Chest Pain, Dyspnea on Exertion, and Exercise Induced Asthma in Children and Adolescents

Nudel, Dov B.; Diamant, Shmuel; Brady, Timothy K.; Jarenwattananon, M; Buckley, Barbara; Gootman, Norman

doi:10.1177/000992288702600802

Cited by 21 publications

(7 citation statements)

References 25 publications

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“…In studies of children with chest pain, prevalence of cardiac abnormalities ranges from 0% to 10%. 2,3,9Y11 Noncardiac medical diagnoses are common, including musculoskeletal conditions such as costochondritis, 12 pulmonary conditions such as asthma or pneumonia, 13,14 gastrointestinal illnesses, 15,16 or other identifiable causes such as cocaine use. 17 However, most cases have no clear medical explanation.…”

mentioning

confidence: 99%

Psychopathology and Disability in Children With Unexplained Chest Pain Presenting to the Pediatric Emergency Department

Lipsitz¹,

Gur²,

Sonnet³

et al. 2010

Pediatric Emergency Care

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Objective: Chest pain is a common presentation in the pediatric emergency department (PED). In the majority of cases, no clear medical cause is found. Among adults with noncardiac chest pain, psychopathology including panic disorder is common. We assessed the likelihood and type of psychopathology as well as the health status of children and adolescents with unexplained chest pain who presented to the PED.Methods: We performed a semistructured diagnostic interview of children 8 to 17 years old who presented to an urban, tertiary-care PED with a primary complaint of chest pain for which no medical cause was found. We used Diagnostic Statistical Manual of Mental Disorders, Fourth Edition criteria to diagnose psychopathology. We also assessed pain severity, extent of other somatic complaints, quality of life, and functional disability using standard, validated instruments. Results:We enrolled 32 children with a mean age of 12.8 (SD, 2.9) years (range, 8Y17 years); 47% were female. Twenty-six (81%) were diagnosed with a Diagnostic Statistical Manual of Mental Disorders, Fourth Edition anxiety disorder; 9 (28%) had full-criteria panic disorder. Quality of life was compromised in multiple domains, and children reported a range of functional disabilities due to chest pain. Other somatic symptoms, including other pain complaints, were commonly reported in this sample.Conclusion: Unexplained chest pain in the PED is frequently associated with potentially treatable anxiety disorders. Emergency physicians should consider the possibility of anxiety disorders in patients with medically unexplained chest pain.C hest pain is a common complaint in the pediatric emergency department (PED). 1Y3 Annually, it accounts for roughly 400,000 emergency visits in the United States for individuals 18 years or younger. 4 Chest pain presents a significant clinical burden for the pediatric emergency room physician 5 and is one of the more common reasons for performing electrocardiograms in the PED. 6 It is also a frequent cause for seeking pediatric cardiologist consultation within the hospital setting 7 and is among the most common reasons for referral to the pediatric cardiologist. 8 Prior to adulthood, chest pain is only rarely an indication of cardiac disease. In studies of children with chest pain, prevalence of cardiac abnormalities ranges from 0% to 10%. 2,3,9Y11 Noncardiac medical diagnoses are common, including musculoskeletal conditions such as costochondritis, 12 pulmonary conditions such as asthma or pneumonia, 13,14 gastrointestinal illnesses, 15,16 or other identifiable causes such as cocaine use. 17 However, most cases have no clear medical explanation. 18 Despite the overall benign medical picture, pediatric chest pain often persists for years after the first visit to the PED or specialist. 19,20 Some children with chest pain make repeated visits for additional medical testing. 21 Many experience disability, including school absence and sleep abnormalities. 2,19,22 Our objective was to conduct a pilot study to determine the li...

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confidence: 99%

Psychopathology and Disability in Children With Unexplained Chest Pain Presenting to the Pediatric Emergency Department

Lipsitz¹,

Gur²,

Sonnet³

et al. 2010

Pediatric Emergency Care

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“…As seen in Table 1, commonly the diagnosis remains undefined and termed 'Idiopathic', totaling 25-45% of all cases [1,23,24]. The majority of idiopathic cases are likely a collection of stress-or behavior-related conditions, occult asthma, or undiagnosed musculoskeletal disease [25,26]. Among pediatric patients, chest pain is more likely to be chronic in nature, rather than acute and life threatening.…”

Section: Etiologiesmentioning

confidence: 99%

Chest Pain in Children

Lang¹,

Colin²

2006

CPR

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Pain arising from the chest area creates anxiety in children and their parents, often leading to unnecessary activity restriction, school absences, and medical utilization. A thorough but pragmatic evaluation requires a grasp of the pathophysiology of several organ systems and an understanding of epidemiologic and behavioral patterns specific to children. Few symptoms in pediatrics test a clinician's skill more than chest pain. Though the etiology is frequently benign, it is often uncertain, and sprinkled among cases of chest pain are potentially fatal conditions. This review summarizes chest pain in children of all ages, with particular emphasis on adolescents. We review the organic causes including musculoskeletal trauma, strain and inflammation, respiratory conditions such as occult asthma, pneumonia and bronchitis, and the important role of esophageal disease. We discuss the relatively minor role of cardiac disease, but highlight the conditions that are vital to consider, such as arrhythmia, mitral valve disease, Kawasaki syndrome, Marfan syndrome, and cocaine use. Anxiety, depression, and other psychological factors often further complicate the presentation. A pediatrician's best tools are diagnostic acumen, which may be lifesaving, and supportive dialogue, to impart reassurance to a worried family.We explore the most common and most lethal causes by age, organ system, and predisposing illness. We review the neuroanatomic considerations important in visceral, chest wall, and mediastinal pain, and the sensation within the lung, airways, and pleurae. Lastly, we highlight pragmatic 'take-home' tips for the clinician, most of which involve good history-taking and physical examination, but also include the utility of basic testing that can detect the rare cases of fatal cardiopulmonary disease.

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“…Stress-induced asthma should be considered in pediatric patients with thoracic pain symptoms or dyspnea associated to exercise. In the evaluation of 180 young individuals with thoracic pain or dyspnea associated to exercise, 9.5% of patients with pain and 21.2% of patients with dyspnea developed stress-induced asthma (8) . Although rare in children, the ischemic response should be investigated in the evolution of the coronary involvement in the Kawasaki disease.…”

Section: Class IIImentioning

confidence: 99%

Indicações do teste ergométrico em crianças e adolescentes

Silva¹,

Saraiva²

2004

Rev Bras Med Esporte

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The exercise test (ET) is a low-risk procedure that presents extremely rare complications, especially among pediatric age populations. In this reviewing, the main ET indications in children and adolescents (age up to 19 years) are presented as a method of diagnostic, prognostic and functional evaluation in several situations: evaluation of the physical capacity, evaluation of symptoms related to exercise, evaluation of clinical and surgical treatments in patients with cardiomyopathies, congenital and valvar cardiopathies, asthmatic patients and pre-participation in physical activities programs, among others.Adult patients have as most frequent indication of ET the search for diagnostic information, when intermediate probability of significant coronary arterial disease occurs in the absence of significant alterations of the ECG in rest (1) . The ischemic disease is rare among young populations, what shows a significant difference in indication and interpretation and results in low risk in the ET routine in the pediatric age population. The complications are extremely rare even when ET is performed in children with congenital cardiopathies and arrhythmias. The ET applications in young individuals are mainly related to the measure of the physical capacity, evaluation of known cardiac abnormalities and evaluation of symptoms related to exercise (2) .

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Chest Pain, Dyspnea on Exertion, and Exercise Induced Asthma in Children and Adolescents

Cited by 21 publications

References 25 publications

Psychopathology and Disability in Children With Unexplained Chest Pain Presenting to the Pediatric Emergency Department

Psychopathology and Disability in Children With Unexplained Chest Pain Presenting to the Pediatric Emergency Department

Chest Pain in Children

Indicações do teste ergométrico em crianças e adolescentes

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