What the Electrocardiogram Reveals in Children with Chest Pain

Abstract Background: Chest discomfort is a frequent cause of referral to pediatric cardiology, though cardiac origins are uncommon in children. Focused diagnostic strategies can help optimize resource use and reduce costs. Objectives: This study aimed to describe the characteristics of chest discomfort related to cardiac causes in children. Methods: A cross-sectional analysis was carried out at the Pediatric Cardiology Division of Ngoerah Hospital. Children under 18 years presenting with chest discomfort in outpatient or inpatient settings were included. Data were obtained retrospectively from the division’s registry covering August 2021 to May 2024, encompassing age, diagnosis, findings from physical examinations, and results of diagnostic tests (including chest X-ray, electrocardiography [ECG], and echocardiography). Descriptive statistics were generated for all variables using SPSS version 23.0. Results: Fifty-two pediatric patients were included, with a predominance of males. Palpitations were the most common symptom (63.46%), followed by fatigue (19.2%) and chest pain (17.3%). Most of the children had normal examinations; four had a systolic murmur. Seventeen patients exhibited red flag signs, with ECG findings of sinus tachycardia (19.6%) and AV block (17.7%) being most frequent. Echocardiography was performed in nine patients, five of whom had abnormal findings. Most of the patients were ultimately diagnosed with idiopathic or musculoskeletal chest pain. Conclusions: Electrocardiography, combined with a thorough history and physical examination, remains a key tool for identifying clinically significant cardiac causes of chest discomfort in children.