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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 MSK Respiratory Breast GI Vascular Cardiac Toxic Neuro Psychogenic Idiopathic MSK Chest Pain MSK Traumatic Non-Traumatic Costochondritis Slipping Rib Prrecodial catch Respiratory Chest Pain Respiratory Pneumonia Bronchitis RAD Pleural effusion Pleuritis Pneumothorax Pneumomediastinum Cystic fibrosis Marfan’s GI Chest Pain GI Reflux esophagitis Gastritis Esophageal spasm Achalasia Stricture Vascular Chest Pain Vascular Pulmonary embolus Pulmonary HTN Acute chest syndrome Cardiac Chest Pain Cardiac LV outflow obstruction Aortic root disection Pericarditis Myocarditis Tachyarrhytmias 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: 1068. • Geggel, Robert. Approachto chest pain in children. www.uptodate.com
