Pain in the chest in children

Usually, pain occurs in the front of the chest.

Pain in the chest area is conventionally divided into the following groups:

• cardiovascular pain (coronary artery disease, cardiomyopathy, aortic stenosis, regurgitation, pericarditis, aortic dissection, embolism or pulmonary infarction, pulmonary hypertension);
• Pulmonary genesis (pleurisy with or without pneumonia, pneumothorax);
• gastrointestinal genesis (spasms of the esophagus, esophagitis, reflux, peptic ulcer, pancreatitis, cholecystitis);
• neuromuscular origin (myositis, chondrites, osteitis, neuritis);
• Other (shingles, trauma, mediastinal tumors, hyperventilation syndrome, unexplained causes).

Pain can be acute, chronic, relapsing, superficial (neuromuscular, bone) or deep (cardiac genesis, as well as esophagitis, mediastinal tumors).

A detailed medical history and clinical examination allows differentiating cardiac pain and pain caused by diseases of other organs.

Pain in the chest may occur if there is a disturbance in the rhythm of the heart. In such cases, jerky, unpleasant sensations are observed. They arise and at rest, often disappear when loaded. When a detailed survey, as a rule, it turns out that along with the pain patients feel a sense of interruption, heartbeats, "sinking" of the heart.

Acute pericarditis occurs with precardial pain, varying in intensity from a feeling of blunt pressure to severe harsh. Pain increases with coughing, breathing, lying down. Breathing frequent, shallow. At auscultation, a pericardial friction noise is heard, the characteristic of which varies with a varying degree of fibrinous overlapping from a gentle rustle to a coarse machine sound. The noise of friction of the pericardium increases with the pressure of the phonendoscope, bending of the patient, deep inspiration. On ECG with pericarditis, low voltage is registered in all leads (with a pronounced exhalation the voltage fluctuates in time to the breath), and the ST segment has a horizontal or concave shape. Difficulties in differential diagnosis of pericarditis occur in the syndrome of early repolarization. It occurs more often in young patients with vagotonia and proceeds with a slight elevation of the ST segment. In addition, with pericardial often marked with pointed prong P and inverted tine T.

Pain in the chest with pleural damage manifests itself by its dependence on respiration. They increase with inhalation and decrease (sometimes almost to complete extinction) on exhalation, so patients prefer to breathe often and superficially. The pain radiates on the somato of Zakharyin-Ged along the sensitive branch of the corresponding nerve. Thus, with the defeat of the pleura that lines the central parts of the diaphragm, the pain spreads to the shoulders, and when the peripheral parts of the diaphragmatic pleura are affected - the stomach. With auscultation, dry parietal pleurisy is characterized by a typical pleural friction noise, which increases with deepening of breathing. Two-sided noise of pleural friction in young strong people with a general mild condition often accompanies viral infections, especially Coxsackie.

Functional pain in the heart is often observed in girls and emotional young men, with hypermobility syndrome, mitral valve prolapse. It provokes the appearance of cardialgia of stuffiness, emotional loads. Usually, such pain develops not during physical work, but after it. Physical exercise leads even to an improvement in the condition. Pain can be blunt, precardial, sometimes last for hours. In other cases, the pain may be firing like a fleeting intensive injection, clearly localized, accompanied by difficulty exhaling. Changes on ECG and EchoCG are not detected.

[1], [2], [3], [4]