Chest Pain

Chest pain is a common complaint in pediatrics, but infrequently caused by a cardiac problem. Standardized Clinical Assessment and Management Plans (SCAMPs^®) is a quality improvement tool aimed at reducing practice variation, decreasing unnecessary utilization of resources and improving patient care and outcomes. The SCAMPs^® methodology gives primary care providers evidence-based guidelines to better assess the child who presents with chest pain rather than immediately sending the child to a cardiology consultation.

How should I initially evaluate and manage my patient?

Providers should evaluate their patients:

Detailed history of the event, past medical history and family history
Physical examination

Provider should initially manage their patients chest pains by:

In the absence of medical red-flag criteria, children presenting with chest pain ought to be reassured that their heart is healthy and that there is no need for any further cardiac workup. The pediatrician is encouraged to investigate and treat non-cardiac etiology (ex. asthma, exercise-induced asthma, costochondritis, musculoskeletal, panic disorder, gastroesophageal reflux disease).
Patients with medical red-flag criteria for referral ought to restrict exercise until fully evaluated by cardiology. It’s to be noted that a normal chest X-ray and/or electrocardiogram (ECG) does not rule out cardiac disease and is not a substitute for a full cardiology evaluation in the patient who has medical red-flag criteria for referral.