Chest Pain Evaluation in Teenagers

Initial Assessment

The American College of Cardiology recommends a focused history, including characteristics and duration of symptoms, associated features, and cardiovascular risk factor assessment, for teenagers presenting with chest pain 2
A physical examination should focus on identifying potentially serious causes of chest pain, such as cardiac, pulmonary, or gastrointestinal issues, in teenagers with chest pain 3
The American Heart Association suggests that a 12-lead ECG should be performed for all teenagers with chest pain unless a clear non-cardiac cause is evident 1, 3
Chest radiography is useful to evaluate for potential cardiac, pulmonary, and thoracic causes when clinically indicated in teenagers with chest pain 1

Chest pain characteristics that increase suspicion for cardiac origin in teenagers include central location, pressure-like quality, exertional onset, and retrosternal location 2, 4
Red flag symptoms warranting immediate evaluation in teenagers with chest pain include severe prolonged pain, syncope, palpitations, exertional chest pain, family history of sudden cardiac death, or abnormal cardiac examination 5, 6
The American College of Cardiology recommends that women who present with chest pain should be considered at risk for underdiagnosis, and potential cardiac causes should always be considered 2, 4

The initial evaluation of a teenager with chest pain should include a complete history and physical examination, as well as a 12-lead ECG for all patients 1, 2, 3
Abnormal ECG findings require comparison with previous ECGs if available, and serial ECGs should be performed if symptoms are ongoing in teenagers with chest pain 1

Overreliance on a single normal ECG to rule out cardiac causes is a common pitfall, as serial ECGs may be necessary if symptoms persist in teenagers with chest pain 1
Failure to consider non-cardiac causes when cardiac evaluation is negative is a common mistake in the evaluation of teenagers with chest pain 7
Missing psychological causes of chest pain, which are common in teenagers, is a pitfall to avoid in the evaluation of chest pain 7
Delayed transfer to the emergency department for patients with concerning symptoms seen in office settings is a pitfall to avoid in the evaluation of teenagers with chest pain 3

For teenagers with sickle cell disease and chest pain, emergency transfer to an acute care setting is recommended by the American Heart Association 8, 7
Cultural competency and addressing language barriers are important when evaluating chest pain in diverse patient populations, according to the American College of Cardiology 9
For recurrent presentations with negative prior workups, referral to cognitive-behavioral therapy may be reasonable, as suggested by the American College of Cardiology 7