Clinical characteristics of children and adolescents admitted with chest pain

Abstract

Abstract Background: Chest pain is a common disease in children. Chest pain is the second most common symptom referred to by paediatric cardiologists after cardiac murmurs. Objective: In this prospective study, we aimed to evaluate clinical characteristics and causes of chest pain in children admitted to our paediatric cardiology outpatient clinics. Methods: We conducted this prospective study among 446 patients with chest pain in a tertiary care hospital from 1 June 2017 to 1 June 2020. The demographic data and clinical characteristics of the patients were analysed. All patients were evaluated with a medical history, physical examination, laboratory tests, electrocardiogram and echocardiogram and if necessary telecardiogram, 24-hour electrocardiogram monitoring, exercise stress test and psychological evaluation were made. Results: The ratio of admissions with acute pain was 4% when 20% of the patients had chronic chest pain. The most common symptoms associated with chest pain were shortness of breath and palpitations. The non-cardiac causes were as follows: 25% musculoskeletal, 14% psychological, 9% respiratory, and 7% gastrointestinal, respectively. We found cardiac chest pain in 49 (11%) of patients. Idiopathic chest pain was found in 153 (34%) patients. Conclusions: Our study showed that the aetiology of chest pain in children and adolescents admitted with chest pain is mostly due to non-cardiac causes. We found the slightly frequency of elevated rate for cardiac aetiologies of paediatric chest pain compared to the literature. We suggest that in addition to anamnesis and careful examination, further investigation, if necessary, is important in determining the aetiology of chest pain.

Keywords

• adolescent
• aetiology
• child
• chest pain
• echocardiogram

Göğüs ağrısı ile başvuran çocuk ve ergenlerin klinik özellikleri

Abstract

Özet Öz: Göğüs ağrısı çocuklarda sık görülen bir hastalıktır. Göğüs ağrısı, pediatrik kardiyologlar tarafından kardiyak üfürümlerden sonra en sık belirtilen ikinci semptomdur. Amaç: Bu prospektif çalışmada, çocuk kardiyoloji polikliniğimize başvuran çocuklarda göğüs ağrısının klinik özelliklerini ve nedenlerini değerlendirmeyi amaçladık. Metod: Bu prospektif çalışmayı 1 Haziran 2017 - 1 Haziran 2020 tarihleri arasında üçüncü basamak bir hastanede göğüs ağrısı olan 446 hasta arasında gerçekleştirdik. Hastaların demografik verileri ve klinik özellikleri analiz edildi. Tüm hastalar anamnez, fizik muayene, laboratuvar testleri, elektrokardiyogram ve ekokardiyogram ile değerlendirildi ve gerekirse telekardiyogram, 24 saatlik elektrokardiyogram monitorizasyonu, egzersiz stres testi ve psikolojik değerlendirme yapıldı. Bulgular: Akut ağrı ile başvuru oranı %4 iken hastaların %20'sinde kronik göğüs ağrısı vardı. Göğüs ağrısı ile ilişkili en yaygın semptomlar nefes darlığı ve çarpıntı idi. Kalp dışı nedenler sırasıyla %25 kas-iskelet, %14 psikolojik, %9 solunum ve %7 gastrointestinal idi. Hastaların 49'unda (%11) kardiyak göğüs ağrısı bulduk. 153 (%34) hastada idiyopatik göğüs ağrısı saptandı. Sonuç: Çalışmamız göğüs ağrısı ile başvuran çocuk ve ergenlerde göğüs ağrısı etiyolojisinin daha çok kalp dışı nedenlere bağlı olduğunu göstermiştir. Literatüre kıyasla pediatrik göğüs ağrısının kardiyak etiyolojileri için biraz yüksek oran sıklığı bulduk. Göğüs ağrısı etiyolojisinin belirlenmesinde anamnez ve dikkatli muayeneye ek olarak gerekirse ileri tetkiklerin önemli olduğunu düşünüyoruz. Anahtar Kelimeler: Adölesan; etiyoloji; çocuk; göğüs ağrısı; ekokardiyogram

Keywords

• adölesan
• etiyoloji
• çocuk
• göğüs ağrısı
• ekokardiyogram

References

1. 1. Alp EK, Hayrullah A. Chest pain and its recurrence in pediatric population: A large cohort study. Journal of Contemporary Medicine. 2021;11(2):124-9.
2. 2. Alp H, Alp E. Evaluation of the Etiology in Children with Chest Pain Who Admitted to Pediatric Cardiology Clinic. The Journal of Pediatric Research. 2014;1:80-3.
3. 3. Ghandi Y, Mehrabi S, Nariman R, Habibi D. Evaluation of clinical manifestation, parameters and causes of chest pain in children. International Journal of Pediatrics. 2020;8(11):12409-19.
4. 4. Angoff GH, Kane DA, Giddins N, Paris YM, Moran AM, Tantengco V, et al. Regional implementation of a pediatric cardiology chest pain guideline using SCAMPs methodology. Pediatrics. 2013;132(4):e1010-e7.
5. 5. Abdel-Moez AM, Abd Allah FEA, Ali ZA. Most frequent causes of chest pain in children and adolescents attending Assiut University Children Hospital. Journal of Current Medical Research and Practice. 2020;5(2):202.
6. 6. Lasda A-D, Kolofotia E. P53 Chest pain in children: common symptom that may conceal organic heart disease. BMJ Publishing Group Ltd; 2019.
7. 7. Danduran MJ, Earing MG, Sheridan DC, Ewalt LA, Frommelt PC. Chest pain: characteristics of children/adolescents. Pediatric cardiology. 2008;29(4):775-81.
8. 8. Çağdaş DN, Paç FA. Cardiac chest pain in children. Anatolian Journal of Cardiology/Anadolu Kardiyoloji Dergisi. 2009;9(5).

9. 9. Sert A, Aypar E, Odabas D, Gokcen C. Clinical characteristics and causes of chest pain in 380 children referred to a paediatric cardiology unit. Cardiology in the Young. 2013;23(3):361-7.
10. 10. Traube C, Silver G, Reeder RW, Doyle H, Hegel E, Wolfe HA, et al. Pediatric delirium in critically-ill children: an international point prevalence study. Critical care medicine. 2017;45(4):584.
11. 11. Hambrook JT, Kimball TR, Khoury P, Cnota J. Disparities exist in the emergency department evaluation of pediatric chest pain. Congenital Heart Disease. 2010;5(3):285-91.
12. 12. Saleeb SF, Li WYV, Warren SZ, Lock JE. Effectiveness of screening for life-threatening chest pain in children. Pediatrics. 2011;128(5):e1062-e8.
13. 13. Melton TH, Croarkin PE, Strawn JR, McClintock SM. Comorbid Anxiety and Depressive Symptoms in Children and Adolescents: A Systematic Review and Analysis. J Psychiatr Pract. 2016;22(2):84-98.
14. 14. Eliacik K, Bolat N, Kanik A, Malas N, Demircan T, Hortu H, et al. Adolescents with unexplained chest pain reported depression and impaired emotional and social functioning. Acta paediatrica. 2020;109(8):1642-8.
15. 15. Kenar A, Örün UA, Yoldaş T, Kayalı Ş, Bodur Ş, Karademir S. Anxiety, depression, and behavioural rating scales in children with non-cardiac chest pain. Cardiology in the Young. 2019;29(10):1268-71.
16. 16. Friedman KG, Alexander ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. The Journal of pediatrics. 2013;163(3):896-901. e3.
17. 17. Wang T, Peng K, Jiang M, Yu J, Zhou X. Noncardiac chest pain and gastroesophageal reflux in children. Zhonghua jie he he hu xi za zhi= Zhonghua Jiehe he Huxi Zazhi= Chinese Journal of Tuberculosis and Respiratory Diseases. 2006;29(8):563-6.
18. 18. Berezin S, Medow MS, Glassman MS, Newman LJ. Chest pain of gastrointestinal origin. Arch Dis Child. 1988;63(12):1457-1460.
19. 19. Chen L, Duan H, Li G, Li X. The Etiology of Chest Pain in Children Admitted to Cardiology Clinics and the Use Echocardiography to Screen for Cardiac Chest Pain in Children. Front Pediatr. 2022;10:882022.
20. 20. Aygun E, Aygun ST, Uysal T, Aygun F, Dursun H, Irdem A. Aetiological evaluation of chest pain in childhood and adolescence. Cardiol Young. 2020 May;30(5):617-623.
21. 21. Selbst, SM. Approach to the child with chest pain. Pediatr Clin North Am 2010; 57: 1221–1234.