The vast majority of chest pain reported by children is non cardiac in origin. Children with cardiac disease causing chest pain can usually be identified from pertinent points of the history.
Cardiac pain is central and may radiate down the left arm or to the neck. It is not pleuritic in nature and children will often have difficulty localising it to a specific site. Chest pain associated with exertion is a “red flag” and referral should be considered, particularly if the chest pain is predictably reproducible or is associated with pallor, sweating, presyncope, or syncope.
Features indicating chest pain is unlikely to be cardiac in origin include pain that is:
Cardiac causes of chest pain include
Congenital abnormalities of the coronary arteries are rare but are a cause of sudden death in children and adults. They include an abnormal origin of the left coronary artery so that the LCA runs between the aorta and main pulmonary artery. Ischaemia occurs secondary to compression of the coronary artery by the great vessels.
Kawasaki disease, a vasculitis that has a predilection for the coronary arteries, causes coronary artery aneurysms. Stenosis of the entrance or exit of large aneurysms may cause myocardial ischaemia and infarction years after the acute illness.