Etiology and symptomatology of chest pain in children referred to a cardiology practice

Aims: Chest pain in children is often suspected to originate from cardiac disease. Aim of this study was to characterise the symptomatology of supposed cardiac chest pain in children and to investigate whether cardiac disease indeed underlies the pain or not. Furthermore, indications fora psychosomatic origin of the pain were searched for. Methods:The study involved 456 children referred to a pediatric cardiology outpatient department for chest pain. The patients were evaluated by ECG and echocardiogram. In selected cases, a ch est radiograph, exercise EGG, or a 24-hour ECG monitoring was performed. A subgroup of 52 children and parents was interviewed on the basis of a questionnaire to evaluate the symptomatology of the pain,the family history,and psychosocial factors. Results: 15% of the children had diverse structural anomalies or arrhythmias usually of a low grade. The frequency of these findings did not differ from that of a control group without chest pain. Independent of the presence of these findings cardiac function was normal during exercise. The characteristic symptomatology (short, sharp, no radiation) did not correspond to that of ischemic heart disease, and was largely identical in children with and without cardiac findings. Factors typical of psychosomatic dis orders were observed:a positive family history of,,functional cardiac complaints" and other psychosomatic disorders particularly with regard to the mother, other somatic complaints prior to or along with the chest pain, and the presence of stressful life events. Conclusions: These data suggest that the described chest pain in children is a psychosomatic condition rather than caused by organic cardiac disease.