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.

Pop-up div Successfully Displayed

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