Göğüs Ağrısı ile Çocuk Kardiyoloji Polikliniğine Başvuran Vakaların Etiyolojik Özellikleri

Abstract

Amaç: Göğüs ağrısı çocuk popülasyonunda, özellikle adölesan dönemde çocuk kardiyoloji polkliniğine başvurularda önemli bir şikâyet bulgusudur. Çalışmanın amacı, göğüs ağrısı şikâyeti ile başvuran hastaların etiyolojik özelliklerinin sıklığını belirlemek bu konuda ekokardiyografinin önemini değerlendirmektir. Gereç ve Yöntemler: 2014-2019 yılları arasında Kırıkkale Üniversitesi Tıp Fakültesi Hastanesi Çocuk Kardiyoloji Kliniği’ne göğüs ağrısı şikâyeti ile başvuran hastaların etiyolojik ve epidemiyolojik özelliklerini retrospektif olarak inceledik. Bulgular: Bu çalışmaya bin yüz altmış dört hasta dahil edildi. Hastaların yaş ortalaması 12.9±2.0 (dağılım 10-17) idi. 1164 hastanın %87.9'una (n=1023) ekokardiyografik değerlendirme yapıldı. 769 (%75.2) hastada kardiyak anormallik yoktu. Mitral valv prolapsusu (MVP) 164 (%16.0) hastada saptandı. Bu hastaların 116'sında (%11.3) ayrıca mitral yetmezlik (MY) vardı. (117/164 (%71.4)). MVP'li hastalarda kadın üstünlüğü vardı (117/164, %71.4). Ekokardiyografi bulguları normal olan hastalar, ortalama hemoglobin (Hb), ortalama eritrosit hacmi (MCV), CK, CK-MB, Troponin, Pro-BNP ve CRP düzeyleri açısından MVP+MI olan hastalarla karşılaştırıldı. Bu parametreler açısından bu gruplar arasında anlamlı fark yoktu. Sonuç: Çocuklarda kardiyak ilişkili göğüs ağrısının en yaygın nedeninin MVP/MI olduğunu gösterdik. Bu nedenle özellikle üfürüm gibi fizik muayene bulgusu olan göğüs ağrısı, bir pediatrik kardiyolog tarafından ideal olarak ekokardiyografi ile değerlendirilmelidir.

Keywords

• Göğüs ağrısı
• mitral valv prolapsusu
• kardiyak belirteçler

ETIOLOGICAL FEATURES OF CASES WITH CHEST PAIN IN THE PEDIATRIC CARDIOLOGY OUTPATIENT CLINIC

Abstract

Objective: Chest pain in children, especially in adolescence, constitutes a significant proportion of the presentations to pediatric cardiology clinics. We aimed to determine the frequency of chest pain causes in the pediatric age group and the importance of echocardiography. Material and Methods: We retrospectively examined the etiological and epidemiological characteristics of patients with chest pain who were admitted to Kırıkkale University Medical Faculty Hospital Pediatric Cardiology Clinic and Pediatric Emergency Service between 2014 and 2019. Results: One thousand hundred sixty-four patients were enrolled in this study. The mean age of the patients was 12.9±2.0 years (range 10-17 years). Echocardiographic evaluation was performed in 87.9% (n=1023) of 1164 patients. In 769 (75.2%) patients, there was no cardiac abnormality. Mitral valve prolapse (MVP) was detected in 164 (16.0%) patients. Out of these patients, 116 (11.3%) also had mitral insufficiency (MI). There was a female preponderance (117/164, 71.4%) among the patients with MVP. Patients with normal echocardiography findings, were compared with patients who had MVP+MI with respect to mean hemoglobin, mean corpuscular volume, Creatine kinase, Creatine kinase- MB, troponin, pro-B-type natriuretic peptide, and C-reaktif protein levels. There was no significant difference between these groups with respect to these parameters. Conclusion: We showed that MVP/MI is the most common cause of cardiac related chest pain in children. Therefore, chest pain, especially with physical examination findings, such as a murmur, should be evaluated by a pediatric cardiologist, ideally by echocardiography.

Keywords

• Chest pain
• mitral valve prolapse
• cardiac markers

References

1. Cava JR, Sayger PL. Chest pain in children and adolescents. Pediatr Clin North Am. 2004;51(6):1553-68.
2. Daşkapan A, Şanlı C, Aydoğan-Arslan S, Çiledağ- Özdemir F, Korkem D, Kara U. Evaluation of the functional capacity, respiratory functions and musculoskeletal systems of the children with chest pain for non-cardiac reasons. Turk J Pediatr. 2017;59(3):295-303.
3. Cava JR, Danduran MJ, Fedderly RT, Sayger PL. Exercise recommendations and risk factors for sudden cardiac death. Pediatr Clin N Am. 2004;51(5):1401-20.
4. Gesuete V, Fregolent D, Contorno S, Tamaro G, Barbi E, Cozzi G. Follow-up study of patients admitted to the pediatric emergency department for chest pain. Eur J Pediatr. 2020;179(2):303-8.
5. Brown JL, Hirsh DA, Mahle WT. Use of troponin as a screen for chest pain in the pediatric emergency department. Pediatr Cardiol. 2012;33(2):337-42.
6. Chun JH, Kim TH, Han MY, Kim NY, Yoon KL. Analysis of clinical characteristics and causes of chest pain in children and adolescents. Korean J Pediatr. 2015;58(11):440-5.
7. Sanders SP, Colan SD, Cordes TM, Donofrio MT, Ensing GJ, Geva T, et al. American Society of Echocardiography; Society of Pediatric Echocardiography; American College of Cardiology Foundation; American Heart Association; American College of Physicians Task Force on Clinical Competence (ACC/AHA/AAP Writing Committee to Develop Training Recommendations for Pediatric Cardiology). ACCF/AHA/AAP recommendations for training in pediatric cardiology. Task force 2: Pediatric training guidelines for noninvasive cardiac imaging endorsed by the American Society of Echocardiography and the Society of Pediatric Echocardiography. J Am Coll Cardiol. 2005;46(7):1384-8.
8. Selbst SM, Ruddy RM, Clark BJ, Henretig FM, Santulli T Jr. Pediatric chest pain: A prospective study. Pediatrics. 1988;82(3):319-23.

9. Danduran MJ, Earing MG, Sheridan DC, Ewalt LA, Frommelt PC. Chest pain: Characteristics of children/adolescents. Pediatr Cardiol. 2008;29(4):775-81.
10. Friedman KG, Kane DA, Rathod RH, Renaud A, Farias M, Geggel R, et al. Management of pediatric chest pain using a standardized assessment and management plan. Pediatrics. 2011;128(2):239-45.
11. Verghese GR, Friedman KG, Rathod RH, Meiri A, Saleeb SF, Graham DA, et al. Resource utilization reduction for evaluation of chest pain in pediatrics using a novel standardized clinical assessment and management plan (SCAMP). J Am Heart Assoc. 2012;1(2)jah3-e000349.
12. Drossner DM, Hirsh DA, Sturm JJ, Mahle WT, Goo DJ, Massey R, Simon HK. Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain. Am J Emerg Med. 2011;29(6):632-8.
13. Hanson CL, Hokanson JS. Etiology of chest pain in children and adolescents referred to cardiology clinic. WMJ. 2011;110(2):58-62.
14. Alpert MA, Mukerji V, Sabeti M, Russell JL, Beitman BD. Mitral valve prolapse, panic disorder, and chest pain. Med Clin N Am. 1991;75(5):1119- 33.
15. 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.
16. 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 Emerg Care. 2018;34(11):778- 82.
17. Liesemer K, Casper TC, Korgenski K, Menon SC. Use and misuse of serum troponin assays in pediatric practice. Am J Cardiol. 2012;110(2):284-9.
18. Ruigomez A, Rodriguez LA, Wallander MA, Johansson S, Jones R. Chest pain in general practice: Incidence, comorbidity and mortality. Fam Pract. 2006;23(2):167-74.
19. Driscoll DJ. Chest pain in children and adolescents. In: Allen HD, Driscoll DJ, Shaddy RE, Feltes TF (eds). Moss and Adams‘ heart disease in infants, children, and adolescents: including the fetus and young adult. 7th ed. Philadelphia, Lippincott Williams & Wilkins, 2008;1444-6.
20. Aygun E, Aygun ST. Aetiological evaluation of chest pain in childhood and adolescence. Cardiol Young. 2020;30(5):617-23.
21. Saleeb SF, Li WY, Warren SZ, Lock JE: Effectiveness of screening for lifethreatening chest pain in children. Pediatrics. 2011,128(5):e1062-8.
22. Thull-Freedman J. Evaluation of chest pain in the pediatric patient. Med Clin North Am. 2010, 94(2):327-47.
23. Sabri MR, Ghavanini M, Haghighat M, Imanieh MH. Chest pain in children and adolescents: Epigastric tenderness as a guide to reduce unnecessary work-up. Pediatr Cardiol. 2003;24(1):3-5.
24. Eliacik K, Kanik A, Bolat N, Mertek H, Guven B, Karadas U, et al. Anxiety, depression, suicidal ideation, and stressful life events in non-cardiac adolescent chest pain: A comparative study about the hidden part of the iceberg. Cardiol Young. 2017;27(6):1098-103
25. Brims FJ, Davies HE, Lee YC. Respiratory chest pain: Diagnosis and treatment. Med Clin North Am. 2010;94(2):217-32.
26. Parlar-Chun R, Kakarala K, Singh M. Descriptions and outcomes of cardiac evaluations in pediatric patients hospitalized for asthma. J Asthma. 2020;57(11):1195-201.
27. Freed LA, Benjamin EJ, Levy D, Larson MG, Evans JC, Fuller DL, et al. Mitral valve prolapse in the general population: The benign nature of echocardiographic features in the Framingham Heart Study. J Am Coll Cardiol. 2002;40:1298-304.
28. Nishimura RA, Tajik AJ. Follow-up observations in patients with mitral valve prolapse. Herz. 1988;13(5):326-34.
29. Feigenbaum H. Echocardiography in the management of mitral valve prolapse. Aust N Z J Med. 1992;22(5 Suppl):550-5.
30. Waller BF, Maron BJ, DelNegro AA, Gottdiener JS, Roberts WC. Frequency and significance of M-mode echocardiographic evidence of mitral valve prolapse in clinical isolated pure mitral regurgitation: Analysis of 65 patients having mitral valve replacement. Am J Cardiol. 1984;53(1):139-47.
31. Naçar N, Atalay S, Tutar HE, Ekici F. Mitral kapak prolapsuslu çocuklarda tanı kriterleri ve izlem. Ankara Ünv. Tıp. Fak. Mec. 2002;55(4):283-90.
32. Hickey AJ, MacMahon SW, Wilcken DE. Mitral valve prolapse and bacterial endocarditis: When is antibiotic prophylaxis necessary? Am Heart J. 1985;109(3 Pt 1):431-5.
33. Ahmed MI, Sanagala T, Denney T, Inusah S, McGiffin D, Knowlan D, O'Rourke RA, et al. Mitral valve prolapse with a late-systolic regurgitant murmur may be associated with significant hemodynamic consequences. The American Journal of the Medical Sciences. 2009;338(2):113-5.