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

Further Diagnostic Testing

Laboratory testing is rarely required in patients with chest pain. Please discuss indications for labs with Cardiology.

History Physical Exam
ECG
  • Exertional
  • Acute onset, awakens from sleep
  • Substernal crushing pressure
  • Radiation to shoulder, arm, neck, jaw
  • Syncope, dizziness
  • Palpitations
  • Dyspnea, Orthopnea
  • Risk Factors for PE
  • Suspect drug exposure/abuse
  • Consider with fever
  • Ill appearance
  • Significant VS abnormality
  • Abnormal cardiac exam
  • Consider with fever
Chest X-ray, 2 view
  • Fever
  • Respiratory distress
  • Trauma
  • Awakens patient from sleep
  • Acute onset
  • History of Kawasaki disease, CTD
  • Suspect foreign body
  • Fever
  • Ill appearance
  • Significant VS abnormality
  • Abnormal lung exam
  • Abnormal cardiac exam
  • Crepitations
CBC, ESR, CRP
  • Concern for myo/pericarditis
CK – MB Studies Troponin
  • Concern for ischemia, myo/pericarditis
BMP
  • Arrhythmia with abnormal ECG
Drug Screen
  • Suspected drug use
D-Dimer
  • Concern for PE
BNP
  • Concern for congestive heart failure