Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Chest Pain without Known Cardiac Disease

(+) History or
Physical Examination
(+) Past Medical History
or Family History
(-) History or
Physical Examination
  • Monitor, ECG,
  • Cardiology Consult
  • Discuss need for chest X-ray, labs with Cardiology
Cardiology consult

Risk Factors for Cardiovascular Etiology

History Physical Exam Non-Cardiac
Past Medical History
Family History
  • Cyanosis
  • Tachypnea, shortness of breath, work of breathing
  • Abnormal heart rhythm
  • Hypotension
  • New or significant murmur
  • Gallop
  • Friction rub
  • Abnormal 2nd heart sound
  • Decreased femoral/peripheral pulses
  • Rheumatologic disease, lupus
  • Aortopathy, such as:
    • Marfan syndrome
    • Loeys-Dietz syndrome
    • Turner syndrome
  • Sickle cell disease
  • Sudden death or myocardial infarction under 50 years old
  • Unexplained sudden death in young relative
  • Cardiomyopathy
Posted: January 2014
Revised: February 2023
Authors: M. M'Farrej, MD; P. Stephens, MD; J. Lavelle, MD; M. Elias, MD