Pedi CAD (From Burns)
● Know that a child should be referred for elevated B/P if under the age of 10.
Chest pain in children:
○ Abnormal coronaries due to Kawasaki dz/other coronary artery disease
○ Cocaine abuse
○
...
Pedi CAD (From Burns)
● Know that a child should be referred for elevated B/P if under the age of 10.
Chest pain in children:
○ Abnormal coronaries due to Kawasaki dz/other coronary artery disease
○ Cocaine abuse
○ Pericarditis and myocarditis
○ Post pericardiotomy syndrome (recent heart sx)
● First goal of chest pain (CP) is to rule out cardiac causes.
● Causes of CP in children:
○ Arrhythmia
○ Aortic stenosis
○ Pulmonary stenosis
○ Hypertrophic cardiomyopathy
○ Mitral valve prolapse
○ Eisenmenger syndrome (congenital heart disease)
● Most frequent cause of chest pain is musculoskeletal originating in the chest wall.
● Chest wall pain with exercise indicates bronchospasm.
● Chest pain with syncope, exertional dyspnea, or irregularities in heart rhythm
require cardiac eval.
● PE: complete chest, lung, heart, and abd. Exam. Listen for murmur’s, rubs,
clicks.
● ECG for irregular heart rhythms.
● Point tenderness to costochondral joints made worse with physical activity or
deep inspirations is suggestive of costochondritis, palpate each costochondral
junction for tenderness.
● Note rales, wheezing, tachypnea, and decreased breath sounds can suggest
pulmonary dz.
● Studies: CXR, pulmonary function test, 24-hour Holter monitor (24 hour or 30-day
event monitor), stress test, ECG for suspected problems.
● Refer to Pedi cardiology with chest pain that worsens with exercise, angina or
positive findings on examination.
Long QT Syndrome
● Linked to 13 different genes. Genetic prolongation of the QT segment increases
susceptibility to further drug-induced long QT-interval (antiarrhythmics like
amiodarone/sotalol, psychotic drugs (haloperidol/ziprasidone), antibiotics (cipro,
clarithromycin, erythromycin).
● Delayed repolarization (the long-QT interval).
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● May be asymptomatic until experiences syncope or sudden death from torsade
de pointe V. tach. Some will have positive family history for syncope, sudden
death, known QT syndrome, note that congenital deafness is a characteristic of
one type of long-QT syndrome.
Palpitations: (from up to date)
● Palpitations describe a noticeable heartbeat that may be concerning to the
patient (eg, too fast, irregular, or too strong). Palpitations in children typically
arise from physiologic stimuli, such as fever, exercise, anxiety, or anemia, rather
than life-threatening causes (eg, cardiac arrhythmia). In addition, children with
serious arrhythmias may report no palpitations. Children with a serious
underlying cause for their palpitations often have a history of syncope, congenital
heart disease, or cardiac surgery
● Causes of palpitations in children
○ Life threatening cardiac conditions
○ Arrhythmia (eg, Wolff-Parkinson-White syndrome, prolonged QT
syndrome, cardiac structural abnormalities [congenital heart disease,
intracardiac tumors])
○ Hypertrophic cardiomyopathy (HCM)
○ Myocarditis
○ Sick sinus syndrome
○ Pacemaker malfunction
○ Life threatening non-cardiac conditions
○ Hypoglycemia
○ Toxic exposure
○ Pheochromocytoma
○ Common conditions
○ Premature atrial contractions
○ Premature ventricular contractions
○ Fever
○ Anemia
○ Exercise
○ Emotional arousal
○ Anxiety, panic attack
○ Hyperventilation syndrome
○ Drug-induced (caffeine, herbal medications, dietary supplements,
albuterol, isotretinoin)
○ Postural orthostatic tachycardia syndrome (POTS)
○ Other conditions
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○ Acute rheumatic fever with valvular disease
○ Hyperthyroidism
○ Mitral valve prolapse
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