-rarely is CP due to a heart problem in kids/teens
-avg age of peds pt w CP is 12-14yo, but as young as 4yo
-#1 cause is MSK
Chest Cage/Chest Wall Pain
Costochondritis- 2-4 contiguous costochondral/costosternal jcts
-usually unilateral, usually at more cephalad jts
-sharp, x sec-minutes, incr w deep breathing
-no jts inflmn/swelling
-+reproducible w palpation
Teitze Syndrome- uncommon in kids; = inflmn of 1 costochondral jct w warmth, swelling, tenderness
Nonspecific Chest Wall Pain (Idiopathic CP)- sharp, pt points to center of chest or infranipple, lasts sec to minutes, incr w deep breath; sometimes squeezing on chest cage or gently pressing on sternum can reproduce it. Often can't be reproduced w palpation/pushing. No tender costochondral/sternal jts. Very common type of chest wall pn.
Precordial Catch Syndrome- brief (seconds), sharp, stabbing pain inf to the L nipple or at LLSB. Often pleuritic- incr w bending fwd. --> forces pt to breathe slowly. ?cause.
Slipping Rib Syndrome- rare but --> intense pain
-at 8-10th ribs (don't attach directly to sternum, just to each other)
-?bc of chest trauma--> disrupt connections to ea other...
-+hooking maneuver--> + dx -put fingers under inf rib margin & pulls antly--> pn and click
HyperSn Xiphoid Syndrome- uncommon, pressure on xiphoid--> pn
Trauma & Muscle Strain- +h/o trauma, reproducible, but must c/s myocardial contusion, hemopericardium
Sickle Cell Disease- causes acute chest syndrome...
Asthma- asthma or exercise induced asthma...
Infection- pneumonitis, bronchitis; herpes zoster can --> CP often before skin erruption
Pericarditis- more sev than benign forms, incr w lying down, decr w lean fwd, see diffuse ST elevation
Gastrointestinal- GERD
Pneumothorax- an uncommon cause of CP; c/s if abrupt onset sev CP; must c/s espec in pts w Marfan's
Pulmonary Embolism
Psychogenic
Illicit Drugs - e.g. cocaine, PCP
Cardiac Chest Pain
-c/s HOCM, AS, pericarditis, arrhythmias, coronary insuffic, dissecting Ao aneurysm (espec Marfan), MVP
-cor insuffic- c/s if KD, Williams synd, anom coronary origin, cor AV and cor-cameral fistulas, though CP is an uncommon way to present w these
Medical Evaluation
-H&P
-check FHx for premature heart/lung dz, premie death
-few pts have true angina, but if +angina, then test
-if CP assoc w light-headedness or presyncope--> c/s serious underlying CP cause and investigate