Chest pain in children

Typically, pain occurs in the anterior chest.

Chest pain is conventionally divided into the following groups:

• cardiovascular pain (coronary artery disease, cardiomyopathy, aortic stenosis, regurgitation, pericarditis, aortic dissection, pulmonary embolism or infarction, pulmonary hypertension);
• pulmonary origin (pleurisy with or without pneumonia, pneumothorax);
• gastrointestinal genesis (esophageal spasms, esophagitis, reflux, peptic ulcer, pancreatitis, cholecystitis);
• neuromuscular origin (myositis, chondritis, ostitis, neuritis);
• other (shingles, trauma, mediastinal tumors, hyperventilation syndrome, unexplained causes).

Pain can be acute, chronic, recurrent, superficial (neuromuscular, bone) or deep (of cardiac origin, as well as esophagitis, mediastinal tumors).

A detailed anamnesis and clinical examination allow us to differentiate cardiac pain from pain caused by diseases of other organs.

Chest pain may occur with heart rhythm disturbances. In such cases, jerky, unpleasant sensations are observed. They occur at rest, and often disappear under load. A detailed survey usually reveals that, along with pain, patients feel a feeling of interruptions, palpitations, and a "stopping" of the heart.

Acute pericarditis is accompanied by precordial pains, varying in intensity from a feeling of dull pressure to severe sharp ones. The pains increase with coughing, breathing, and in a lying position. Breathing is frequent and shallow. During auscultation, pericardial friction noise is heard, the characteristics of which, with varying degrees of fibrinous deposits, change from a gentle rustle to a rough machine sound. Pericardial friction noise increases with pressure from a phonendoscope, bending the patient, and deep inspiration. In the ECG with pericarditis, low voltage is recorded in all leads (with pronounced effusion, the voltage fluctuates in time with breathing), and the ST segment elevation has a horizontal or concave shape. Difficulties in the differential diagnosis of pericarditis occur with early repolarization syndrome. It is more common in young patients with vagotonia and occurs with a slight ST segment elevation. In addition, with pericarditis, a pointed P wave and an inverted T wave are often noted.

Chest pains with pleural damage are manifested by their dependence on breathing. They intensify with inhalation and decrease (sometimes almost to complete disappearance) on exhalation, so patients prefer to breathe frequently and shallowly. The pain radiates to the Zakharyin-Ged somatome along the sensitive branch of the corresponding nerve. Thus, with damage to the pleura lining the central parts of the diaphragm, the pain spreads to the shoulders, and with damage to the peripheral parts of the diaphragmatic pleura - to the abdomen. On auscultation, dry parietal pleurisy is characterized by a typical pleural friction noise, which intensifies with deepening breathing. Bilateral pleural friction noise in young, strong people with a generally mild condition often accompanies viral infections, especially Coxsackie.

Functional pains in the heart area are often observed in girls and emotional young men, with hypermobility syndrome, mitral valve prolapse. Cardialgia is provoked by stuffiness and emotional stress. Usually, such pains develop not during physical work, but after it. Physical activity even leads to an improvement in the condition. The pains can be dull, precordial, sometimes lasting for hours. In other cases, the pains can be shooting like a fleeting intense prick, clearly localized, accompanied by difficulty exhaling. No changes are detected on the ECG and EchoCG.

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