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    What causes chest pain during physical activity in a child?

Posted on Tue, 7 Jul 2015 in Hypertension and Heart Disease
Question: My 8 yr old son began complaining of chest pain this season. It often causes him to have to ask to be taken out of the game and he can't keep up with the other kids very long. He used to be one of the fastest. After he stops, the pain stops. But once he is back in the game the pain returns and he needs to rest again. He seems to become short of breath a lot more quickly too. Last year he was jumping in a bounce house and blacked out. The kids were playing with a rubber ball in there and was told it hit him. He was evaluated for concussion (negative) and released. Now I wonder if he possibly fainted. im wondering what this could possibly be an indication of ?(I am waiting for the office to open so I can reschedule a 7/1 dr appt to hopefully this week
Answered by Dr. Ilir Sharka 21 minutes later
Brief Answer:
I recommend you to perform some tests to examine mediastinal structures

Detailed Answer:

Thank you for asking on HCM! I understand your concern.

I would like to explain that the first thing to determine is the nature of the pain, if it is modulated from the movements. If the pain changes during body movements the probability to be related to any heart disorder is very low.

I recommend you to consult with the GP, to determine the nature of the pain and for a careful physical examination. An ECG, a cardiac ultrasound and a chest Xray are necessary to exclude a possible lesion of the mediastinal structures (such as the heart, the aorta, airways). Routine blood test for inflammation is also needed.

Regarding the episode of loss of conscience, it doesn't seem to be related to the heart. But I would recommend you to perform the above mentioned tests, to be sure of this.

Hope to have been helpful!

Feel free to ask any other questions!

Greetings! Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ilir Sharka 7 hours later
The pain does not seem to be related to the types of movements he is doing. The pain seems to intensify as his activity intensifies. You couldn't pay this kid enough to sit out a game so it concerns me even more when he voluntarily asks to be taken out because he of it. He doesn't conplain of heart pain any other time except when participating in his sports
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
A comprehensive differential diagnosis is necessary.

Detailed Answer:

Hello again!

As I explained you before, a comprehensive differential diagnosis is necessary to identify the right cause of pain.

The whole thoracic structures should be investigated as the possible source of pain (chest wall, inflamed pleura, costo-chondral joints, backbone disorders, intercostal neuralgia, pulmonary circulation disorders, any anomalous origin of coronary arteries, any congenital heart disorders, etc).

I recommend you to discuss with his doctor and perform the above mentioned tests, and if necessary a total imagine thoracic study (CT or MRI) would be helpful to identify the precise underlying cause.

Possible anemia and pulmonary dysfinction should be ruled out/in too (complete blood count, arterial blood gas analysis, pulmonary function test, etc).

Meanwhile, I strongly recommend to avoid him from participating in competitive sports until the differential is completed.

Best regards! Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ilir Sharka 5 hours later
One last question. I know you mentioned a comprehensive set of tests be performed, and I intend to see they are. However, if the EKG should come back normal is thAt a good indicator that it is not cardiac related?
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
ECG is necessary, but not sufficient.

Detailed Answer:
Hi again!

A normal ECG is adequate for excluding rhythm and conductance abnormalities, but would never be able to exclude any structural as well as ischemic implications.

All the above mentioned medical tests are needed to build the entire picture.

Best wishes! Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Ilir Sharka


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