Chest pain: When is it heart related?

When your child complains of chest pain, it’s easy to quickly become concerned. How do you know if the issue is heart-related? We talked to Dr. Alex Arevalo, a Le Bonheur cardiologist. Here’s what he had to say:

I think just about everyone gets a little chest pain, and it is a frequent reason why we see patients. My job is to make sure it is not “cardiac chest pain.”

The likelihood of chest pain being a cardiac issue is rare – about 1 percent. The most common causes are idiopathic (we don't know why), musculoskeletal (muscles, nerves, bones), pulmonary (lung issues, like asthma) and GI or stomach problems, like reflux.

The most concerning symptom of chest pain is when it occurs consistently with exercise. If a child faints or passes out during exercise, he or she should be seen by a cardiologist immediately.

Chest pain might be heart related if:

  • The pain is usually associated with exercise and is made better by stopping exercise
  • The child or teen gets light headedness with exercise or passing out (syncope)
  • The child needs immediate CPR after passing out (intense passing out)
  • The child has a prior heart history

If there are concerns that it’s a cardiac problem, there are common tests that can help rule out or diagnose any cardiac causes, including:

  • echocardiograms (ultrasound of the heart)
  • electrocardiogram (which tests the basic electricity of the heart)

These tests are simple and can be done on the same day.

When is chest pain probably GI (gut) related?

  • It’s associated with foods, especially greasy and spicy foods like fried chicken
  • It usually occurs at rest, not with exercise (and can be worst at night while lying down)

When should you suspect lung- or asthma-related chest pain?

  • It can happen with and without exercise
  • It’s usually associated cough and wheezing
  • The child or adolescent has other diseases like dry and/or sensitive skin (eczema) or seasonal allergies
  • It’s associated with coughing during exercise, or the child coughs in the middle of the night

When should you suspect it’s a musculoskeletal (muscle/nerves/bones) issue?

  • It’s associated with trauma (common in an adolescent who started weight lifting, or got in a fight)
  • It’s also associated with colds because sometimes the virus can live and replicate in muscles and irritate them
  • The pain is usually worse with movement or while breathing
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