ED Pathway for the Evaluation/Treatment of Chest Pain in Children
Without Known Cardiac Disease
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(+) History or
Physical Examination
(+) Past Medical History
or Family History
(-) History or
Physical Examination
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  • Monitor, ECG,
  • Bedside Cardiology Consult
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ECG
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Abnormal
Normal
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  • Discuss need for chest X-ray, labs with Cardiology
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Abnormal
Normal
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  • Cardiology phone consult
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Risk Factors for Cardiovascular Etiology

History Physical Exam Past Medical History Family History
  • Exertional
  • Acute onset, awakens from sleep
  • Substernal crushing pressure
  • Radiation to shoulder, arm, neck, jaw
  • Syncope, dizziness
  • Palpitations
  • Dyspnea
  • Orthopnea
  • Pulmonary embolus
    risk factors
  • Drug use
  • Age < 12 years
  • Cyanosis
  • Tachypnea, shortness of breath, WOB
  • Abnormal breath sounds
  • Bradycardia, tachycardia, dysrhythmia
  • HTN, hypotension
  • New murmur, significant murmur
  • Gallop, friction rub
  • Abnormal 2nd heart sound
  • Distant heart sounds
  • Decreased femoral / peripheral pulses
  • Peripheral edema
  • Rheumatologic disease, SLE
  • Neoplasm
  • Thrombophilia
  • Connective tissue disorder
  • Marfan
  • Behavioral health issue
  • Anemia
  • Diabetes
  • Other chronic medical problems
  • Sudden death in youth
  • Unexplained death
  • Severe familial hyperlipidemia
  • Cardiomyopathy
  • Pulmonary hypertension
  • Deafness at birth
Posted: January 2014
Authors: M. Farah, MD; S. Mohan, MD; D. Nandi, MD; P. Stephens, MD; D. Amaya, CRNP
References