Skip to Main Content

++

Probability diagnosis

++

Musculoskeletal (chest wall pain):

++

  • cough strain (10%)

  • injury

  • muscle strain

  • costochondritis

  • precordial catch syndrome (stitch in side)

  • asthma

++

Note: Most cases are unknown (21%).

++

Serious disorders not to be missed

++

Vascular:

++

  • ischaemic pain: structural cardiac conditions

  • arrhythmias (e.g. PSVT)

++

Infection:

++

  • pericarditis

  • myocarditis

  • pneumonia

  • herpes zoster

++

Other:

++

  • pneumothorax

  • POTS syndrome

++

Pitfalls (often missed)

++

Kawasaki syndrome

++

Breast disorders

++

Rarities:

++

  • Bornholm disease

  • oesophagitis or gastric pain

++

Is the patient trying to tell me something?

++

Psychogenic: stress, anxiety, depression (10%).

++

Key history

++

  • Usual features of the pain including aggravating and relieving factors such as movement, exercise, rest, swallowing, breathing and eating.

  • Note associated symptoms such as fever, cough, dizziness, overexertion, syncope and recent viral illness.

  • Note family history, especially cardiac disease including unexplained sudden death, recent stressful events and drug history.

++

Key examination

++

  • Vital signs especially pulse (including nature) and temperature

  • Palpation of chest wall to determine any tenderness or signs of injury

  • Basic cardiovascular and respiratory examination

++

Key investigations

++

  • No investigation usually required

  • Consider ECG and CXR

++

Diagnostic tips

++

  • Most cases of chest pain in children are of unknown aetiology and probably psychogenic.

  • Chest pain is more common in adolescents.

  • Less than 5% of cases are caused by cardiac disease.

  • Myocardial ischaemia is rare in children but consider it in any child with exercise-induced pain, adolescents with longstanding diabetes and children with sickle cell anaemia.

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

Murtagh Collection Full Site: One-Year Subscription

Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.

$145 USD
Buy Now

Pay Per View: Timed Access to all of Murtagh Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.