Chest Pain in Young People

Chest Pain in Children and Adolescents

Heart disease is extremely common in this country, especially in older people, so it is natural that anyone with chest pain would immediately worry about having some sort of heart problem. We see people collapse with chest pain on TV every day, and occasionally read about sudden death in an apparently healthy athlete.
In children and adolescents, chest pain is a surprisingly common symptom, and accounts for a lot of trips to Emergency departments, a lot of anxiety, and lots of referrals to me for evaluation. The reality is that chest pain in this age range is rarely due to a heart problem, however, and when it is, it is usually very clear by checking a few key points from the story and the physical exam. I often do an EKG but testing is not usually helpful in this setting as compared to a good history and exam. And the evaluations almost always show that the pain comes from somewhere other than the heart: the lungs, the chest wall, the esophagus, etc.
As a cardiologist, my primary goal is finding those unusual cases where the chest pain is indeed coming from the heart. If it is not from the heart, I may or may not be able to identify a specific cause of the pain, and even if I do, I may not have a specific treatment to make it stop.
Either way, I can generally reassure everyone that the pain is not a dangerous or life-threatening problem, even if it is very annoying or disruptive.

Time permitting, we can discuss the problem in a very open-ended fashion. However in order to direct our conversation to some key points, there are a few questions I will want the patient and family to think about:

1) Is there any Kawasaki disease; any connective tissue disorder like Marfan syndrome; or any inflammatory condition like lupus, rheumatoid arthritis, etc. in the family or patient history?

2) Has the patient ever had any type of heart disease? Does he or she have any other medical issues, such as asthma?

3) Has anyone in the family been born with any type of heart problem?

4) Has anyone in the family died suddenly (or collapsed) under the age of 50 years, including car accidents, drowning or other accidental deaths?

5) Has the patient ever fainted in any situation?

6) How long has the pain been going on? Where is it located and what does it feel like? How long does it last? Does anything seem to make it better or worse (certain positions, breathing, drinking something, resting, etc.?)

7) Does it consistently happen with physical activities, exercise or other exertion? If so, does it happen only with exertion (that is, does it also occur during quiet activities sometimes?) Does strenuous exertion usually bring it out, or just occasionally?

8) Is the pain associated with fever, rash, swollen joints, or other signs of illness?

9) Is the pain associated with a sense of a racing heart?