The Indian Journal of Pediatrics

, Volume 78, Issue 10, pp 1262–1267 | Cite as

Acute Chest Pain

Symposium on PGIMER Protocols in Emergency Medicine


Chest pain is a worrisome symptom that often causes parents to bring their child to emergency department(ED) for evaluation. In the majority of cases, the etiology of the chest pain is benign, but in one-fourth of the cases symptoms are distressing enough to cause children to miss school. The clinician’s primary goal in ED evaluation of chest pain is to identify serious causes and rule out organic pathology. The diagnostic evaluation includes a thorough history and physical examination. Younger children are more likely to have a cardiorespiratory source for their chest pain, whereas an adolescent is more likely to have a psychogenic cause. Children having an organic cause of chest pain are more likely to have acute pain, sleep disturbance due to pain and associated fever or abnormal examination findings, whereas those with non-organic chest pain are more likely to have pain for a longer duration. Chest radiograph is required in some, especially in patients with history of trauma . In children, myocardial ischemia is rare, thus routine ECG is not required on every patient. However, both pericarditis and myocarditis can present with chest pain and fever. Musculoskeletal chest pain, such as caused by costochondritis and trauma, is generally reproducible on palpation and is exaggerated by physical activity or breathing. Pneumonia with or without pleural effusion, usually presents with fever and tachypnea; chest pain may be presenting symptom sometimes. In asthmatic children bronchospasm and persistent coughing can lead to excess use of chest wall muscles and chest pain. Patients’ who report acute pain and subsequent respiratory distress should raise suspicion of a spontaneous pneumothorax or pneumomediastinum. ED management includes analgesics, specific treatment directed at underlying etiology and appropriate referral.


Chest pain Children Osteochondritis Psychogenic chest pain 


  1. 1.
    Massin MM, Bourguinont A, Coremans C, et al. Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic. Clin Pediatr. 2004;43:231–8.CrossRefGoogle Scholar
  2. 2.
    Rowe BH, Dulberg CS, Peterson RG, et al. Characteristics of children presenting with chest pain to a pediatric emergency department. Can Med Assoc J. 1990;143:388–94.Google Scholar
  3. 3.
    Selbst SM, Ruddy RM, Clark BJ, et al. Pediatric chest pain: a prospective study. Pediatr. 1998;82:319–23.Google Scholar
  4. 4.
    Lin CH, Lin WC, Ho YJ, et al. Children with chest pain visiting the emergency department. Pediatr neonatol. 2008;49:26–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Driscoll DJ, Glicklich LB, Callen WJ. Chest pain in children: a prospective study. Pediatrics. 1976;57:648–51.PubMedGoogle Scholar
  6. 6.
    Zavaras-Angelidou KA, Weinhouse E, Nelson DB. Review of 180 episodes of chest pain in 134 children. Pediatr Emerg Care. 1992;8:189–93.PubMedCrossRefGoogle Scholar
  7. 7.
    Freedman JT. Evaluation of chest pain in pediatric patient. Med Clin N Am. 2010;94:327–47.CrossRefGoogle Scholar
  8. 8.
    Evangelista JA, Parsons M, Renneburg AK. Chest pain in children: diagnosis through history and physical examination. J Pediatr Health Care. 2000;14:3–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Yildirim A, Karakurt C, Karademir S, et al. Chest pain in children. Int Pediatr. 2004;19:175–9.Google Scholar
  10. 10.
    Lane JR, Ben-Shachar G. Myocardial infarction in healthy adolescents. Pediatrics. 2007;120:e938–43.PubMedCrossRefGoogle Scholar
  11. 11.
    Gokhale J, Selbst SM. Chest pain and chest wall deformity. Pediatr Clin N Am. 2009;56:49–65.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2011

Authors and Affiliations

  1. 1.Department of Pediatrics, Advanced Pediatrics CentrePostgraduate Institute of Medical Education and ResearchChandigarhIndia

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