Chest Pain, Syncope, and Palpitations in the Pediatric Patient

Abstract

Chest pain, syncope, and palpitations are the most common chief complaints in children that might be cardiac in origin. Although all three are often associated with significant heart disease in adults, they usually represent benign conditions in children, do not require aggressive treatment, and may be considered to some degree “functional.” Nevertheless, parents of children with any of these complaints are often anxious that their child may be the exceptional case with life-threatening (usually cardiac) disease. The purpose of this chapter is to provide the primary care practitioner with a practical office approach to the child with chest pain, syncope, or palpitations of a semiacute or chronic nature. For each complaint the most common noncardiac, as well as the rarer cardiac causes will be reviewed. A discussion follows that emphasizes important aspects of the history and physical examination that will help to differentiate cardiac from less serious, noncardiac causes. The main objective is to help the practitioner to evaluate each complaint effectively, reassure patients and families appropriately, and avoid unnecessary testing and referrals to an emergency department or subspecialists.