ED Pathway for the Evaluation/Treatment of Chest Pain in Children without Known Cardiac Disease

Characteristics of Pain and Etiology

Pericarditis
  • Pain
    • Sharp, stabbing sternal pain and L shoulder pain
    • Improved by leaning forward
  • +/- Cough
  • Friction rub, muffled heart tones
  • Pulsus paradoxus, distended neck veins with severe disease
  • ECG
  • +/- Cardiomegaly on chest X-ray
Myocarditis
  • Pain
    • Dull, substernal
  • Fever, tachycardia, respiratory distress, fatigue
  • Impending / existing shock
  • Acutely ill-appearing
  • Gallop, Mitral regurgitation murmur
  • ECG
    • Low voltage precordial leads, ectopy
Arrhythmia
  • Acute onset and offset of pain, palpitations
Myocardial Infarction
  • Pain
    • Crushing, radiation to neck, jaw
    • Associated diaphoresis, dyspnea, nausea
  • Substance exposure, abuse