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Chest Pain in Kids: What Parents Need to Know
Chest pain is always concerning, especially when the pain is occurring in young children and as parents, it's important to know what symptoms to look out for. Dr. Prema Ramaswamy discusses chest pain in kids, signs to keep an eye on, when to see a specialist, and more.
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Learn more about Prema Ramaswamy, MD
Prema Ramaswamy, MD
Dr. Prema Ramaswamy is the Director of the Pediatric Cardiology Division, Department of Pediatrics, at Maimonides Children's Hospital in Brooklyn, NY. Dr. Ramaswamy completed her residency in Pediatrics at Montefiore Medical Center, Albert Einstein School of Medicine, followed by a fellowship in Pediatric Cardiology at New York Hospital-Cornell Medical Center.Learn more about Prema Ramaswamy, MD
Transcription:
Chest Pain in Kids: What Parents Need to Know
Prakash Chandran: Chest pain is always concerning, especially when the pain is occurring in young children. Though in most situations, the pain isn't serious. There are cases where the pain can be more dangerous and needs attention. As a parent, it's important to know which symptoms to look out for. Here to tell us more is Dr. Prema Ramaswami. She's the director of the pediatric Cardiology division at Maimonidies Children's Hospital. This is Maimo Med Talk. I'm your host, Prakash Chandran. So Dr. Ramaswami, it's really great to have you here today. Thank you so much for joining us. I think the question that is on every parent's mind is, if my child experiences chest pain, what exactly does that mean?
Prema Ramaswamy, MD: Thank you Prakash. It turns out that just pain and children is actually quite different from that in adults. So the good news for parents, is that. Most likely this is not something very serious. just so they know that if someone above 40 were having chest pain, there's a 50% chance that the chest pain is because of the heart in children, on the other hand, and you know, that includes young adults. So people under 40 chest pain accounts for less than 4%, and in some studies, less than 1% of chest pain.
Prakash Chandran: So one of the things you're saying is that less than 4% of the time, the chest pain is related to the heart. When children experience, chest pain, generally, what is the cause for it or what have you most commonly seen?
Prema Ramaswamy, MD: So the most common reasons. Children have chest pain, is that the pain is actually coming from the chest wall muscle, not the heart muscle inside. So it's the chest wall muscle that is responsible for the pain in really quite the majority of children who have chest pain. And this can hurt Just because of growth, it can hurt due to activity. Since the arm muscles are attached to the chest movement of the arms are just playing basketball, etcetera, you could stress certain chest muscles.
But really the most common reason that chest pain in children is recurrent is because once children and their family members become aware of this chest pain, then anxiety sets in and anxiety in and of itself can cause our muscles to be tight. So that sort of leads to this vicious cycle of anxiety, causes the muscles to be tight, which then the child recognizes as chest pain and makes the child more anxious and so sets off the cycle.
Prakash Chandran: Yeah, that makes sense. And I do wanna talk about that a little bit more. But before we do, I do wanna understand this less than four, percent chest pain that is caused by the heart. Could you explain that in a little more detail?
Prema Ramaswamy, MD: Chest pain that is truly because of the heart is serious, and while it is quite rare, thankfully it is still something that needs to be picked up quickly, because it can be potentially life threatening and in this group are included, things such as infections of the heart, a condition where they may be a virus that's affecting either the coverings of the heart or the heart itself. And then there may be certain things that are genetic and the child may have this condition. And so taking a good family history, may help point to that.
Prakash Chandran: And what exactly are those conditions? Can you tell us a little bit more about them?
Prema Ramaswamy, MD: So again, I want to start by saying, these would be much rarer than the musculoskeletal pain, but within the heart, things that can cause chest pain, one is if the heart is, Affected by viruses. And so there is a condition called myocarditis, which can cause chest pain or pericarditis with a covering of the heart is affected and that can cause pain. Both of these are caused by similar viruses, and while pericarditis is fairly benign and tends to recover, spontaneously, in the majority of cases, myocarditis is occasionaly dangerous, and needs to be recognized.
So that is a condition that we do not want to miss. There are other things in the heart that, are genetic and, they may be a family history. And these are important to recognize because, they are associated with sudden death in children and young adults. So hypertrophic cardiomyopathy is one such condition, and it is the most common cause of sudden. In children and young adults. And that is something that is passed down in families. So taking a detailed family history can help elucidate the scores.
And then finally, they are some rare things, which can be detected by an echocardiogram, which, cardiologists can perform in the office. A cardiologist can pretty much, with an examination rule out most, if not all, of these very dangerous conditions, which can cause chest pain in children, but thankfully, do so only rarely.
Prakash Chandran: Okay, so I'd like to understand a little bit more about the most common symptoms and what children feel when they have chest pain. Now, you said it was normally because of the chest wall muscle. So talk about those symptoms, but also talk about when it is something more serious, how those symptoms differ from the traditional chest wall muscle pain.
Prema Ramaswamy, MD: So a couple of questions that I've found quite useful in trying to differentiate. the kids who might just have this benign chest pain because of the muscle versus truly dangerous chest pain. Is to see A, how long they've had it. Chest pain that has lasted for more than two weeks, and especially if it's something that they don't even remember when it started and started months to years ago. But every now and then they feel that, that is more likely to fall in this muscular skeletal category.
The other really important thing that helps is does this chest pain occur at. As well as exercise, and that is very reassuring. If it does, on the other hand, chest pain that occurs only with exercise or chest pain that's associated with difficulty in breathing or dizziness, those would be symptoms where, I would recommend they seek a medical attention immediately.
Prakash Chandran: So when children come in with chest pain, how are these symptoms typically evaluated or diagnosed?
Prema Ramaswamy, MD: Basic history is very important. So, just going through, the whole history of when this pain started, when does it come on, how severe. Is it, how long does it last? Is it associated with certain things? All these questions help us in formulating possible diagnosis, and then in addition to the heart, They may be other things that are going on, for example, things in the gastrointestinal tract or in the lungs. And those are actually much more common than is the heart as a cause of chest pain in children.
So for example, when we talk about the gastrointestinal tract, there was a condition called reflux or gastro esophageal reflux, which can cause burning pain in the chest. And that is more associated with food timings and position of the child when the pain comes on and that can help point us in that direction. The other thing that is, much more common in children than is a cardiac cause of chest pain asthma. So asthma can cause exercise-induced chest pain in children. That is actually way more common than the heart being responsible for the chest pain.
However, if a child does have chest pain only with exercise, that is something that they should mention to their pediatrician. That is something that a pediatrician can help them sort out in terms of which children need to go see the cardiologist versus not.
Prakash Chandran: Okay, so just to be clear, when the chest pain occurs only with exercise and potentially there's the pain and the difficulty breathing. That's the time they should think about seeing their pediatrician to potentially get a referral to a specialist.
Prema Ramaswamy, MD: Yes. And it doesn't hurt for them to speak to the pediatrician about any chest pain that they have because a pediatrician can help reassure them in the majority of cases, and if there is anything concerning in the history of the examination, then the pediatrician can then send them to the cardiologist.
Prakash Chandran: Little bit about treatments. Let's say it's kind of the more benign chest pain that we're talking about, are there things that parents can do at home to alleviate some of the musculoskeletal, chest pain, or do you always recommend maybe going in to see someone?
Prema Ramaswamy, MD: Since the pain has a very strong psychological component, there really is no medical treatment in terms of medicines that are required. Really what the child needs to be, tooled is. There's nothing wrong with the heart and the parents can't try to do it with help, with the pediatrician and several times, that is all that is needed. But frequently, even being told that repeatedly is not enough, and I see several such children who do come to me. When I see them, I go over the history and I examine them very carefully.
And as I'm examining them, I point out to them everything that is normal, that their heart rate is normal, their blood pressure is normal, that their cardiac examination is normal. And then finally, Do certain tests to rule out some of those rare conditions in the heart that I spoke about, and then I tell them that these tests, the echocardiogram, for example. It is really a confirmatory test that we're not guessing anymore, that at this point I can actually tell the child that his or her heart, is really completely normal. And that usually helps.
Prakash Chandran: Now, how about especially during like cold season, sometimes children get pretty severe coughs and sometimes in that coughing spell, they can experience chest pain. How do you separate that from some of the other chest pain that we're talking about right now?
Prema Ramaswamy, MD: So that would again be related to the lungs. And like I'd mentioned earlier, the lungs are an important organ system in the chest, which can account for chest pain. And in fact, they are much more common, they do this much more commonly than, the heart. So, if a child has pneumonia, a child may have chest pain. if a child has, inflammation of the covering of the lungs, that can cause chest pain. And like I mentioned earlier, asthma can cause chest pain. and in some children this may just occur with exercise, so it may not be the typical, symptoms that many parents are used to. So, it is the totality of the symptoms and the signs which help point us either in the direction of the lung or the heart or the GI
Prakash Chandran: So this has been a super informative conversation. one question that I always like to ask in closing is, given all of your experience, Dr. Ramaswami, what is one thing that you wish more parents knew, about chest pain and their children before they came to see you?
Prema Ramaswamy, MD: Well, the only thing, I'd like to be able to tell them is that chances are really good that this is not dangerous because I do think that, anxiety is such a large component, not just in the children, but in the families, who come to see me and that just feel they've needlessly suffered for the weeks to the appointment. So I'd like them to know that in the majority, Their child is going to be just fine.
Prakash Chandran: Well, that is very reassuring. Dr. Ramaswami Thank you so much for your time today.
Prema Ramaswamy, MD: My pleasure.
Prakash Chandran: That was Dr. Prema Ramaswami, Director of the pediatric Cardiology Division at Maimonidies Children's Hospital. To learn more about this topic, you can visit maimo.org, and that is spelled M A I M O.org, and you can check out all of our other podcasts for other topics that might be of interest to you. This has been Maimo Med Talk. I'm your host Prakash Chandran, stay well.
Chest Pain in Kids: What Parents Need to Know
Prakash Chandran: Chest pain is always concerning, especially when the pain is occurring in young children. Though in most situations, the pain isn't serious. There are cases where the pain can be more dangerous and needs attention. As a parent, it's important to know which symptoms to look out for. Here to tell us more is Dr. Prema Ramaswami. She's the director of the pediatric Cardiology division at Maimonidies Children's Hospital. This is Maimo Med Talk. I'm your host, Prakash Chandran. So Dr. Ramaswami, it's really great to have you here today. Thank you so much for joining us. I think the question that is on every parent's mind is, if my child experiences chest pain, what exactly does that mean?
Prema Ramaswamy, MD: Thank you Prakash. It turns out that just pain and children is actually quite different from that in adults. So the good news for parents, is that. Most likely this is not something very serious. just so they know that if someone above 40 were having chest pain, there's a 50% chance that the chest pain is because of the heart in children, on the other hand, and you know, that includes young adults. So people under 40 chest pain accounts for less than 4%, and in some studies, less than 1% of chest pain.
Prakash Chandran: So one of the things you're saying is that less than 4% of the time, the chest pain is related to the heart. When children experience, chest pain, generally, what is the cause for it or what have you most commonly seen?
Prema Ramaswamy, MD: So the most common reasons. Children have chest pain, is that the pain is actually coming from the chest wall muscle, not the heart muscle inside. So it's the chest wall muscle that is responsible for the pain in really quite the majority of children who have chest pain. And this can hurt Just because of growth, it can hurt due to activity. Since the arm muscles are attached to the chest movement of the arms are just playing basketball, etcetera, you could stress certain chest muscles.
But really the most common reason that chest pain in children is recurrent is because once children and their family members become aware of this chest pain, then anxiety sets in and anxiety in and of itself can cause our muscles to be tight. So that sort of leads to this vicious cycle of anxiety, causes the muscles to be tight, which then the child recognizes as chest pain and makes the child more anxious and so sets off the cycle.
Prakash Chandran: Yeah, that makes sense. And I do wanna talk about that a little bit more. But before we do, I do wanna understand this less than four, percent chest pain that is caused by the heart. Could you explain that in a little more detail?
Prema Ramaswamy, MD: Chest pain that is truly because of the heart is serious, and while it is quite rare, thankfully it is still something that needs to be picked up quickly, because it can be potentially life threatening and in this group are included, things such as infections of the heart, a condition where they may be a virus that's affecting either the coverings of the heart or the heart itself. And then there may be certain things that are genetic and the child may have this condition. And so taking a good family history, may help point to that.
Prakash Chandran: And what exactly are those conditions? Can you tell us a little bit more about them?
Prema Ramaswamy, MD: So again, I want to start by saying, these would be much rarer than the musculoskeletal pain, but within the heart, things that can cause chest pain, one is if the heart is, Affected by viruses. And so there is a condition called myocarditis, which can cause chest pain or pericarditis with a covering of the heart is affected and that can cause pain. Both of these are caused by similar viruses, and while pericarditis is fairly benign and tends to recover, spontaneously, in the majority of cases, myocarditis is occasionaly dangerous, and needs to be recognized.
So that is a condition that we do not want to miss. There are other things in the heart that, are genetic and, they may be a family history. And these are important to recognize because, they are associated with sudden death in children and young adults. So hypertrophic cardiomyopathy is one such condition, and it is the most common cause of sudden. In children and young adults. And that is something that is passed down in families. So taking a detailed family history can help elucidate the scores.
And then finally, they are some rare things, which can be detected by an echocardiogram, which, cardiologists can perform in the office. A cardiologist can pretty much, with an examination rule out most, if not all, of these very dangerous conditions, which can cause chest pain in children, but thankfully, do so only rarely.
Prakash Chandran: Okay, so I'd like to understand a little bit more about the most common symptoms and what children feel when they have chest pain. Now, you said it was normally because of the chest wall muscle. So talk about those symptoms, but also talk about when it is something more serious, how those symptoms differ from the traditional chest wall muscle pain.
Prema Ramaswamy, MD: So a couple of questions that I've found quite useful in trying to differentiate. the kids who might just have this benign chest pain because of the muscle versus truly dangerous chest pain. Is to see A, how long they've had it. Chest pain that has lasted for more than two weeks, and especially if it's something that they don't even remember when it started and started months to years ago. But every now and then they feel that, that is more likely to fall in this muscular skeletal category.
The other really important thing that helps is does this chest pain occur at. As well as exercise, and that is very reassuring. If it does, on the other hand, chest pain that occurs only with exercise or chest pain that's associated with difficulty in breathing or dizziness, those would be symptoms where, I would recommend they seek a medical attention immediately.
Prakash Chandran: So when children come in with chest pain, how are these symptoms typically evaluated or diagnosed?
Prema Ramaswamy, MD: Basic history is very important. So, just going through, the whole history of when this pain started, when does it come on, how severe. Is it, how long does it last? Is it associated with certain things? All these questions help us in formulating possible diagnosis, and then in addition to the heart, They may be other things that are going on, for example, things in the gastrointestinal tract or in the lungs. And those are actually much more common than is the heart as a cause of chest pain in children.
So for example, when we talk about the gastrointestinal tract, there was a condition called reflux or gastro esophageal reflux, which can cause burning pain in the chest. And that is more associated with food timings and position of the child when the pain comes on and that can help point us in that direction. The other thing that is, much more common in children than is a cardiac cause of chest pain asthma. So asthma can cause exercise-induced chest pain in children. That is actually way more common than the heart being responsible for the chest pain.
However, if a child does have chest pain only with exercise, that is something that they should mention to their pediatrician. That is something that a pediatrician can help them sort out in terms of which children need to go see the cardiologist versus not.
Prakash Chandran: Okay, so just to be clear, when the chest pain occurs only with exercise and potentially there's the pain and the difficulty breathing. That's the time they should think about seeing their pediatrician to potentially get a referral to a specialist.
Prema Ramaswamy, MD: Yes. And it doesn't hurt for them to speak to the pediatrician about any chest pain that they have because a pediatrician can help reassure them in the majority of cases, and if there is anything concerning in the history of the examination, then the pediatrician can then send them to the cardiologist.
Prakash Chandran: Little bit about treatments. Let's say it's kind of the more benign chest pain that we're talking about, are there things that parents can do at home to alleviate some of the musculoskeletal, chest pain, or do you always recommend maybe going in to see someone?
Prema Ramaswamy, MD: Since the pain has a very strong psychological component, there really is no medical treatment in terms of medicines that are required. Really what the child needs to be, tooled is. There's nothing wrong with the heart and the parents can't try to do it with help, with the pediatrician and several times, that is all that is needed. But frequently, even being told that repeatedly is not enough, and I see several such children who do come to me. When I see them, I go over the history and I examine them very carefully.
And as I'm examining them, I point out to them everything that is normal, that their heart rate is normal, their blood pressure is normal, that their cardiac examination is normal. And then finally, Do certain tests to rule out some of those rare conditions in the heart that I spoke about, and then I tell them that these tests, the echocardiogram, for example. It is really a confirmatory test that we're not guessing anymore, that at this point I can actually tell the child that his or her heart, is really completely normal. And that usually helps.
Prakash Chandran: Now, how about especially during like cold season, sometimes children get pretty severe coughs and sometimes in that coughing spell, they can experience chest pain. How do you separate that from some of the other chest pain that we're talking about right now?
Prema Ramaswamy, MD: So that would again be related to the lungs. And like I'd mentioned earlier, the lungs are an important organ system in the chest, which can account for chest pain. And in fact, they are much more common, they do this much more commonly than, the heart. So, if a child has pneumonia, a child may have chest pain. if a child has, inflammation of the covering of the lungs, that can cause chest pain. And like I mentioned earlier, asthma can cause chest pain. and in some children this may just occur with exercise, so it may not be the typical, symptoms that many parents are used to. So, it is the totality of the symptoms and the signs which help point us either in the direction of the lung or the heart or the GI
Prakash Chandran: So this has been a super informative conversation. one question that I always like to ask in closing is, given all of your experience, Dr. Ramaswami, what is one thing that you wish more parents knew, about chest pain and their children before they came to see you?
Prema Ramaswamy, MD: Well, the only thing, I'd like to be able to tell them is that chances are really good that this is not dangerous because I do think that, anxiety is such a large component, not just in the children, but in the families, who come to see me and that just feel they've needlessly suffered for the weeks to the appointment. So I'd like them to know that in the majority, Their child is going to be just fine.
Prakash Chandran: Well, that is very reassuring. Dr. Ramaswami Thank you so much for your time today.
Prema Ramaswamy, MD: My pleasure.
Prakash Chandran: That was Dr. Prema Ramaswami, Director of the pediatric Cardiology Division at Maimonidies Children's Hospital. To learn more about this topic, you can visit maimo.org, and that is spelled M A I M O.org, and you can check out all of our other podcasts for other topics that might be of interest to you. This has been Maimo Med Talk. I'm your host Prakash Chandran, stay well.