclear, leading to diagnostic challenges.
Purpose of the Study:
- To determine the frequency of cardiac disease associated with pediatric chest pain.
- To investigate the relationship between congenital cardiac anomalies and chest pain in children.
- To assess the natural history of idiopathic chest pain in pediatric patients.
Main Methods:
- Retrospective review of 67 pediatric patients presenting with chest pain.
- Analysis of cardiac disease association and congenital anomalies.
- Follow-up evaluation of patients with idiopathic chest pain.
Main Results:
- Only 6% of patients had chest pain linked to known cardiac causes.
- 85% of cases had undetermined causes, with 20 having isolated congenital anomalies without established causal links.
- Follow-up showed most idiopathic chest pain cases were self-limited.
Conclusions:
- Chest pain in children is infrequently cardiac-related, even with co-existing congenital cardiac lesions.
- Idiopathic pediatric chest pain generally has a benign and self-limiting course.
- Congenital cardiac anomalies, when isolated, do not appear to be a significant cause of chest pain in this population.
Abstract:
Records of 67 pediatric patients with a primary complaint of chest pain were reviewed to determine the frequency of associated cardiac disease. Only four of 67 (6%) had chest pain associated with cardiac diseases that usually cause chest pain. Fifty-seven (85%) patients had chest pain in which no clear cause could be determined. Of these 57, 20 patients also had isolated congenital cardiac anomalies, i.e., atrial septal defect. A causal relationship of these lesions to the chest pain could not be established. Thirty-four of the 37 patients with chest pain and no cardiac abnormalities were evaluated by telephone at a mean of 13 months after their clinic assessment. Twenty-nine of the 34 were either asymptomatic or had reduced symptoms. There was no correlation between duration of symptoms prior to their clinical study and the persistence of chest pain at follow-up. From this study, we conclude that chest pain in pediatric patients is infrequently due to cardiac disease even when associated with previously unsuspected, isolated congenital cardiac lesions. Idiopathic chest pain tends to be self-limited.