G16(P) Chest pain in children: does it need cardiology input?

Introduction Chest pain in children is a common complaint & is one of the commonest reasons for referral to a paediatrician with cardiology expertise (PEC) after heart murmurs. Although it causes high levels of anxiety in parents, the causes for these are usually benign. Often these children are referred to PECs for investigation and management. Aim To look at the demographics of children presenting to the PEC outpatient clinic, review the presenting symptoms, investigations done and diagnosis with outcome. Methods We reviewed the notes for the patient attending PEC clinic for complaints of chest pain over the last 3 years. Results There were 40 referrals to the PEC clinic for children with chest pain. The age ranges were between 5–16 years with the average age being 13.8 years, with 55% being in the 12–16 years range. There were 17 boys and 23 girls. 29 children complained of bilateral, 8 left sided and 3 had central chest pain. 24 of these children had other symptoms like palpitations, dizziness, chest tightness, lethargy, chronic fatigue, breathing difficulties, anxiety, pain in the arms and fingers. All of them had further investigations that included blood tests, ECG, CXR, and echocardiography. Amongst the 26 children who had vitamin D levels done, 38% had low levels, 42% had insufficient levels and 20% had normal levels. All patients had ECGs and echocardiography done which did not reveal any underlying cardiac cause for the chest pain. High dose vitamin D supplements were given for 9 cases. None of the cases needed cardiac interventions or treatment. Discussion Chest pain is a common problem in adolescent children particularly in the 12–16 age group. Investigations were usually all normal, apart from findings of low vitamin D level in 80% of the children screened. Notably cardiac investigations were all normal suggesting that the possibility of underlying cardiac problems is very rare. Based on this study we recommend that chest pain in children should be seen in the general paediatric clinic and necessitates cardiac referrals or investigation only in a handful of these.