Diagnostic Evaluation of Children Presenting with Chest Pain to Pediatric Cardiology Clinic: Covid-19 Pandemic's Effect to Etiology

Abstract

Aim: The aim of this study was to evaluate the etiology of chest pains and demographic data of these patients, and to investigate the effect of the COVID-19 pandemic on these variables. Material and Methods: The study included patients who presented with complaints of chest pain at the Paediatric Cardiology Clinic between November 2019 and August 2020. The patients were separated into two groups from the date of when restrictions to daily life were implemented because of the COVID-19 pandemic in Turkey, as Group 1 who presented before March 2020, and Group 2 who presented after March 2020. Results: Evaluation was made of a total of 251 patients comprising 136 (54.2%) females and 115 (45.8%) males with a mean age of 11.6 ± 2.9 years. The chest pain was felt most often in the precordial area (46.2%) as a needle pricking (64.9%). The cause of the chest pain was determined to be the musculoskeletal system (55%), psychogenic (16.3%) and idiopathic (13.5%) respectively. A cardiac reason was determined in 2.8% of the patients. In the comparisons of the two groups, psychogenic reasons were seen more in Group 2 after the pandemic, and more patients had been referred by a physician and from rural areas (p<0.05). Conclusion: To prevent repeated polyclinic presentations with non-cardiac chest pain, and unnecessary and lengthy tests, the concerns of families must be eliminated. After the beginning of the COVID-19 pandemic, there was determined to be an increase in children with chest pains of psychogenic cause.

Keywords

• Chest pain
• COVİD-19
• Pandemic
• Psychogenic

Çocuk Kardiyoloji polikliniğine göğüs ağrısı şikayetiyle başvuran hastaların tanısal değerlendirilmesi: Covid 19 pandemisinin etiyolojiye etkisi.

Abstract

Amaç: Çalışmamızda göğüs ağrılarını demografik ve etiyolojik açıdan değerlendirmeyi ve bu değişkenlere covid 19 pandemisinin etkisini araştırmayı amaçladık. Gereç ve Yöntem: Kasım 2019- Ağustos 2020 tarihleri arasında çocuk kardiyoloji polikliniğine göğüs ağrısı şikayetiyle başvuran hastalar çalışmaya alındı. Hastaların özgeçmiş ve soygeçmiş bilgileri, göğüs ağrısının özellikleri, fizik muayene bulguları, ekg ve ekokardiyografik bulguları kaydedildi. Hastalar Türkiye’de covid 19 pandemisi nedeniyle toplumsal yaşamda kısıtlamaların uygulanmaya başlandığı Mart 2020 öncesi (grup I) ve sonrası (grup II) olmak üzere iki gruba ayrıldı. Bulgular: Çalışmaya yaş ortalaması 11,6 ± 2,9 yıl olan 136’sı kız (%54,2) toplam 251 hasta alındı. Ebeveynlerin %46’sı, hastaların ise %12’si göğüs ağrısının kardiyak kökenli olduğunu düşünüyordu. Göğüs ağrısı en sık prekordiyal alanda (%46,2) ve iğne batar tarzda (%64,9) hissedilmekteydi. Hastaların 116’sında (%46,2) soygeçmişinde kalp hastalığı mevcuttu. Göğüs ağrısının en sık sırayla kas-iskelet sistemi (%55), psikojenik (%16,3) ve idyopatik (%13,5) sebepli olduğu görüldü. Hastaların %2,8’inde kardiyak sebep saptandı. Gruplararası karşılaştırmada pandemi sonrası (grup II) de psikojenik sebeplerin daha fazla olduğu, hastaların daha fazla hekim sevkiyle ve kırsaldan geldiği saptandı (p<0,05). Sonuç: Nonkardiyak göğüs ağrılarında tekrarlayan poliklinik başvuruları, gereksiz ve uzun süren tetkikleri önlemek için ailelerin endişeleri giderilmelidir. Covid 19 pandemisi sonrasında çocuklarda psikojenik nedenli göğüs ağrılarında artış saptandı.

Keywords

• COVİD-19
• Göğüs ağrısı
• Pandemi
• Psikojenik

References

1. 1. Barbut G, Needleman JP. Pediatric Chest Pain. Pediatr Rev 2020; 41(19): 469-80.
2. 2. İrdem A, Duras E, Sazak S, Yakut MN, Uysal T, Dursun H. Diagnostic Evaluation of Children Admitted To Pediatric Cardiology Clinic Due To Chest Pain. Van Tıp Derg 2019; 26(2): 146-52. (Article in Turkish)
3. 3. Friedman KG, Alexander ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr 2013; 163(3): 896-901.
4. 4. Geggel RL. Conditions leading to pediatric cardiology consultation in a tertiary academic hospital. Pediatrics 2004; 114(4): 409–17.
5. 5. Tufan ZK, Bircan Kayaaslan B. Crushing the curve, the role of national and international institutions and policy makers in COVID-19 pandemic. Turk J Med Sci 2020; 50(3): 495-508.
6. 6. Goyal K, Chauhan P, Chhikara K, Gupta P, Singh MP. Fear of COVID 2019: First suicidal case in India! Asian J Psychiatr 2020; 49: 101989.
7. 7. Kar SK, Arafat SY, Kabir R, Sharma P, Saxena SK. Coping with Mental Health Challenges During COVID-19. In: Saxena SK, editors. Coronavirus Disease 2019 (COVID-19) Singapore: Springer; 2020. p. 199-213.
8. 8. Kardeş VÇ. Mental and Behavioral Evaluation of During and After the Pandemic. Turk J Diab Obes 2020; 4(2): 160-9. (Article in Turkish)

9. 9. Mohan S, Nandi D, Stephens P, Mʼfarrej M, Vogel RL, Bonafide CP. Implementation of a Clinical Pathway for Chest Pain in a Pediatric Emergency Department. Pediatr Emer Care 2018; 34(11): 778-82.
10. 10. Danduran MJ, Earing MG, Sheridan DC, Ewalt LA, Frommelt PC. Chest pain: characteristics of children/adolescents. Pediatr Cardiol 2008; 29(4): 775-81.
11. 11. Pantell RH, Goodman JBW. Adolescent chest pain: a prospective study. Pediatrics 1983; 71(6): 881-7.
12. 12. Lipsitz JD, Masia C, Apfel H, et al. Noncardiac chest pain and psychopathology in children and adolescents. J Psychosom Res 2005; 59(3): 185-8.
13. 13. Saleeb SF, Li WY, Warren SZ, Lock JE. Effectiveness of screening for life-threatening chest pain in children. Pediatrics 2011; 128(5): 1062-8.
14. 14. Kocis KC. Chest pain in pediatrics. Pediatr Clin N Am 1999; 46(2): 189-203.
15. 15. Dervişoğlu P, Kösecik M. Approach to Children with Chest Pain. Sakarya Med J 2016; 6(4): 262-6 (Article in Turkish)
16. 16. Veeram SR, Reddy MD, Harinder R, Singh MD, Reddy V. Chest pain in children and adolescents. Pediatr Rev 2010; 31(1): 1-9.
17. 17. Park MK. Child with chest pain. In: Park MK, editors. Park’s Pediatric Cardiology for Practitioners (6th ed) Saunders: Elsevier; 2014. p. 495-504.
18. 18. Eliacik K, Kanik A, Bolat N,et al. Anxiety depression, suicidal ideation and stressful life events in noncardiac adolescent chest pain: a comparative study about the hidden part of the iceberg. Cardiol Young 2017; 27(6): 1098-103.
19. 19. Khan S, Siddique R, Li H, et al. Impact of coronavirus outbreak on psychological health J Glob Health. 2020; 10(1): 010331.
20. 20. World Health Organization. Coronavirus disease 2019 (COVID-19) Weekly Epidemiological Update October 5, 2020. Available from: https://www.who.int/publications/m/item/weekly-epidemiological-update---5-october-2020 Geneva: WHO; 2020.
21. 21. Bao Y, Sun Y, Meng S, Shi J, Lu L. 2019-nCoV epidemic: address mental health care to empower society. Lancet 2020; 395(10224): e37–e38.