Evaluation of Chest Pain in Adolescents

Key Considerations for History Taking

The American College of Cardiology recommends asking about pain characteristics, including exact location and radiation of pain, to help determine the cause of chest pain in adolescents 1
The American College of Cardiology suggests inquiring about the onset, duration, quality, and severity of pain, as well as aggravating and alleviating factors, to guide further evaluation 2
The American College of Cardiology advises asking about associated symptoms, such as fever or recent illness, to consider potential respiratory causes of chest pain 3
The American College of Cardiology recommends inquiring about past medical history, including known cardiac conditions, to assess the risk of cardiac causes of chest pain 1
The American College of Cardiology suggests asking about family history, including cardiac disease or sudden death, to evaluate the risk of inherited cardiac conditions 1

The American College of Cardiology notes that musculoskeletal causes, such as costochondritis, are common causes of chest pain in adolescents, and recommends a thorough physical examination to diagnose these conditions 1
The American College of Cardiology recommends considering respiratory causes, such as pneumonia or pleuritis, and using diagnostic studies like chest radiographs to evaluate these conditions 1
The American College of Cardiology advises considering cardiac causes, such as pericarditis or myocarditis, and using diagnostic studies like electrocardiograms and echocardiograms to evaluate these conditions 1
The American Academy of Pediatrics suggests considering psychogenic causes, such as anxiety or panic disorder, and using diagnostic criteria to evaluate these conditions 4

The American College of Cardiology recommends reassurance and breathing exercises for anxiety-related chest pain, and considers referral to cognitive-behavioral therapy for recurrent episodes 5
The American College of Cardiology advises anti-inflammatory medications for pericarditis, and recommends cardiology consultation for suspected cardiac etiologies 1
The American Academy of Pediatrics suggests follow-up with a primary care provider for musculoskeletal or idiopathic chest pain, and recommends return precautions for worsening symptoms 3

The American Heart Association recommends obtaining a focused history capturing pain characteristics, such as exact location, radiation pattern, quality, and severity, as well as temporal features, aggravating factors, relieving factors, and associated symptoms, in patients presenting with thoracic pain 6
A thorough clinical assessment should include evaluation of pain characteristics, such as onset, duration, and severity, as well as associated symptoms like fever, dyspnea, and palpitations, to guide diagnostic decisions and management, according to the American College of Cardiology 6
The American Thoracic Society suggests that pneumothorax, characterized by sudden-onset sharp chest pain with dyspnea, should be considered in the differential diagnosis of thoracic pain, particularly in patients with risk factors 6
Acute coronary syndrome, although rare in adolescents without risk factors, should be considered in the differential diagnosis of thoracic pain, characterized by retrosternal discomfort building gradually over minutes, as recommended by the American Heart Association 6
Pulmonary embolism, although uncommon in adolescents, should be considered in patients presenting with sudden dyspnea and risk factors, according to the American College of Chest Physicians 6
Esophageal disorders, such as burning retrosternal pain related to meals, should be considered in the differential diagnosis of thoracic pain, as suggested by the American Gastroenterological Association 6