Objective: Exercise-induced chest pain in pediatric patients with structural heart disease can be secondary to life-threatening conditions like ischemia and arrhythmias. The aim of this study was to evaluate exercise induced chest pain in pediatric patients.
METHODS
A retrospective chart review study was conducted. 350 children with chest pain presented to pediatric cardiology outpatient clinic at Penn State Hershey Children’s hospital (7/04-1/08). All patients had resting cardiac echocardiogram and exercise stress test (EST). Deep sternal palpation was performed on 313 patients, pre- and post-stress test to identify costochondritis. (4 patients on Digoxin were excluded)
RESULTS
Of these 313 patients (mean age 14 years), 175 (56%) experienced skeletal chest pain pre- and/ or post-EST. 114 (65%) patients complained of palpable chest pain pre- and post-EST and 6 (5%) had complaints of chest pain pre but not post-EST. 30% (55) of patients denied reproducible chest pain pre-stress test but complained of chest pain with palpation post-test. Of these 55 subjects with post-test chest pain, 69% had normal cardiac anatomy, 16% had significant structural heart disease and 15% had minor structural anomalies. Significant ST segment changes were identified in 2 of the 55 patients, both had structurally normal hearts with no regional wall motion abnormalities on stress echocardiogram. .
CONCLUSION
These data indicate that the most common etiology of exercise-induced chest pain in patients even with complex cardiac structure is non-cardiac. Exercise-induced costochondritis should be considered in the differential diagnosis regardless of cardiac anatomy and may easily be identified in the exercise laboratory