Chest pain
My son’s chest hurts. He gets tired! Is all chest pain bad, is it a serious illness?
Chest pain is an unusual cause of consultation for the pediatrician in primary care or in hospital emergency services (0.25-0.6%) but it is a frequent reason for consultation in the case of the child cardiologist.
It is very seldom due to serious or significant illness. The tendency to compare it with the adult generates great anxiety and concern in both the child and the parents, which often make it synonymous with cardiac involvement.
The main causes of chest pain in the child are as follows:
– Idiopathic: the most frequent (35%)
– Musculoskeletal or chondrocostal origin (30%)
– Psychogenic (14%), such as anxiety, tension, stress, depression or conversion disorders.
– Respiratory cause (12%), the most frequent in this group is effort-induced asthma, others may be pneumothorax, pleurisy, cough, pneumonia.
– Gastrointestinal disorders (4-7%).
– Cardiac origin (1-4%).
As for the cardiac causes of chest pain in the child, it can be divided into three sections: congenital cardiac disorders, acquired disorders and arrhythmias.
Congenital heart disorders:
1. Aortic stenosis.
2. Hypertrophic cardiomyopathy.
3. Mitral valve prolapse.
4. Congenital coronary disorders, the most frequent being the abnormal origin of the left coronary artery of the pulmonary artery trunk.
5. Acquired cardiac disorders
6. Pericarditis
7. Kawasaki disease
8. Arrhythmias
– Others: some patients have a complex of signs and symptoms: chest pain, headache, dizziness, blurred vision (light halos or whitish or dark flashes), sweating of hands and feet that remain cold and stress or tension, concentrated urine (yellowish ), tiredness especially in the evening; functional murmurs; fainting or blackouts, and tend to be slightly anxious and / or apprehensive; occasionally palpitations, eventually colic; to which an autonomic nervous system disorder (dysautonomias, neurocardiogenic syncope) could be integrated with potential long-term cardiac repercussion.
