Chest pain is a frequent complaint in children and adolescents, and may lead to school absences and restriction of activities, often causing significant anxiety in the patient and family. The etiology of chest pain in children is not typically due to a serious organic cause without positive history and physical exam findings in the cardiac or respiratory systems. Good history taking skills and a thorough physical exam can point you in the direction of non-cardiac causes including GI, psychogenic, and other rare causes (see Appendix A). A study performed by the New England Congenital Cardiology Association (NECCA) identified 1016 ambulatory patients, ages 7 to 21 years, who were referred to a cardiologist for chest pain. Only two patients (< 0.2%) had chest pain due to an underlying cardiac condition, 1 with pericarditis and 1 with an anomalous coronary artery origin. Therefore, the vast majority of patients presenting to primary care settings with chest pain have a benign etiology. With careful screening, the patients at highest risk can be accurately identified and referred for evaluation by a Pediatric Cardiologist.
