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
ECG
Abnormal
Normal
  • Discuss need for chest X-ray, labs with Cardiology
Abnormal
Normal
Cardiology phone consult

Risk Factors for Cardiovascular Etiology

History Physical Exam Past Medical History Family History
  • 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: October 2021
Authors: M. M'Farrej, MD; P. Stephens, MD; J. Lavelle, MD; M. Elias, MD