My child complains of Chest Pain. Should you be worried?

Chest pain is a common complaint among children. For a parent, it can be worrisome because there is a natural tendency to associate chest pain with the heart. The good news is, in more than 95% of cases, chest pain is non-cardiac in origin.

What signs will tell me that the pain may be related to the heart?

Chest pain that occurs in association with certain pointers needs a thorough evaluation. Some of the features that may suggest a heart-related condition include:

Associated breathing difficulty or dizziness
Chest pain that is brought on by exercise
When cardiac disorders run in the family or there have been sudden deaths at a young age in the family
A past medical condition like Kawasaki disease or connective tissue disorder
The following features suggest that a non-cardiac cause is likely:

If the pain follows direct trauma to the chest or is worsened on local pressure: the muscles or bones that form the chest wall are the likely origin of pain
Wheezing or fever and cough: a lung problem is likely
A burning pain beneath the breastbone, especially in relation to certain types of food: may be related to the digestive system
A stressful situation at school or home: a psychological cause of chest pain may be considered.
What can I expect at the doctor s visit?

If your child complains of chest pain, it is important to take him or her to the doctor. Your doctor will first take a detailed history and examine the child. ECG, a record of the electrical activity of the heart, gives an initial idea whether or not the pain may be related to the heart. Other tests that may be ordered include a chest XRay, a  heart-scan  (echocardiogram), a stress test, or further tests based on the findings on evaluation.

Chest Pain In Children - Should You Be Worried?

The term 'chest pain  is a very common term and is usually used in day to day life. Basically, chest pain refers to the pain that may generate in your chest, shoulder and can travel to your ribs, jaws and towards your arms. The feeling of the pain can be sharp or dull, depending on the severity of your condition and cause.

There can be several reasons behind chest pain. You need to conduct a few tests to examine the real cause of the chest pain. It is always advised by health experts to take the symptoms of chest pain very seriously in order to avoid any serious problem in the future. Most of the severe and life-threatening diseases behind chest pain involve lung and heart problems. People having serious heart problems often feel discomfort, followed by pain in their chest area.

Symptoms
Chest pain which is related to any heart disease such as heart attack usually has symptoms like:

Feeling of fullness and tightness in the chest region
Vomiting
Nausea
Burning or crushing pain, which travels from the chest to jaw, hands and back region.
Weakness
Breathing problem
Usually, it is very tough to distinguish whether the pain is associated with a heart problem or not. But generally chest pains which are not related to heart problems involves symptoms like

Sensation in your mouth
Problem in swallowing food
Pain that worsens when you cough
Burning sensation in your chest
Common causes of chest pain

Angina: Angina is a medical condition described as a feeling of discomfort or pain in the chest region. This situation occurs when your heart muscles don't receive blood, which contains rich oxygen. Angina is a symptom of Coronary Heart Disease (CHD). The pain can take place in your shoulder, jaw, neck and arms also.
Lung problems: People with lung disorders can encounter various types of chest pains. But some common causes are:
Pleurisy: It is a type of medical condition, which occurs due to inflammation of the lining of chest and lungs. Due to this, you feel a sharp pain at the time of breathing, coughing or sneezing.
Pneumonia: It is a type of lung infection, which causes chest pain.
Pneumothorax: It is a type of lung disorder, which occurs when a portion of your chest gets collapsed.
Asthma: It is a type of condition, which occurs due to shortness of breath and causes chest pain while coughing, sneezing and breathing.
Gastrointestinal problem: Gastroesophageal reflux disease (GERD) is also a common reason for chest pain such as burning sensation in your heart.
Other causes of chest pain: There are several other reasons of chest pain such as muscle strain, ribs injury, shingles, anxiety and panic attacks. It is always important to visit a physician whenever you encounter any of such chest pain symptoms.

How Chest Pain Related to Heart Problems?

In addition to pumping blood to various organs, the heart also has its own blood supply, through which it receives its oxygen and nutrient supply. In patients with coronary artery disease and atherosclerosis, there is a narrowing of the blood vessels which reduces the amount of blood flow to the target organs, including the heart. 

When this happens in the heart, there is chest pain due to overexertion of the heart muscles. There could be two patterns to this chest pain. With regular exertion like exercise, there would be chest pain, and most patients are familiar with this pattern.

This is known as angina pectoris or stable angina. In some people or in some instances, chest pain occurs which is sudden and not of a predictable pattern. It could be related to extreme exertion or stress. This is known as unstable angina and can lead to heart attack and be life-threatening.

Stable angina or angina pectoris has a stable, predictable pattern which most patients get familiar with over a period of time and learn to manage. Read on to know more about the signs and symptoms and management techniques.

Signs and symptoms: Stable angina usually occurs after a round of physical exertion. The patient feels a feeling of tightness in the chest which feels like the chest being squeezed. The pain can gradually spread to the shoulder, arms and even the neck. The pain can also be induced by eating, exposure to cold, emotional stress. It lasts for about 15 minutes and is relieved by rest and sublingual nitroglycerin. The pain intensity does not change with position or coughing. In addition, the patient may also experience shortness of breath, fatigue, profuse sweating, nausea, and dizziness.
The patient may be able to detect signs on further testing including ECG, echocardiography and stress testing. Features like cardiomegaly, altered ejection fraction would be detected based on the severity of the disease.

Treatment: Immediate treatment to relieve the pain includes resting and sublingual nitroglycerin. On an ongoing basis, the treatment would include 3 approaches   lifestyle changes, medications, and surgery.

Lifestyle changes: Regular exercise, smoking cessation, reduced fat intake, reduced alcohol consumption, weight loss, and stress management are some lifestyle changes to be made to improve symptoms.
Medications: A number of medications would be used depending on patient s symptoms. Aspirin to prevent clotting, medications to control blood pressure and cholesterol and diabetes.
Surgery: In patients with advanced coronary artery disease, revascularization methods may be required, which includes angioplasty and coronary bypass.
In a person with known risk factors, it is advisable to have regular checkups so that the disease progression can be controlled and symptoms managed with minimal intervention.

Predictable Chest Pain Pattern - What Does It Indicate?

Hemothorax is a serious and possibly a life-threatening condition in which blood collects between the lungs and the chest wall due to a traumatic injury or some other factor. It can be caused due to an extrapleural or an intrapleural injury. An extrapleural injury damages the chest wall on the outside while an intrapleural injury damages the chest wall on the inside.
Sometimes, Hemothorax is accompanied by excess air in the pleural cavity, known as pneumothorax. If they both occur at the same time, the condition is said to be hemopneumothorax. When blood accumulation is as large as nearly one liter, it has the potential to lead to shock and is referred to as Massive Hemothorax, which can be fatal.

Causes-
Hemothorax can be caused by a number of factors discussed as follows:
  Traumatic injury in an accident or sports causes the pleural lining of the lungs or chest to rupture. It causes blood to spill over into the pleural cavity, and it finds no way to drain itself out. Chest and lungs are so sensitive that even the smallest of injuries (or seemingly small) have the potential to cause Hemothorax.
  Tuberculosis and other lung infections can cause Hemothorax.
  Pulmonary embolism refers to a blood clot in the lungs that can cause Hemothorax.
  Lung or pleural cancer also have the potential to cause grave disease.
  Defective blood clotting as in hemophilia in which blood lacks clotting factors can cause Hemothorax.
  Tissue necrosis in the lungs or pulmonary infarction is a lung tissue dysfunction which can cause Hemothorax.
  Tearing of pulmonary blood vessels due to an invasive surgical procedure also has the potential of causing Hemothorax.
  Patients who have undergone major surgeries like lung transplant and open- heart surgery are very likely to get Hemothorax.


Symptoms-
There are many symptoms associated with Hemothorax like low blood pressure, rapid rate of heart, cold and pale skin color, chest pain while breathing, tense and shallow
breathing, difficulty in breathing, anxiety, and restlessness.


Diagnosis-
  Physical examination includes listening to the sounds of abnormal breathing and to the sounds of liquid in the chest.
  An X-Ray image reveals the presence of liquid in the pleural cavity.
  A full Computed Tomography Scan can reveal the occurrence as well as the cause of Hemothorax.
  An ultrasound provides good insight into the situation of the lungs and the pleural cavity.
  Sometimes, a sample of the pleural fluid is extracted for test and diagnosis.


Treatment-
The procedure is performed under anesthesia. A catheter or a needle is inserted into the chest through ribs for removing air and blood from the pleural cavity. If the lung collapses, it is expanded using the chest tube, which is left attached to a closed system. This ensures the escape of air and fluid from the pleural cavity and prevents additional air from entering the pleural space. This section is hence left in a water seal or hooked up to suction.
If the injury is small, chest drainage might be sufficient depending upon the case. However, if there is a major injury, it might require stopping bleeding at its source through a surgery.


Take Away-
Hemothorax can cause a collapsed lung that might progress to lead to respiratory failure. If left untreated, Hemothorax can cause infection in pleura, lung or pleural fluid in the chest cavity. Hemothorax can cause scarring of the lung tissue and pleural membranes. Retained Hemothorax occurs when blood stays in the pleural cavity for too long. It might clot and get difficult to remove through the catheter. It might also cause the buildup of pus in the surrounding region leading to an infection. Retained Hemothorax is treated by draining the fluid differently or through a video-assisted surgical procedure. Before opting for any treatment or surgery, one should always consult a doctor.

Chest Injuries And Hemothorax - Know How Serious It Can Be!

Things to do in case of chest pain or angina pain

Unlike yesteryears chest pain or heart related problems aren’t just age related anymore. Many young people under 30 are experiencing chest pain. It seems to be directly proportional to the increasing stress levels.The medical term for mild chest pain is angina pectoris and it happens when your heart is not getting its usual requirement for blood. Such a situation occurs when one or more arteries are blocked. Angina Pectoris is experienced usually while doing physical activities or experiencing strong emotions. At such times, the heart doesn't get as much blood as it requires for normal functioning.

Broadly speaking, discomfort in the upper part of the body is the symptom of angina, the symptoms typically include:

1.  It may feel like you are suffering from indigestion or gas or fullness and pressure.

2.  It may also feel like chest pain spreading to the neck, back, arms, shoulder or jaw.

3. You feel better after a little rest or some medication.

4. It doesn't last for too long, at the most five minutes.

5. Shortness of breath, anxiety, dizziness, sweating, fatigue and nausea and also symptoms of angina.

Physical conditions and habits which put you at the high risk zone for angina are:
1. When you don't get enough exercise.
2. If you are a smoker
3. If you are overweight
4.  If you have a history of heart diseases
5. If you are diabetic
6. If you suffer from blood pressure of high cholesterol

Steps You Must Do To Manage the Pain and Resultant Effects

1. Calm Down - The first thing to do to counter angina pains is to rest and calm down. If you are doing physical activity, stop doing it. And if you are under emotional turbulence, you need to find ways to calm down immediately. Meditate, if needed.

2. Get Professional Help - Do not delay in consulting the doctor and ensure that you take the prescribed medication diligently. In situations where the damage is much more and medications cannot clear the problem, surgery is resorted to.

3. Change Of Lifestyle - In the long run, lifestyle change is a good idea. Staying fit, a clean medical report and keeping a healthy lifestyle will keep enough blood pumping into your heart.

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Why You Must Not Dismiss Chest Pain as a Minor Affair!

If you thought that chest pain occurred only due to a heart-related issue like a heart attack, you are wrong. Chest pain is one of the most common reasons that people visit the emergency services and it can be caused due to problems with your heart, lungs and digestive system. 

Chest pain can be due to either of these two main reasons:

Heart- related Issues

1. Heart attacks called myocardial infarctions are very common reasons for chest pains. During a heart attack, the blood supply that serves the heart with oxygen is cut off due to plaque build-up in heart arteries causing the death of heart muscles. 

Other reasons for heart attacks are blood clots or torn blood vessels. 
Not all people having a heart attack have symptoms. Usually, people report symptoms like chest pain, upper body pain, nausea, sweating, fatigue, and trouble breathing.
A heart attack is a serious medical emergency for which immediate care is needed.
2. Angina pectoris is a type of chest pain that results from reduced blood flow to the heart. Low blood flow means your heart doesn t get enough oxygen. The angina pain is often triggered by physical activity or emotional stress and feels like a vice squeezing your chest or a heavy weight on your chest. It can also spread from your chest to your neck, arms, and shoulders. Other symptoms are fatigue, dizziness and nausea and these normally last up to 15 minutes only.

3. Unstable angina which causes crushing chest pains suddenly and even when you are not doing anything strenuous is a medical emergency as it can lead to a heart attack. This usually shows that your heart, arteries are narrowing alarmingly.

4. Other heat-related reasons for chest pains are-

Mitral valve narrowing or stenosis
Heart arrhythmias
Coronary Artery disease
Inflammation of heart muscles or pericardium and weakening of the heart muscles. 
All of these are emergencies and need immediate medical attention to prevent a fatality.

Not Heart- related:

1. Lung conditions like Pneumonia, Bronchitis, Pulmonary embolism. 

Pneumonia is an infection in one or both lungs caused by fungi, bacteria, or viruses. It causes inflammation in your lung s air sacs and makes them full of pus which makes it difficult to breathe and causes chest pains, amongst other debilitating symptoms.
Bronchitis is an inflammation of your bronchial tubes. It can be chronic or acute and it can cause a cough with mucus and chest pains. 
Pulmonary embolism is a blood clot that occurs in the lungs. It can go on to damage parts of your lung due to limited blood flow. Apart from this, it can also decrease oxygen levels in the blood and affect other organs. 
It can be life-threatening due to permanent lung damage. The most common symptom of a pulmonary embolism is gradual or sudden shortness of breath. 

There is also- 

bluish skin tone 
anxiety
fainting
hest pain that extends into your arm, jaw, neck, and shoulder
lightheadedness
2. Rib cage inflammation or Costochondritis is also known as Tietze s syndrome. It is an inflammation of the cartilage in the rib cage. Patients experience chest pain in the upper and middle rib area on either side of the body due to this. The pain can also radiate to the back or the abdomen, getting worse if you move, stretch, or breathe deeply.

3. Food pipe disease or Esophagitis is any inflammation or irritation of the oesophagus, a tube that sends food from your throat down to your stomach.

Common causes of food pipe disease are acid reflux or GERD and bacterial or viral infections. 

GERD- This condition occurs when the stomach contents and acids back up into the oesophagus. This causes chest pain that can mimic a heart disease. There may also be oesophagal spasms due to GERD.

Chest Pain - Reasons and Treatment

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