Abstract 2679: Chest Pain: Characteristics of Children/Adolescents Evaluated in the Cardiac Exercise Laboratory
INTRODUCTION: Chest pain (CP) in children/adolescents is a common referral for the pediatric cardiologist.
METHODS: A group of 263 patients (141 M/122 F, 13.4 yrs, R:5–22 yrs) with the primary complaint of CP underwent evaluation in the cardiac stress lab at Children’s Hospital of Wisconsin with the addition of pulmonary function testing (PFTs) and oxygen consumption.
RESULTS: Echos at rest were obtained in 184/263 (70%) with no significant cardiac abnormalities identified. EKGs at rest and exercise revealed no significant ST-T wave changes or arrhythmias. Endurance time (EXT) and oxygen consumption (VO2/kg) were below predicted in 26% and 46% respectively. CP was reproduced in 36%. Reactive airway disease (RAD) as a pre-existing condition was reported in 19% of patients, but abnormal resting PFTs were found in 26% (n=68) with 48/68 never having the diagnosis of RAD. Overweight (OW=Body Mass Index >85th%ile), was seen in 28% of the cohort with 16% identified as being obese (OB=Body Mass Index >95th%ile). Racial and gender breakdown of the population with percent abnormal as follows: Race was not a predictor of OW/OB. A significant increase in the incidence of RAD (p<0.01) was seen in AA, and decreased EXT (p= 0.01) in H. VO2/kg was significantly reduced in both AA & H (p< 0.01). Comparisons between pre-teens (PT) (<13 yrs, n=92) and teens (T) (≥13 yrs, n=168) were also investigated. PT had significantly higher incidence of OW (p < 0.01), OB (P<0.01) as well as reduced VO2% (p<0.05).
CONCLUSIONS: These results identify both racial and age-related differences in the etiology of CP in children. Most importantly true cardiac pathology appears extremely rare. OW, deconditioning, and respiratory compromise play important roles in CP. The need for comprehensive cardiopulmonary monitoring is emphasized by these findings and a focus towards managing RAD and obesity in children with CP must be considered.