Evaluation of Chest Pain in Children

1986 ◽  
Vol 8 (2) ◽  
pp. 56-62
Author(s):  
Steven M. Selbst
Keyword(s):  
Chest Pain ◽  
Physical Examination ◽  
Laboratory Tests ◽  
Good Prognosis ◽  
Detailed History ◽  
Common Complaint ◽  
Complete Physical Examination

Childhood chest pain is a common complaint and often a recurrent, chronic symptom. A detailed history and complete physical examination are the most important aspects of evaluating a child with chest pain. Childhood chest pain has a good prognosis. Laboratory tests should only be ordered if they are indicated on the basis of history and physical examination findings.

DIAGNOSIS AND TREATMENT: RECURRENT ABDOMINAL PAIN IN CHILDREN—A SURGEON'S VIEWPOINT

PEDIATRICS ◽  
1967 ◽  
Vol 40 (6) ◽  
pp. 1024-1026
Author(s):  
Donald G. Marshall
Keyword(s):  
Abdominal Pain ◽  
Physical Examination ◽  
Recent Article ◽  
Recurrent Abdominal Pain ◽  
Diagnosis And Treatment ◽  
Subsequent Paper ◽  
Organic Disease ◽  
Detailed History ◽  
Psychogenic Pain ◽  
Complete Physical Examination

MUCH has been written in recent years about the importance of psychogenic disturbances as causes of abdominal pain in childhood. Yet, by no means all recurrent abdominal pain is so caused. A recent article in Pediatrics on nonorganic abdominal pain therefore promised this subsequent paper on pain of organic origin. I would like to caution the reader that his "surgeon's viewpoint" tends to exclude consideration of organic abdominal pain not surgically treated. Perhaps a third paper is indicated. Abdominal pain of whatever origin requires a planned approach to diagnosis. While it is only too easy for the clinician to submit a patient to innumerable investigations of varying degrees of unlikelihood of revealing disorders of differing degrees of rarity, a detailed history and searching interview with the parents, together with a complete physical examination, will go very far to reduce the number of cases submitted to any but quite simple tests. The diagnosis of psychogenic pain, no less than that of organic pain, must rest on positive findings. To make a diagnosis of psychogenic pain, there must be something more than the absence of demonstrable organic disease. There must be significant psychopathology. If there is evidence of neither this nor organic disease, one must resolve to be irresolute and decide to be undecided. One must not make a diagnosis of psychic disease simply because one can find no organic cause. One must also remember that psychic disturbance does not confer immunity from organic disease. A neurotic, psychotic, or brain-damaged child can have appendicitis.

Role of anxiety and depression in adolescents with chest pain referred to a cardiology clinic

2016 ◽  
Vol 27 (1) ◽  
pp. 125-130 ◽  
Author(s):  
Zahra Khairandish ◽  
Leila Jamali ◽  
Saeedeh Haghbin
Keyword(s):  
Chest Pain ◽  
Physical Examination ◽  
Normal Population ◽  
Severe Depression ◽  
Anxiety And Depression ◽  
Detailed History ◽  
Significant Difference ◽  
Cardiology Clinic ◽  
Full Physical Examination

AbstractBackgroundWe carried out this study in order to evaluate the causes of chest pain in teenagers and the role of anxiety and depression in this age group compared with the normal population.MethodsIn this prospective case–control study, all patients aged 11–18 years with chest pain and no history of trauma and referred to a paediatric cardiology clinic from March, 2009–April, 2010 were selected. A chest pain protocol including a detailed history, full physical examination, required blood tests, electrocardiography, and echocardiography was performed for all. The presence of depression and anxiety and their severity were assessed by Beck questionnaires. The patients were compared with age- and sex-matched, randomly selected healthy controls.ResultsIn total, 194 patients with a mean age of 14±2 years were selected. The most frequent presentation was idiopathic chest pain (43.3%), followed by the psychological group (29.9%). These groups had no abnormal points in history, physical, and para-clinical tests. Moderate-to-severe depression was found in 45.9% in the patients group, compared with 17.6% of controls, which was statistically significant (p=0.016). Moreover, anxiety was detected in 67.5% of patients versus 15.4% in controls, which is a statistically significant difference (p=0.009). Cardiac chest pain with 9.27% was the most common type of organic causes.ConclusionChest pain during teenage is more prevalent, but not risky. Undergoing a detailed history and full physical examination can help diagnose the causes in the majority of cases. Given the prevalence of a psychological group as well as role of anxiety and depression in most patients, referring to a psychiatrist is suggested.

Was tun bei akutem Thoraxschmerz?

2019 ◽  
Vol 144 (17) ◽  
pp. 1223-1228
Author(s):  
Bernhard Haring ◽  
Alexander Schmidt ◽  
Stefan Frantz
Keyword(s):  
Clinical Practice ◽  
Chest Pain ◽  
Physical Examination ◽  
Laboratory Tests ◽  
Acute Chest Pain ◽  
Differential Diagnoses ◽  
Life Threatening ◽  
Cardinal Symptoms

AbstractAcute chest pain is one of the most important cardinal symptoms in medicine. There are several important differential diagnoses for chest pain. Therefore, a thorough history and physical examination, as well as the 12-lead ECG and laboratory tests are crucial. In clinical practice, it is useful to distinguish between cardiac chest pain and other forms of chest pain in order to treat patients appropriately and to exclude potentially life-threatening conditions.

scholarly journals The Causes of Chest Pain in Children and the Criteria for Targeted Myocardial Enzyme Testing in Identifying the Causes of Chest Pain in Children

2021 ◽  
Vol 8 ◽  
Author(s):  
Li Chen ◽  
Hongzhou Duan ◽  
Xiaoyan Li ◽  
Zuozhen Yang ◽  
Meng Jiao ◽  
...  
Keyword(s):  
Chest Pain ◽  
Physical Examination ◽  
Resource Use ◽  
Diagnostic Procedure ◽  
Pediatric Cardiology ◽  
Diagnostic Procedures ◽  
Chest Tightness ◽  
Adolescent Group ◽  
Common Complaint ◽  
Cardiac Evaluation

Aims: Chest pain is a common complaint at pediatric cardiology clinics and often leads to an extensive cardiac evaluation. In this study, we analyzed the causes of chest pain in Chinese children and developed diagnostic procedures and criteria for targeted myocardial enzyme testing.Methods and Results: We retrospectively analyzed the clinical data of patients aged below 18 years visiting our hospital for chest pain between 2005 and 2019. Based on auxiliary exams and clinical diagnosis, we developed diagnostic procedures and criteria for targeted myocardial enzyme testing in children with chest pain. A total of 7,251 children were included in this study. The chest pain was of cardiac origin in 581 patients (8.0%). The incidence of non-cardiac chest pain was significantly higher in the preschool group and the school-age group than in the adolescent group (93.5 vs. 93.8 vs. 90.3%, P < 0.05). Among children with cardiac chest pain, the most common concomitant symptom was chest tightness (67.0%). Myocardial enzyme testing was performed in 5,408 patients and was abnormal in 453 patients. We developed a diagnostic procedure and criteria for targeted myocardial enzyme testing using pertinent history, physical examination, and ECG findings or UCG finding. Applying the diagnostic procedure and criteria could lead to the reduction in myocardial enzyme testing while still capturing all cardiac diagnoses.Conclusion: In children, chest pain is mostly benign and rarely cardiac. During diagnosis, targeted myocardial enzyme testing based on medical history and physical examination can effectively reduce resource use.

Children with Fevers: II

PEDIATRICS ◽  
1969 ◽  
Vol 44 (3) ◽  
pp. 452-452
Author(s):  
Deryle T. Whipple
Keyword(s):  
Young Child ◽  
Physical Examination ◽  
Infectious Mononucleosis ◽  
Recent Article ◽  
Complete Physical Examination ◽  
Limited Coverage

In a recent article in Pediatrics (43:290, 1969) , Dr. Cone reviewed the approach to a child with fever. The list of patients with fever of undetermined origin will shrink markedly in the presence of a complete physical examination (especially the ears), a CBC, and urinalysis performed properly. I am surprised Dr. Cone omits infectious mononucleosis from his admittedly limited coverage of this subject. In the young child the Mono test or Heterophile may remain consistently normal.

scholarly journals Primary pulmonary nodular Amyloidosis

2005 ◽  
Vol 63 (3) ◽  
Author(s):  
F. Agresta ◽  
A. Marin ◽  
D. Della Libera ◽  
F. Romanzi ◽  
L.F. Ciardo ◽  
...  
Keyword(s):  
Physical Examination ◽  
Laboratory Tests ◽  
Left Lung ◽  
Solitary Nodule ◽  
Radiological Features ◽  
Video Assisted ◽  
Patient’S History ◽  
Benign Course ◽  
Radiologic Characteristics ◽  
Multiple Nodules

Primary nodular amyloidosis of the lung is an uncommon manifestation. The disease runs a benign course, but offers diagnostic problems due to non-specific radiological features entering the big field of the solitary nodule. We describe the case of a 60 year old man with multiple nodules on the left lung operated on diagnostic and therapeutic video-assisted thoracoscopy and discuss the possibilities, if any, of suspecting such a disease through radiologic characteristics along with findings from the patient’s history, physical examination and laboratory tests.

scholarly journals Recém-nascido com deficiência de glicerol quinase: um caso clínico

2018 ◽  
Vol 28 (3) ◽  
pp. 31385
Author(s):  
Cristina Duarte P. V. G. Madureira ◽  
Cláudia Teles-Silva ◽  
Cláudia Melo ◽  
Susana Gama de Sousa
Keyword(s):  
Emergency Department ◽  
Metabolic Acidosis ◽  
Birth Weight ◽  
Physical Examination ◽  
Laboratory Tests ◽  
Neonatal Period ◽  
Glycerol Kinase ◽  
Glutamic Pyruvic Transaminase ◽  
Glycerol Kinase Deficiency ◽  
Hypernatremic Dehydration

AIMS: To report the case of a newborn with glycerol kinase deficiency, in which an isolated mutation not yet described in the GK gene was identified.CASE DESCRIPTION: A neonate with 10 days of age was brought to the emergency department for refusal to feed with 24 hours of evolution. Physical examination showed a loss of 31% of birth weight and signs of dehydration. Laboratory tests revealed a metabolic acidosis with increased anion gap, creatinine 2.41 mg/dL, urea 306 mg/dL, hypernatremia (182 mEq/L), hyperkalemia (6.8 mEq/L), hyperchloremia (151 mEq/L), glutamic-oxalacetic transaminase 879 U/L, glutamic-pyruvic transaminase 243 U/L, triglycerides 725 mg/dL. Chromotagraphy of organic acids revealed hyperglycerolemia and glyceroluria compatible with glycerol kinase deficiency. The genetic study revealed a mutation not yet described: c.187T> C (p.S63P) as hemizygote status in the GK gene.CONCLUSIONS: The most frequent cause of hypernatremic dehydration in the neonatal period is maternal hypogalactia. In more severe cases of dehydration, other etiologies should be considered, including metabolic causes such as glycerol kinase deficiency. In this case a mutation not yet described in the GK gene was found.

scholarly journals Successful Management of Rhabdomyolysis with Acute Infection Resulting from Chronic Sacrococcygeal Pressure Ulcers in a Paraplegic Patient: A Case Report

2020 ◽  
Author(s):  
Kai Huang ◽  
Yansheng Zhu
Keyword(s):  
Physical Examination ◽  
Laboratory Tests ◽  
Pressure Ulcers ◽  
Acute Infection ◽  
Case Presentation ◽  
The Past ◽  
Sacrococcygeal Region ◽  
Skin Sensation ◽  
Life Threatening ◽  
Paraplegic Patient

Abstract Background: Rhabdomyolysis, a potentially life-threatening syndrome, is caused by the breakdown of skeletal muscle cells and leakage of intramyocellular contents into the bloodstream. The treatment of cases with rhabdomyolysis resulting from chronic sacrococcygeal pressure ulcers have been rarely reported.Case presentation: A 62-year-old man suffered from high fever and dark-colored urine. For the past 30 years, the patient has lived with paraplegia, which led to his immobility. According to his physical examination, the wound on his sacrococcygeal region was dehisced and exuded repeatedly with loss of skin sensation. Upon corroboration of a physical examination and laboratory tests, the patient was diagnosed with rhabdomyolysis with an acute infection resulting from sacrococcygeal pressure ulcers. We first debrided the necrotic tissue, and then the chronic ulcer was repaired. The wound dressing was changed frequently, and antimicrobial therapy and nutritional support were included in the treatment. The fever and dark-colored urine were gradually relieved post-operatively. Renal function was also improved according to the typical indicators in laboratory tests. Additionally, the size of the pressure ulcers was reduced, to some extent. The patient was discharged after one month of hospitalization.Conclusions: Accurate diagnosis is critical for clinicians to administer precise treatment to paraplegic patients with progressive rhabdomyolysis.

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