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Primary care physicians can diagnose most pediatric chest pain through history and physical exams. Referral to a pediatric cardiologist is recommended for concerning cardiac risk factors or murmurs.
Area of Science:
- Pediatric Cardiology
- Internal Medicine
Background:
- Chest pain is a common presenting complaint in children and adolescents.
- Determining the etiology of chest pain in young patients can be challenging for primary care physicians.
- While often benign, chest pain can sometimes indicate serious underlying conditions.
Purpose of the Study:
- To outline the diagnostic approach for evaluating chest pain in patients under 21 years of age.
- To identify clinical scenarios warranting specialist consultation with a pediatric cardiologist.
- To emphasize the importance of reassurance for both children and parents.
Main Methods:
- Detailed history taking and physical examination by the primary care physician.
- Consideration of electrocardiogram (ECG) and chest x-ray when indicated.
- Systematic exploration of noncardiac causes of chest pain.
- Referral criteria for pediatric cardiology evaluation.
Main Results:
- Most cases of pediatric chest pain can be diagnosed by primary care physicians.
- Noncardiac causes are frequent and typically benign, requiring parental reassurance.
- Electrocardiograms and chest x-rays can aid in diagnosis.
- Specific indicators (e.g., family history of coronary artery disease, personal risk factors, murmurs) necessitate pediatric cardiology consultation.
Conclusions:
- A thorough history and physical examination are crucial for evaluating pediatric chest pain.
- Reassurance is vital for benign conditions, with psychotherapy occasionally indicated.
- Consultation with a pediatric cardiologist is essential for suspected or confirmed cardiac pathology.
- Specialist reassurance can alleviate anxiety even when the primary care physician suspects a benign cause.
Abstract:
The primary care physician can often delineate the cause of chest pain in a patient under 21 years of age after a thoughtful, careful, and thorough history and physical examination. Occasionally, an ECG and a chest x-ray film may be helpful. Noncardiac causes for the chest pain should be explored, and if found, the child and the parents should be assured that the problem is not serious. Occasionally, psychotherapy may be indicated. A pediatric cardiologist should be consulted when a strong family history of coronary artery disease or a personal history of coronary risk factors is present or a murmur is detected that may not be innocent. The specialist also should evaluate children who have organic cardiac disease. Finally, although the primary care physician may strongly suspect that the chest pain has little or no significance, reassurance by a pediatric cardiologist is frequently helpful to the child and the family.