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

Differential Diagnosis of Chest Pain in Children

Cardiac Related Causes
  • Coronary Artery Disease (ischemia, infarction)
    • Anomalous coronary artery
    • Kawasaki disease
    • Diabetes mellitus (long-standing)
  • Arrhythmia
    • SVT
    • VT
  • Structural Abnormalities
    • Hypertrophic cardiomyopathy
    • Severe pulmonic stenosis
    • Aortic valve stenosis
  • Infection
    • Myocarditis
    • Pericarditis
  • Aortic Dissection (thoracic)
History
  • Musculoskeletal Disorders
    • Chest wall strain
    • Direct trauma, contusion, rib fracture
    • Costochondritis
  • Respiratory Disorders
    • Severe cough
    • Asthma
    • Pneumonia
    • Pneumothorax, pneumomediastinum
  • Psychological Disorders
    • Stress-related pain
  • GI Disorders
    • Reflux esophagitis
    • Esophageal foreign body, caustic ingestion
    • Pill induced esophagitis
  • Miscellaneous
    • PE
    • SCD with vasocclusive crisis
    • Abdominal aortic aneurysm (Marfan)
    • Pleural effusion (inflammatory disease)
    • Zoster
    • Pleurodynia (coxsackie virus)
    • Breast tenderness (physiologic, pregnancy)
    • Tietze syndrome
    • Texidor's Twinge / Precordial Catch syndrome
    • Chest mass
  • Idiopathic

From Selbst SM. Approach to the Child with Chest Pain. Pediatr Clin North Am. 2010 Dec;57(6):1221-34.