In our outpatient clinic The Cove we see children who are referred by GPs and other health care professionals if they have a suspected heart condition.
Often children are found to have heart murmurs when a health care professional listen to them. These are often innocent in nature and don’t need any further tests. Occasionally the child or young person might be referred to this clinic for further evaluation if their doctor or nurse feels that it is necessary.
Children are also referred to this clinic with other complaints like palpitations, faints, chest pain and a family history of congenital heart conditions in close relatives.
In this clinic you will be seen by a consultant paediatrician with expertise in cardiology. Once every two months we have a Paediatric cardiologist from Great Ormond Street Hospital visiting us for some of our more complex patients.
If your child is diagnosed with a heart condition the doctor will explain the diagnosis and answer all your questions. Often all we might need is to review your child periodically. Sometimes we may have to admit your child to the children’s ward or the doctor might start your child on some medication.
We will endeavour to perform the necessary tests on the same day to avoid multiple trips to the hospital. Occasionally this may not be possible and you will then be requested to return on another date for further tests.
What services are provided?
- One stop clinic for children with a suspected heart condition
- Paediatric Echocardiogram (Ultrasound scan of the heart)
- ECG ( Electrical tracing of the heart)
How can I get a referral?
Patients under 16 years of age can be referred by their GP or any other hospital doctor who sees them for any other medical needs.
Heart murmurs in a healthy newborn baby
The doctor or our advanced nurse practitioner has heard a heart murmur during your baby’s routine newborn examination.
Parents may find this worrying and upsetting, but we would like to reassure you that the vast majority of these murmurs heard during the first few days of life disappear within the first few months.
What is a heart murmur?
A murmur is the medical term used to describe extra sounds that blood makes as it passes through the valves and blood vessels of the heart. It can be heard through a stethoscope between normal heartbeats.
What causes the murmur?
It is common for newborn babies to have heart murmurs in the first days of life.
- It can be caused by fast blood flow through the heart, which is normal for babies.
- The blood circulation system in the baby whilst inside the womb is different from the circulation system in the newborn baby. After birth, changes take place in the circulation pathways, and these can cause murmurs.
- However sometimes, murmurs can also be caused by blood crossing through a hole in the heart, a valve that is too narrow, or a leak in a heart valve/structural heart problem.
What might happen to the murmur?
Most murmurs disappear as the baby grows. This is because the changes that were taking place in the blood circulation system are now complete.
In some babies, the murmurs can persist into childhood without anything being wrong with the heart – these are called 'innocent' or 'functional' murmurs.
In some babies there can be problems with the heart but this is usually associated with other problems, which may become apparent in the first few days of life, such as rapid breathing, feeding difficulties, blue lips and failure to gain weight. In some babies there can be no symptoms or signs, apart from a heart murmur.
What happens next?
Our team will discuss with you what the next best course of action will be for your baby; this depends on our assessment of your baby. You will be encouraged to ask about all your concerns and our team will try their best to answer your questions.
We will also be informing your GP about the heart murmur. Your baby will be seen in clinic by a senior paediatrician in a few weeks’ time. If the murmur is still present in a few weeks, the paediatrician will refer your baby to be seen in a cardiology clinic, which may include further tests. Your baby may get a scan of the heart, which should not cause your baby any discomfort.
If your baby becomes unwell in any way, please contact your GP or attend the Emergency Department for further advice
In particular we would like you to be aware of the following symptoms:
- Is your baby feeling breathless, tired and disinterested to feed?
- Has there been any change in his / her colour?
- Is he / she excessively pale or blue?
- Is your baby sweaty? Especially whilst feeding?
- Is your baby inactive and sleepy?
- Is your baby breathless, breathing fast, or there is sucking in of the spaces between ribs?
- Does your baby have clammy or cold skin?
None of these symptoms necessarily mean that your baby has a heart problem, but we feel it would be wise for a doctor to check that all is well.
We would like to add that these symptoms should prompt parents to seek medical advice, regardless of whether or not a heart murmur has been heard.
Any further concerns:
If parents are concerned about any aspect of their baby’s health, please contact your GP surgery or contact NHS 111 for further advice.
References:
British Heart Foundation - https://www.bhf.org.uk/informationsupport/conditions/heart-murmurs
Children’s Heart Federation
A heart palpitation occurs when a person feels that his or her heart is beating irregularly.
It might feel like the heart is skipping beats, or is beating faster than usual when the person is at rest (not exercising). Sometimes exercise can cause the palpitations to occur, with the heart continuing to race despite stopping exercise.
Heart palpitations often don't indicate a health problem. They can be caused by a variety of factors, including: being startled, frightened or under stress. Cold, allergy, and asthma medications; herbal supplements and other drugs. Caffeine and alcohol can also cause heart palpitations. Two of the most frequent causes for heart palpitations are just not drinking enough fluid on a regular basis, or being unfit (out of good physical shape).
Younger children may not be able to describe exactly what they are feeling when this happens, although sometimes they will say that their heart is "beeping" fast.
Rarely, heart palpitations can be a sign of a serious medical condition, such as anemia, thyroid problems or an arrhythmia (an arrhythmia is an irregular heartbeat caused by a problem with the heart's built-in electrical system).
What should I do if my child has a heart palpitation?
If your child experiences any of the following along with heart palpitations, you should make an appointment with your GP. If your child appears unwell with this then seek immediate medical help.You should keep a log of when palpitations occur and under what conditions, and talk to your GP about it. If you are able to check your child’s heart rate by taking the pulse or touching the chest directly when the palpitations occur, that information will be helpful to your doctor.
Make sure to tell your doctor if your family has a history of known heart abnormalities or unexplained death before the age of 50 (including sudden infant death syndrome).
How can a doctor tell if heart palpitations are cause for concern?
Your GP will consider factors such as the frequency and intensity of the heart palpitations and your child's medical history. In the majority of cases, no treatment is necessary for heart palpitations. Your doctor may make general recommendations, such as cutting back on caffeinated drinks or increasing routine hydration.
If your GP refers you to our clinic we will examine your child and listen carefully to your concerns.
Your child might have some further tests including an ECG, Heart scan and an ECG holter recording (ECG recording over several hours).
What are the treatment options for heart palpitations?
In rare cases where we do find an underlying heart condition, one treatment option includes medications. Another option is ablation, a catheterisation technique using heat or cold to sear off abnormal electrical passageways in the heart. If you need this you will be referred to Great Ormond Street Hospital In London.
Further reading, courtesy of the British Heart Foundation:
Palpitations; https://www.bhf.org.uk/informationsupport/conditions/palpitations
ECGs; https://www.bhf.org.uk/informationsupport/tests/ecg
Caring for a child with heart disease;
What happens during fainting?
When you are upright, standing or sitting still, blood drops under the influence of gravity down into your legs. With more blood held in your legs, less blood returns to the heart, and the amount of blood the heart can pump around the body diminishes, and the blood pressure in the circulation will begin to drop.
Usually the body counteracts this and tries to maintain the blood pressure, by constricting the blood vessels in the legs and abdomen, and by making the heart beat faster. In some people, these attempts to maintain the blood pressure are ineffective in the specific situations when the fainting reaction occurs
So when you begin to feel sweaty and faint this is because instead of constricting, some blood vessels get even wider (“vaso-dilate”), and the heart instead of speeding up may slow down or even stop momentarily. The result of this faulty response is that the heart cannot pump enough blood to the brain, and the lack of oxygen reaching the brain then makes you pass out. This is called Vasovagal syncope (syncope, pronounced sin-co-pee, is the Greek / medical term for a blackout caused by not enough blood reaching the brain).
If you faint to the floor, or lie down before fainting (and if possible raise your legs), blood immediately returns to your heart, which can then pump blood to your brain again, and you regain consciousness.
If you stay sitting up, your brain will remain starved of oxygen for longer, and during your faint you might even have jerky movements, that can be misinterpreted as a fit. Some people are incontinent during a profound faint. Again this is not evidence that the collapse was a fit.
Feeling ill and nauseous after a faint is very common, and is part of the digestive “vagal” activation, which often also makes you feel washed out for a time after a faint.
Why this fainting reaction happens more often to some people than to other is unknown. Some people seem to have more powerful “vagal” reactions in certain situations.
When does a fainting response occur?
Most people learn which circumstances might make them faint. People who are prone to fainting often develop symptoms in the following situations (which are all times when the vagal system is more active):
- During emotional circumstances, or with medical/dental procedures.
- When in pain (especially abdominal pain, or during a period).
- During or directly after a meal, especially if you haven’t eaten for a while.
- After a long period of standing still (in a queue or at a reception).
- After sitting very still, especially then standing.
- In warm surroundings (in a restaurant, warm weather, standing in a hot shower or sauna).
- Directly after exercise.
- When you have not had enough rest.
- During illness, nausea or fever.
Symptoms of Vasovagal fainting
As the vasovagal fainting reaction begins, there is often light headedness, ringing in the ears, and feeling sweaty and nauseous. You may start yawning, and others may notice you have gone grey and sweaty. There is often a desire to get some fresh air (“air-hunger”), or to go urgently to the toilet (but standing up to go outside or to the toilet can then bring on the faint!).
As the blood pressure falls further, there is visual disturbance with black spots in front of the eyes, a feeling of becoming distant, and then one faints. People often recognise the symptoms, but sometimes the same people get very little warning and can pass out more suddenly.
During a faint, if someone feels your pulse it will usually be slow (during a seizure or fit it is usually fast). Some jerky movements may occur, especially if the person is still sitting or slouched with their head higher than their body.
When coming round after a faint, the person often feels awful, sickly and may vomit, or even have diarrhoea. Often there is prolonged fatigue after a faint.
Symptoms that are more worrying, and suggest the collapse may not be just a simple faint are:
- Chest pain, severe breathlessness or severe headache before collapsing
- Fitting with stiffness and/or jerky movements immediately on collapsing
- Not breathing or going blue whilst unconscious
- Prolonged unconsciousness, lasting more than 5-10 minutes once lying down.
IF IN DOUBT CALL 999 IMMEDIATELY AND CONSIDER STARTING BASIC LIFE SUPPORT.
Advice
Being susceptible to fainting is not a serious disease, but can be very frightening and frustrating to you and those around you. With advice and understanding of the problem, most people can avoid or minimise most faints. Worrying will only tend to make it worse.
It is important to understand what is happening to you during a faint. Ask your doctor for more explanation if you don’t fully understand what fainting is or if you have any more questions. Also, explain your faints to your family, so they can help and support you.
Try to work out in which particular set of circumstances you are most likely to faint. Then try to avoid these sets of circumstances (e.g. stressed, long day, little food or drink, etc)
When standing still (e.g. in queues), move up and down on the balls of your feet, so your calf muscles squeeze blood back up to your heart, or stand cross-legged (so you use more muscles to stay up, and stimulate your sympathetic system to keep up your blood pressure).
When standing or sitting still, occasionally clench tightly your thigh and buttock muscles for 10-15 seconds (this also keeps your sympathetic system active).
Try to wear elasticated support socks (“flight socks”) to prevent pooling of blood in the legs.
Ensure you drink enough fluids (tea, coffee and alcohol don’t count), especially on hot days, or if you have been exercising or have had diarrhoea or vomiting. Your urine should be clear. Avoid alcohol if you are hot – both heat and alcohol relax your blood vessels, lowering your blood pressure.
”Isotonic” fluids can be especially helpful – these are 'sports' drinks that contain some salt and minerals, to help keep your circulation properly hydrated. But avoid the ones with caffeine.
Avoid large meals on an empty stomach.
If you recognise the start of any symptoms of the fainting reaction, try to lie down immediately, ideally with your legs elevated. Sitting bent forward with your head down between your legs may help, but is not ideal as your legs remain down, and though abdominal compression might help, it might also worsen the vagal reaction, prolong your symptoms and delay recovery.
Remember, it is better to decide to lie down and remain conscious, than to pass out and wake up on the floor in a mess, surrounded by anxious onlookers.
Once you begin to feel faint, do not stand up quickly (e.g. to outside for fresh air) or stand still.
If you faint, do not try to sit up or get up quickly when you come round - you may faint again!
Further reading:
Low blood pressure - on the British Heart Foundation website
The atrial septum is the wall of tissue and muscle between the upper two chambers (atria) of the heart.
An ASD is a hole in this wall. A hole or defect such as this allows both upper chambers of the heart (atria) to communicate and permits an abnormal flow of blood from one chamber to the other. This means that the oxygen-rich and the oxygen-poor blood, instead of being kept separate, are allowed to mix and flow from the heart to the body and lungs.
This type of heart problem can occur on its own, but may also occur together with other forms of congenital heart disease.
What are the signs and symptoms of atrial septal defect?
Children with an atrial septal defect (or PFO) may only show mild symptoms of having a heart condition, or may not have any symptoms at all.
Frequent chest infections can be a sign that the oxygenation process is not working efficiently due to extra blood flow to the lungs.
Large defects can cause extra strain on the heart causing the right-hand side of the heart to dilate (stretch).
Babies with large defects may be breathless and struggle to feed and gain weight. Older children may show a reduced tolerance for exercise.
The extra flow of blood to the lungs usually produces heart murmurs in children (an abnormal heart sound) that can be detected on routine health checks. This is a common reason for referral.
How is atrial septal defect diagnosed?
Your child will have an echocardiogram, a non-invasive, high frequency ultrasound scan of the heart. It allows doctors to the see the structure of the atrial valve and assess any abnormal blood flow through the heart, as well as the overall performance of the heart and circulatory system.
They may also have an electrocardiogram (ECG). This measures electrical activity in the heart to see how well it is working. Doctors will look to see whether the right side of the heart has thickened and whether it is working harder than it should be.
How is atrial septal defect treated?
The treatment your child needs will depend on the severity of the defect.
Small, central atrial defects can close spontaneously after a few years, and your child may only require regular supervision in an outpatient clinic.
If the defect is slightly larger, and surrounded by good margins of heart tissue, a key hole procedure known as cardiac catheterisation can be used to close the hole. This is usually undertaken as a day-case procedure.
Large central defects or other types of ASD may require open-heart surgery for repair. The type of operation depends upon the position of the defect and any associated tissue damage (lesions).
Further reading
Information from the British Heart Foundation on Atrial Septal Defect
Read about atrial septal defect on the Children's Heart Federation website
An atrioventricular septal defect results in a large hole between the upper filling chambers (atria) and the lower pumping chambers (ventricles) of the heart. There is also only one valve between the atria and ventricles instead of two.
The hole allows more blood to flow from the left side of the heart to the right. This increases the pressure of the blood travelling to the lungs, making the right hand-side of the heart work harder and function less well.
An AVSD is a form of congenital heart disease – a term used to describe a problem with the heart’s structure and function due to abnormal development before birth.
Our doctors and nurses regularly refer to information published by the British Heart Foundation (BHF) and the Children's Heart Federation when explaining AVSD to our patients and their families.
Further reading
Visit the BHF website for more information on atrioventricular septal defects
Read about atrioventricular septal defect on the Children's Heart Federation website
A ventricular septal defect means that there is a hole between the lower pumping chambers (ventricles) in the heart.
The hole allows blood to flow from the left side of the heart to the right, increasing the pressure of the blood travelling to the lungs and making the heart work harder.
A VSD is a form of congenital heart disease – a term used to describe a problem with the heart’s structure and function due to abnormal development before birth.
We would like to direct you to the information published by the British Heart Foundation (BHF) and the Children's Heart Federation when explaining ventricular septal defect (VSD)
If you have any further questions your doctor will try to answer them.
Further reading
Visit the BHF website to find out more about ventricular septal defect
Read about ventricular septal defect on the Children's Heart Federation website
The ductus arteriosus is a blood vessel that allows blood to bypass a babies’ lungs while they are in the womb.
This is because their lungs are underdeveloped until they start breathing. The ductus arteriosus therefore acts as a ‘safety feature’ and is biologically programmed to shut when babies are born at full-term.
The closure usually happens in the first few days or weeks after birth. If it remains open, it is known as PDA.
PDA means a baby has an additional (and abnormal) source of blood flow to the lungs. As a result, there is extra strain on the left-hand side of the heart, which has to collect and deal with the extra blood.
What causes PDA?
This is a congenital heart defect (present when your child was born). The exact cause isn’t often clear. Most heart problems in children are present from birth due to an anomaly in the way the heart forms during the very early stages of pregnancy.
The reasons for this may be due to a number of factors, such as genetics, environmental factors or infection. The likelihood that a heart problem will have been caused directly by anything you have done during pregnancy or early life is very rare.
What are the signs and symptoms of PDA?
The signs and symptoms will vary depending on the size of the PDA, the age of your child and whether they have any other heart problems.
- Small ducts (PDA) Your child may not have any symptoms and the PDA may only be picked up at a routine health check where a heart murmur is also detected.
- Moderate ducts (PDA) Your child may have symptoms of heart failure, such as breathlessness, poor feeding or impaired growth. They may also be more susceptible to chest infections.
- Large ducts (PDA) Your child may have signs of severe heart failure, such as breathlessness at rest, failure to thrive and multiple respiratory infections.
How is PDA detected?
Your child will have an echocardiogram, a non-invasive, high frequency ultrasound scan of the heart. It allows doctors to see the PDA, the aorta and pulmonary blood vessels, how blood is moving through the heart and the impact the blood flow is having on other components of the heart.
Doctors will look to see whether the left ventricle (one of the lower pumping chambers) is dilated, a sign that it is working harder than it should be.
How is PDA treated?
The treatment your child will need will depend on the size of the PDA and any other heart problems they might have.
If the PDA is not affecting blood flow to the heart (and is not audible via stethoscope), it is unlikely to cause your child any health problems in the future.
The first line of treatment in a new born baby is usually with medication to try to close the PDA. If this is not appropriate or does not work, your child will need surgical treatment and we will refer you to Great Ormond Street Hospital for this.
What happens next?
The long-term outlook for PDAs is very good irrespective of the strategy used to close the hole (catheter device closure or cardiac surgery). Further surgical or catheter procedures are not usually required and children lead normal, healthy lives.
Further reading
Read about patent ductus arteriosus on the Children's Heart Federation website
Understanding your child's heart - patent ductus arteriosus on the British Heart Foundation website
Tetralogy of Fallot is a group of four structural abnormalities within the heart that occur together.
These are:
- pulmonary stenosis – a narrowing at, under or above the valve between the right pumping chamber (right ventricle) and the large blood vessel that carries blood to the lungs to pick up oxygen (pulmonary artery)
- ventricular septal defect – a hole between the right and left pumping chambers (ventricles)
- over-riding aorta – the entrance to the large blood vessel that takes blood away from the heart to the rest of the body (aorta) is next to the ventricular septal defect, allowing oxygen-poor blood to flow through it
- thick right ventricle – the heart has to work harder to pump blood through the narrowed pulmonary artery, causing the muscle to thicken
Tetralogy of Fallot is a form of congenital heart disease – a term used to describe a problem with the heart’s structure and function due to abnormal development before birth.
Our doctors refer to information published by the British Heart Foundation (BHF) and the Children's Heart Federation when explaining Tetralogy of Fallot to our patients and their families.
Further reading
Visit the BHF website to find out more about Tetralogy of Fallot
Read about Tetralogy of Fallot on the Children's Heart Federation website
The aortic valve is a one-way valve between the left pumping chamber (ventricle) of the heart and the major blood vessel taking blood to the body (aorta).
AS describes a condition where the aortic valve is smaller or tighter than it should be. As a result, the valve moves less freely and the heart has to contract (squish) harder to push blood across the valve. This extra work can make the heart muscle thicken and become less efficient at pumping blood through.
The tightness commonly occurs at the valve site itself (valvar aortic stenosis) but can also be above the valve, in the blood vessel itself (supravalvar stenosis) or below the valve (sub-valvar stenosis).
The valve structure itself is often abnormal and the valve leaflets (or doors) are thickened themselves or arranged in an unusual configuration with two leaflets rather than the usual three.
What causes AS?
This is a congenital heart defect (present when your child was born). The exact cause of congenital heart defects isn’t often clear. Most heart problems in children are present from birth due to an anomaly in the way the heart forms during the very early stages of pregnancy.
The reasons for this may be due to a number of factors, such as genetics, environmental factors or infection. The likelihood that a heart problem will have been caused directly by anything you have done during pregnancy or early life is very rare.
What are the signs and symptoms of AS?
Mild aortic stenosis is usually picked up at a routine postnatal or six-week check-up alongside a heart murmur (an additional heart sound). In severe cases, your child may experience breathlessness and not be feeding properly. These are both symptoms of heart failure (a term used to describe a state where the heart isn’t working efficiently enough to meet the needs of the body).
Symptoms tend to be rare in older children and young people but again, AS can be picked up alongside tests for a heart murmur. Chest pain or fainting and dizziness after exercise are also signs that the heart is being put under strain.
How is AS diagnosed?
Your child will have an echocardiogram, a non-invasive, high frequency ultrasound scan of the heart. It allows doctors to see the structure of the valve, how blood is moving through the valve and the overall performance of the heart and circulatory system.
They will also have an electrocardiogram (ECG). This measures electrical activity in the heart to see how well it is working. Doctors will look to see whether the left ventricle (one of the lower pumping chambers) has thickened and is working harder than it should be.
How is AS treated?
The treatment your child needs will depend on the severity of the stenosis. If it is only mild, your child may require regular supervision in an outpatient clinic. However, if it is severe enough to cause symptoms, treatment is likely to needed.
Pulmonary stenosis is a narrowing of the valve between the right pumping chamber (right ventricle) and the large blood vessel that carries blood to the lungs to pick up oxygen (pulmonary artery). This means the heart has to work harder to pump blood through the narrowed valve and over time, makes the muscle in the right ventricle thicken.
Pulmonary stenosis is a form of congenital heart disease – a term used to describe a problem with the heart’s structure and function due to abnormal development before birth.
Our Cardiorespiratory Unit regularly refers to information published by the British Heart Foundation (BHF) and the Children's Heart Federation when explaining pulmonary stenosis to our patients and their families.
Further reading
Visit the BHF website for more information on pulmonary stenosis
Read about pulmonary stenosis on the Children's Heart Federation website
The aorta is the major blood vessel carrying oxygenated blood to the body. Coarctation of the aorta refers to a condition where there is a tightness (or narrowing) in the aorta.
As a result, the left-hand side of the heart has to work harder to pump blood away from the heart to the rest of the body. In severe cases, there can be reduced blood flow to the body.
What causes Coarctation of the Aorta?
This is a congenital heart defect (present when your child was born). The exact cause of congenital heart defects isn’t often clear. Most heart problems in children are present from birth due to an anomaly in the way the heart forms during the very early stages of pregnancy.
The reasons for this may be due to a number of factors, such as genetics, environmental factors or infection. The likelihood that a heart problem will have been caused directly by anything you have done during pregnancy or early life is very rare.
What are the signs and symptoms of Coarctation of the Aorta?
The signs and symptoms will depend on the severity of the coarctation, and the age of the child.
Newborn babies may have a weak femoral pulse (located in the inner thigh) and seem very sick very suddenly. They may collapse, feel cool and look grey with a fast respiratory rate and be unable to feed and will require emergency treatment.
Coarctation of aorta may only reveal itself a few days (or weeks) after birth. This is because the ductus arteriosus (a blood vessel that allows blood to bypass a babies’ lungs while they are in the womb) closes at this time. Without this alternative route, the blood is forced to travel through the aorta which, if obstructed, can lead to a sudden presentation of symptoms.
This condition can be diagnosed during pregnancy. In this instance, doctors will usually recommend the baby is delivered in a specialist centre and advise a course of medication to maintain the opening of the ductus arterious until a more detailed cardiac evaluation can be carried out after birth.
Mild degrees of coarctation might not be detected until later in childhood or adolescence. Signs can include weak femoral (leg) pulses, a heart murmur or high blood pressure (hypertension).
How is Coarctation of the Aorta diagnosed?
Your child will have an echocardiogram, a non-invasive, high frequency ultrasound scan of the heart. It allows doctors to to see the aorta and assess the severity of the narrowing and the extent of poor growth (hypoplasia). They will also look at the overall performance of the heart and circulatory system.
Your child may also have an electrocardiogram (ECG). This measures electrical activity in the heart to see how well it is working. Doctors will look to see whether the left side of the heart has thickened and is working harder than it should be.
Doctors may also monitor your child’s blood pressure over a period of time, and carry out exercise tests to assess the way the blood pressure responds to physical exertion.
How is coarctation of the aorta treated?
The treatment your child needs will depend on the severity of the coarctation.
In mild cases, your child may only require regular supervision in an outpatient clinic. If your child's coarctation is more severe then you will be referred to Great Ormond Street Hospital in London for further evaluation and treatment.
Treatment could be either a key hole procedure or surgery depending on the circumstances.
What happens next?
The long-term outlook for Coarctation of the Aorta is usually good but will depend on the severity of the coarctation and whether your child has other heart problems.
Further reading
On the British Heart Foundation website; Understanding your child's heart - Coarctation of the aorta
What causes chest pain in children and teenagers?
A variety of factors can cause a child or teenager to feel chest pain. In most cases, chest pain in children and teenagers is not caused by a heart problem.
The most common cause of chest pain in children and teenagers is chest wall pain. “Chest wall” is a term for the structures that enclose and protect the lungs, including the ribs and sternum.
We do not always know what causes chest wall pain, but it is typically associated with brief sharp pain that is worse with breathing in.
Injury to the ribs, sternum or other bones in the chest and back also can cause chest wall pain. There are also a variety of muscles and joints in the chest area that may be sore, inflamed or strained. Causes can include an infection or injury, such as from sports or a fall.
Typical chest wall pain is not treated with medications, although chest wall injuries and inflammation can respond to non-steroidal anti-inflammatory medications, such as ibuprofen. Otherwise, treatment for the chest pain will be dependent upon the underlying cause of the pain.
Sometimes, a cold (upper respiratory infection) or persistent cough can cause soreness and pain in the chest area. Some children will describe acid reflux (“heartburn”) as chest pain. Stress or anxiety may also bring on a feeling of chest pain.
Heart conditions that can cause chest pain in a child are very rare. They include pericarditis (an inflammation of the sac that surrounds the heart), myocarditis (a viral infection of the heart), arrhythmias (abnormal fast heart rhythms), or, very rarely, blockage or other problems with the coronary arteries (the tiny vessels that carry oxygenated blood to the heart tissue). Another cardiac cause of chest pain can be due to dissection, or tearing, of the aorta, the main artery that directs blood from the heart out to the body.
What should I do if my child has chest pain?
Understandably, when a child complains of chest pain, parents worry there is a problem with the heart. In children, it’s unlikely that chest pain is caused by a heart problem.
However, do not ignore chest pain in a child. Make an appointment with your GP and explain what your child is experiencing. The doctor will decide whether further tests are needed.
If the child complains of chest pain, and also has a fever, is sweating or having trouble breathing, or has a very rapid heart rate, is pale, or has severe pain like a ripping sensation, do not wait — get help immediately. Also, if there is a family history of “aortic dissection,” or tearing of the aorta, or of Marfan syndrome, an emergency evaluation is immediately needed.
What should I expect if my child visits JPUH for chest pain?
The paediatrician will listen to your child’s heart and ask questions about the circumstances that led to the chest pain, your child’s medical history, and the family medical history. The doctor will read an electrocardiogram (ECG ), a record of the electrical activity of your child’s heart, to determine whether a heart problem may be causing your child's symptoms.
The doctor might do other tests, such as an exercise stress test, ECG, or chest X-ray, or might send your child home with a Holter monitor to continuously record your child's heart rhythm as they go about their normal activities. However, the vast majority of children will not need further testing and will likely be found to have a normal heart.