Chest Pain

Agenda History Physical Differential algorithm Management

History Chronicity –Duration –Frequency –Acute vs. chronic Location Severity Radiation Quality/character PMH Family History Medications

Physical ABCs Vitals CV Pulm MSK - reproducible

Differential Chest Pain MSKRespiratoryBreastGIVascularCardiacToxicNeuroPsychogenicIdiopathic

MSK Chest Pain MSK TraumaticNon-Traumatic Costochondritis Slipping Rib Prrecodial catch

Respiratory Chest Pain Respiratory PneumoniaBronchitisRADPleural effusionPleuritisPneumothorax Cystic fibrosis Pneumomediastinu m Marfan’s

GI Chest Pain GI Reflux esophagitis Gastritis Esophageal spasm AchalasiaStricture

Vascular Chest Pain Vascular Pulmonary embolus Pulmonary HTN Acute chest syndrome

Cardiac Chest Pain Cardiac LV outflow obstruction Aortic root disection PericarditisMyocarditisTachyarrhytmias Abnormal coronaries

Management in Asymptomatic Children Schematic approach to evaluation of pediatric patient with chest pain in whom the physical examination is normal. For details about the various conditions, see text. Data from: Brenner, JI, Ringel, RE, Berman, MA. Cardiologic perspectives of chest pain in childhood: a referral problem? To whom? Pediatr Clin North Am 1984; 31:1241.

Management in Symptomatic Children Schematic approach to evaluation of pediatric patient with chest pain in whom the physical examination is abnormal. For details about the various conditions, see the text. Data from: Brenner, JI, Ringel, RE, Berman, MA. Cardiologic perspectives of chest pain in childhood: a referral problem? To whom? Pediatr Clin North Am 1984; 31:1241.

References Selbst, SM. Chest pain in children. Pediatrics 1985; 75: Geggel, Robert. Approachto chest pain in children.