Chest Pain Clinical Pathway — Emergency Department | Children's Hospital of Philadelphia

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Chief Complaint of Chest Pain

History and Physical Examination

Risk Factors for
Cardiovascular Etiology

(+) History or
Physical Examination

(+) Past Medical History
or Family History

(-) History or
Physical Examination

Monitor, ECG,
Cardiology Consult

ECG

Abnormal

Normal

Discuss need for chest X-ray, labs with Cardiology

Outpatient
Treatment

Abnormal

Normal

Cardiology phone consult

Outpatient
Treatment

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	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 Age < 12 years	Sudden death or MI under 50 years old Unexplained death Severe familial hyperlipidemia Cardiomyopathy Pulmonary hypertension Deafness at birth

Posted: January 2014
Revised: March 2016, July 2019, June 2020
Authors: M. M'farrej, MD; S. Mohan, MD; D. Nandi, MD; P. Stephens, MD; D. Amaya, CRNP; J. Lavelle, MD

References

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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

References

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

References

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