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Child Getting Chest Pain During Exercise. Pain Is Under Center Of Ribcage To Middle Chest. Negative EKG. What To Do Next?

Posted on Tue, 5 Nov 2013

Question: My 12 year old daughter has started getting chest pain only during exercise, she is very fit and plays volleyball and basketball. Pain is under center of ribcage to middle chest. She was seen in the emergency room last week and has had a negative EKG and echo but pain is still there, and goes away within 15 minutes of stopping exercise. What should I do next?

Answered by Dr. Y V Siva Sankara Murty (4 hours later)

Brief Answer:
cardiac condition unlikely

Detailed Answer:
Hi,

Thanks for writing to health care magic.
I can understand your concern.

Since cardiac investigations are done and they are normal it is unlikely that a cardiac condition is responsible for that. But a complete examination by a cardiologist and further investigations as advised by him if required will be doubly reassuring.

If a cardiac condition is ruled out completely then the other possibility is reflux esophagitis. Here the acidic contents of the stomach reflux back into the esophagus causing inflammation and pain. This can be confirmed by your doctor by a endoscopy. If this is identified as the cause he may prescribe certain medications which reduce the acidity and prevent the reflux.

Certain measures like not wearing tight garments which increase the abdominal pressure by pressing on the abdomen, avoiding eating just before exercise or play, reducing stress, reduction of caffeinated drinks like colas, coffee, tea etc. may help.

Continue to ask further queries as required.
Hope this helps.
Take care.
Dr Y V Siva Sankara Murty
M.D.(Pediatrics)
Associate Professor of Pediatrics

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Y V Siva Sankara Murty (23 hours later)

Thank you for your response. I should give you a little more information; My daughter never ever complains of pain and will play 3 basketball games in a day, but has now told us that this pain started several months ago and has gotten worse, she stopped playing sat down and started crying holding her chest right below where ribcage meets twice. Per her pediatrician I started her on Prevacid 15mg each morning 2 days ago, however she has no symptoms of acid reflux, no belching,burning,naseau,sour taste in mouth,etc. She eats a very healthy diet with no caffeine, processed foods, or mcdonalds, with only an occasional soda as a treat. ER said maybe exercise induced asthma but she doesn't cough or wheeze. She never has pain at rest, school or when riding her horse, only during lots of exercise. The pediatric cardiologist said no further testing since her ekg and echo were negative but their is clearly something wrong and I am not sure which direction to go now. THank you for taking your time and knowledge to help this mom! Any additional advise you have would be greatly appreciated!

Answered by Dr. Y V Siva Sankara Murty (1 hour later)

Brief Answer:
Yes exercise induced asthma could be a possibility

Detailed Answer:
Hi,

Yes exercise induced asthma could be one of the differential diagnosis that could be considered. A PEFR(peak expiratory flow rate) taken before and after exercise will help in diagnosis. Some times spirometry may be required. They may not have the typical complaints of wheeze or cough.

Your Pediatrician was thinking in the same lines I thought. That is the reason why he started on Prevacid which is Lansoprazole. This helps in reduction of acid production and reduce the symptoms of reflux. The other dietary measures I mentioned will also help if this is the case.

Hope this helps.
Continue to ask further queries as required.
Take care.

Dr Y V Siva Sankara Murty
M.D.(Pediatrics)
Associate Professor of Pediatrics

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar