Chest Pain

Chest Pain

Chest pain is a common complaint in pediatrics, but infrequently caused by a cardiac problem. Standardized Clinical Assessment and Management Plans (SCAMPs®) is a quality improvement tool aimed at reducing practice variation, decreasing unnecessary utilization of resources and improving patient care and outcomes. The SCAMPs® methodology gives primary care providers evidence-based guidelines to better assess the child who presents with chest pain rather than immediately sending the child to a cardiology consultation.

How should I initially evaluate and manage my patient?

Providers should evaluate their patients:

Detailed history of the event, past medical history and family history
Physical examination

Provider should initially manage their patients chest pains by:

In the absence of medical red-flag criteria, children presenting with chest pain ought to be reassured that their heart is healthy and that there is no need for any further cardiac workup. The pediatrician is encouraged to investigate and treat non-cardiac etiology (ex. asthma, exercise-induced asthma, costochondritis, musculoskeletal, panic disorder, gastroesophageal reflux disease).
Patients with medical red-flag criteria for referral ought to restrict exercise until fully evaluated by cardiology. It’s to be noted that a normal chest X-ray and/or electrocardiogram (ECG) does not rule out cardiac disease and is not a substitute for a full cardiology evaluation in the patient who has medical red-flag criteria for referral.

When should I refer my patient?

Providers may consider initiating referral to cardiology when:

The patient has a history of:

Chest pain with exertion
Exertional syncope
Chest pain that radiates to back, jaw, left arm or left shoulder
Chest pain that increases with supine position
Chest pain temporally associated with fever (> 38.4°C)
Syncope with no warning, sudden onset

The patient has past medical history* of:

Hypercoagulable state
Arthritis/vasculitis
Immobilization

*Chest pain SCAMPs® excluded patients with known cardiac disease which otherwise would have represented a red-flag for referral.

The patient's family has a history of:

Sudden unexplained death
Cardiomyopathy
Hypercoagulable state

The patient's physical examination shows:

Respiratory rate > 40 bpm
Temperature > 38.4°C
Ill-appearing
Painful/swollen extremities
Non-innocent murmur
Distant heart sounds
Gallop to suggest heart failure
Pulmonic component of S2
Pericardial friction rub
Peripheral edema

How can I refer my patient?

What can my patient expect from a visit to Children's National Hospital?

Outpatient Appointment Referral Pads

Children's National Hospital offers convenient outpatient locations for specialty care. To help connect your patients with our specialists, please complete the form to request a referral pad from your physician liaison.

Request referral pads