Cardiovascular causes of pediatric chest pain: Case-based review

Chest pain is a common presenting symptom in pediatric emergency rooms and clinics. The wide spectrum of causes may create a diagnostic conundrum for clinicians. The purpose of this article is to review cardiovascular causes of pediatric chest pain with illustrative case histories and discussion of pathophysiology, diagnosis, and treatment. Guidelines for cardiovascular screening include the American College of Cardiology and American Heart Association 14-element checklist, American Academy of Pediatrics recommendations with four questions about cardiac symptoms, signs, and family history, and international guidelines for electrocardiogram interpretation. Noncardiac chest pain may be caused by various conditions, such as exercise-induced asthma. Pericarditis may be acute or chronic and caused by various conditions, including viral infection. Sudden cardiac arrest may occur without previous chest pain and most commonly is caused by hypertrophic cardiomyopathy. Anomalous coronary artery is a rare congenital defect that may cause exertional chest pain or sudden cardiac arrest and may require multidisciplinary care for diagnosis and treatment. Myocarditis may be caused by viral infection, may present with tachycardia, chest pain, difficulty breathing, and cardiovascular instability, and may be diagnosed with endomyocardial biopsy or cardiac magnetic resonance imaging. Spontaneous pneumothorax may present with sharp chest pain in tall, thin adolescent boys, and treatment may include close observation with serial chest radiographs, oxygen therapy, simple aspiration, or chest tube placement. Aortic dissection is a rare, life-threatening condition associated with connective tissue disorders and may necessitate percutaneous endovascular grafting or aortic replacement surgery. Pulmonary embolism may occur in pediatric patients, and risk factors include sepsis, current oral contraceptive use, and recent surgery. Prompt diagnosis and treatment of conditions causing chest pain may be facilitated with a comprehensive history, detailed physical examination, and ancillary studies. • Chest pain is a common presenting symptom in pediatric emergency rooms and clinics. • Pericarditis is the most common cause of pediatric cardiac-related chest pain. • Hypertrophic cardiomyopathy may cause sudden cardiac arrest in young athletes. • Coronary artery anomalies are rare but also may cause sudden cardiac arrest. • Myocarditis, pneumothorax, aortic dissection, and pulmonary embolism are emergencies.