Chest pain is a very frightening symptom. However, in children it almost never has cardiac causes if it is not associated with other symptoms. Nevertheless, the pediatric cardiologist will always perform tests such as electrocardiogram, ultrasound or stress test to accurately diagnose the pathology or non-cardiac pathology that the child may suffer.
What to do when a child has chest pain
It depends on the situation that produces it and the clinical condition of the child when he/she has the pain. It is not the same to have chest pain while playing sports, accompanied by palpitations or loss of consciousness, as it is while relaxing and watching your favorite show without other disabling symptoms.
Chest pain in children: can it mean heart disease or heart problems?
Chest pain is a symptom that scares us a lot because of its significance in older people, which is usually due to a myocardial infarction (heart muscle) or angina pectoris. But in children it does not have cardiac causes, especially if it is not associated with other symptoms, such as palpitations or shortness of breath.
Anginal symptoms are very striking, with vegetative symptoms such as sweating and paleness of the face and, rather than pain, are usually described as tightness throughout the chest with shortness of breath, and the pain may radiate to the left arm or neck.
Chest pains in children are mainly due to muscle pain or pain in the sternum, which is the bone that joins the rib cage in front. Children usually locate it at the tip of a finger in a specific place in the chest, which increases with movement or deep breathing and decreases when still and disappears in a short time, without other symptoms such as palpitations (which would point us towards an arrhythmia).
Diagnostic tests for possible pathologies
The main thing is the clinical history, which will guide us, in most cases, towards something benign.
Then we will confirm our suspicions by means of complementary tests such as electrocardiogram (ECG), cardiac ultrasound and, sometimes, a stress test, which will be performed by the expert in pediatric cardiology. Depending on the findings, we can refine by means of a cardiac catheterization with contrast to rule out possible malformations of the coronary arteries that may cause anginal symptoms due to lack of irrigation in the heart, Holter to try to detect some type of arrhythmia, etc.
Treatment in case of finding any heart pathology
The treatment, as always, will depend on the origin of the pain or pathology.
If it is due to an arrhythmia, for example, we will treat it with drugs or we can destroy the abnormal electrical pathway that produces it with heat or cold by catheterization, to avoid new episodes of tachycardia.
If it is really an anginal type pain, we will have to see the cause that produces it:
We must rule out a thickening of the cardiac muscle (what we call hypertrophic cardiomyopathy) and see what it is due to.
Although sometimes this thickening is genetic, it may be due to an obstruction of the blood through the exit of the left ventricle by a valvular malformation for example or chronic arterial hypertension causing the heart to work with more load than normal.
If the cause cannot be corrected, as in valvular stenosis or arterial hypertension, we will start by offering symptomatic treatment with drugs to relax the muscle and make it work with less load to avoid surgery.
What to do if chest pains recur after treatment?
If these pains recur and are due to potentially dangerous causes, such as the hypertrophic cardiomyopathy mentioned above, we will move on to the next stage in the treatment such as surgery, resecting or trimming part of the thickened muscle and thus freeing the obstruction that produces these symptoms.