Title: Chest Pain in Adolescense
Category: Child Care
In the Journal of Adolescent Health May 1991 issue, there were two good articles addressing chest pain in adolescence. The first article studied 17 patients who had proven mitral valve prolapse. This relatively common cardiac condition was felt to be the most common associated cardiac cause for chest pain in children. In this particular study, 14 of the seventeen adolescents were found to have gastroesophageal abnormalities confirmed by several different types of studies. The causes of their pain was felt to be due to gastro-esophageal reflux with acid from the stomach causing burning in the esophagus, esophageal spasm and in a few cases, gastritis (with burning in the lining of the stomach). In other words, the pain which was in the mid-chest was actually caused directly from a gastrointestinal abnormality and not from the mitral valve prolapse. Mitral valve prolapse means that the valve between the left atrium and ventricle pushes upward into the atrium instead of staying down pointing toward the ventricle as it is supposed to do. This condition can be found in many individuals who have no symptoms whatsoever. In occasional individuals, it is associated with pain and may in rare cases be associated with arrythymias and dangerous heart abnormalities. These more dangerous cases are predominantly in female adults and very rare in children. The authors of this first study questioned whether there could be some connection between having mitral valve prolapse and having gastroesophageal disease and, certainly, this is a topic worthy of future study. The concluding statement was that chest pain in adolescence should be evaluated with studies of the gastrointestinal tract to rule out that common cause of the pain.
The second study, which was done by a different group of adolescent specialists, looked at the adolescent's perception of himself if he had chest pain. They summarized a large series of studies done over the past 15 years on this subject to try to get an idea of the true causes of the chest pain. In past studies, the pain was thought to be musculoskeletal or, in other words, pain from straining of the muscles between the ribs. Also, a large percentage was felt to be idiopathic which means there was never a cause found. In less than a third of the cases was cardiac disease found to be linked with the pain. They found, in light of the studies coming out in the last few years, that gastrointestinal cause such as reflux (mentioned in the first study) should be considered higher on the list. They recommended a simple evaluation by a pediatrician or family doctor in most cases rather than an expensive, expansive work-up which may only scare a child who probably has no cardiac disease. Most pediatricians feel that a chest X-ray and an EKG (if they are found to be normal) along with a normal physical exam is an adequate way of reassuring themselves as a doctor and the teenager and parent that there is no cardiac disease causing the chest pain. If there is any doubt, however, an easy second step is to have an echocardiagram done or have the patient checked by a cardiologist.
In summary, most adolescents who have chest pain do not have heart disease. Possibly the greatest cause of chest pain in adolescents is gastrointestinal abnormalities such as GE reflux. Simply taking antacids, propping the head up in bed, and avoiding heavy, greasy food shortly before sleep, along with better stress-reduction, can go a long way to help this condition.
Other common causes of adolescent chest pain include straining of the muscles of the chest wall from asthma, colds, viral syndromes and stress, or focusing on minor pains which do not have any proven medical cause. For that reason, it is wise to consult your pediatrician for a good physical examination and perhaps a chest X-ray and EKG for reassurance. You will know that nothing serious is going on and not get overly concerned by impending heart disease but be reassured that the statistics are in your favor.