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Ozdemir G, Celebi SK, Kayalı S. An unusual etiology in an 8-year-old girl with chest pain and elevated troponin-I. Pediatr Nephrol 2024:10.1007/s00467-024-06368-8. [PMID: 38607422 DOI: 10.1007/s00467-024-06368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024]
Abstract
Acute post-streptococcal glomerulonephritis (APSGN) is the most common glomerulonephritis of childhood, and clinical presentation can vary widely. This case report presents an atypical manifestation of APSGN in an 8-year-old female patient with pleuritic chest pain and elevated troponin-I, despite lacking classical kidney symptoms. Imaging studies showed cardiomegaly and interstitial lung opacities. Further investigations revealed hematuria and proteinuria, and the diagnosis was confirmed through elevated antistreptolysin-O (ASO) titers and low complement 3 (C3) levels. The patient was successfully managed with fluid restriction, diuretics, and antihypertensives, resulting in the resolution of symptoms and normalization of laboratory values. This case highlights the significance of recognizing atypical manifestations of APSGN for ensuring prompt diagnosis and proper management in the pediatric population.
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Affiliation(s)
- Gulsah Ozdemir
- Division of Pediatric Nephrology, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey.
| | - Serpil Kaya Celebi
- Division of Pediatric Cardiology, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Seyma Kayalı
- Division of Pediatric Cardiology, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
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2
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Huang SW, Liu YK. Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department. Diagnostics (Basel) 2024; 14:526. [PMID: 38473000 DOI: 10.3390/diagnostics14050526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Pediatric chest pain is a common chief complaint in the emergency department. Not surprisingly, children with chest pain are usually brought to the emergency department by their parents out of fear of heart disease. However, chest pain in the pediatric population is generally a benign disease. In this review, we have identified musculoskeletal pain as the most prevalent etiology of chest pain in the pediatric population, accounting for 38.7-86.3% of cases, followed by pulmonary (1.8-12.8%), gastrointestinal (0.3-9.3%), psychogenic (5.1-83.6%), and cardiac chest pain (0.3-8.0%). Various diagnostic procedures are commonly used in the emergency department for cardiac chest pain, including electrocardiogram (ECG), chest radiography, cardiac troponin examination, and echocardiography. However, these examinations demonstrate limited sensitivity in identifying cardiac etiologies, with sensitivities ranging from 0 to 17.8% for ECG and 11.0 to 17.2% for chest radiography. To avoid the overuse of these diagnostic tools, a well-designed standardized algorithm for pediatric chest pain could decrease unnecessary examination without missing severe diseases.
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Affiliation(s)
- Szu-Wei Huang
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei 11695, Taiwan
| | - Ying-Kuo Liu
- Department of Pediatrics, Wan Fang Hospital, Taipei Medical University, Taipei 11695, Taiwan
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Goyal A, El-Wiher N, Joseph B. Not Your Ordinary Teenage Girl With Chest Pain. Clin Pediatr (Phila) 2023; 62:1445-1448. [PMID: 36927173 DOI: 10.1177/00099228231161580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Ashima Goyal
- Division of Pediatric Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Nidal El-Wiher
- Division of Pediatric Intensive Care, Beaumont Hospital, Royal Oak, MI, USA
| | - Benjamin Joseph
- Division of Pediatric Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
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Danon S. Chest Pain, Palpitations, and Syncope: Preventing Sudden Cardiac Death in Children. Adv Pediatr 2023; 70:171-185. [PMID: 37422295 DOI: 10.1016/j.yapd.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Sudden cardiac death is defined as an abrupt, unexpected death of cardiovascular cause with loss of consciousness within 1 hour of onset of symptoms. In an effort to prevent these events, clinicians need to recognize symptoms to identify at risk patients. There is often an overlap in symptoms of chest pain, palpitations, and syncope. The workup depends on the characteristics of these symptoms. The history and physical examination often provide adequate information, but additional testing and referral to pediatric cardiology are sometimes indicated.
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Affiliation(s)
- Saar Danon
- Pediatric Cardiology and Congenital Cardiac Catheterization, Miller Children's and Women's Hospital Long Beach, 2701 Atlantic Avenue, Long Beach, CA 90806, USA; University of California, Irvine, CA, USA.
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Shahid R, Jin J, Hope K, Tunuguntla H, Amdani S. Pediatric Pericarditis: Update. Curr Cardiol Rep 2023; 25:157-170. [PMID: 36749541 PMCID: PMC9903287 DOI: 10.1007/s11886-023-01839-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW While there have now been a variety of large reviews on adult pericarditis, this detailed review specifically focuses on the epidemiology, clinical presentation, diagnosis, and management of pediatric pericarditis. We have tried to highlight most pediatric studies conducted on this topic, with special inclusion of important adult studies that have shaped our understanding of and management for acute and recurrent pericarditis. RECENT FINDINGS We find that the etiology of pediatric pericarditis differs from adult patients with pericarditis and has evolved over the years. Also, with the current COVID-19 pandemic, it is important for pediatric clinicians to be aware of pericardial involvement both due to the infection and from vaccination. Oftentimes, pericarditis maybe the only cardiac involvement in children with COVID-19, and so caregivers should maintain a high index of suspicion when they encounter children with pericarditis. Large-scale contemporary epidemiological data regarding incidence and prevalence of both acute and recurrent pericarditis is lacking in pediatrics, and future studies should focus on highlighting this important research gap. Most of the current management strategies for pediatric pericarditis are from experiences gathered from adult data. Pediatric multicenter trials are warranted to understand the best management strategy for those with acute and recurrent pericarditis. CASE VIGNETTE A 6-year-old child with a past history of pericarditis almost 2 months ago comes in with a 2-day history of chest pain and fever. Per mother, he stopped his steroids about 2 weeks ago, and for the last 2 days has had a temperature of 102F and has been complaining of sharp mid-sternal chest pain that gets worse when he lies down and is relieved when he sits up and leans forward. On examination, he is tachycardic (heart rate 160 bpm), with normal blood pressure for age. He appears to be in pain (5/10), and on auscultation has a pericardial friction rub. His lab studies are notable for elevated white blood cell count and inflammatory markers (CRP and ESR). His electrocardiogram reveals sinus tachycardia and diffuse ST-elevation in all precordial leads. His echocardiogram demonstrates normal biventricular function and a trace pericardial effusion. His cardiac MRI confirms recurrent pericarditis. He is started on indomethacin and colchicine. He has complete resolution of his symptoms by day 3 of admission and is discharged with close follow-up.
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Affiliation(s)
- Rida Shahid
- grid.239578.20000 0001 0675 4725Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, OH USA
| | - Justin Jin
- grid.413808.60000 0004 0388 2248Division of Pediatric Cardiology, Northwestern Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Kyle Hope
- grid.39382.330000 0001 2160 926XLillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Hari Tunuguntla
- grid.39382.330000 0001 2160 926XLillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Shahnawaz Amdani
- grid.239578.20000 0001 0675 4725Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, OH USA
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Deskins S, Luketich SK, Gelman J, Al-Qatarneh S. Refractory pleuritic chest pain: A troublesome consequence of pulmonary embolism. Pediatr Pulmonol 2023; 58:599-601. [PMID: 36251521 DOI: 10.1002/ppul.26211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Seth Deskins
- Department of Internal Medicine-Pediatrics, West Virginia University, Morgantown, West Virginia, USA
| | - Samuel K Luketich
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Jacob Gelman
- Department of Internal Medicine-Pediatrics, West Virginia University, Morgantown, West Virginia, USA
| | - Saif Al-Qatarneh
- Department of Pediatrics, Division of Pulmonology, West Virginia University, Morgantown, West Virginia, USA
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Loza S, Tallman B, Hanson K, Rainey S. A 15-year-old with chest pain: An unexpected etiology. SAGE Open Med Case Rep 2022; 10:2050313X211069026. [PMID: 35070318 PMCID: PMC8777365 DOI: 10.1177/2050313x211069026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/07/2021] [Indexed: 11/15/2022] Open
Abstract
A 15-year-old female with no significant past medical history presented to the
emergency department with 1 day of substernal and pleuritic chest pain, chills,
cough, and hematuria. She also had swelling of the face and ankles that resolved
by presentation. She was found to have elevated troponin and brain natriuretic
peptide during initial workup. Electrocardiogram was normal, but there were
significant pleural effusions on chest x-ray. She was strep positive and had
blood pressure up to 150/90, prompting admission for cardiac monitoring and
cardiology consultation. Blood pressure decreased down to 125/72 without
intervention. She was afebrile with unlabored breathing and normal saturations.
She was clear to auscultation bilaterally, with no abdominal distension or
hepatosplenomegaly, and edema was not evident on exam. There was mild erythema
to the bilateral tonsillar pillars. Initial considerations included viral
myocarditis, pericarditis, and atypical nephritic syndrome. Workup revealed
elevated antistreptolysin antibodies, low C3 complement, negative antineutrophil
cytoplasmic antibodies, and negative flu testing. Renal sonography was
unremarkable. Cardiology recommended echocardiography, which confirmed pleural
effusions but revealed no cardiac abnormalities. Urinalysis revealed hematuria
and mild proteinuria. Diagnosis was found to be post-streptococcal
glomerulonephritis complicated by fluid overload and left ventricular strain
secondary to hypertensive emergency. Post-streptococcal glomerulonephritis is
the most common cause of acute glomerulonephritis in children. The mechanism of
disease is a proliferation and inflammation of the renal glomeruli secondary to
immunologic injury, with deposition of immune complexes, neutrophils,
macrophages, and C3 after complement activation. This leads to hematuria,
proteinuria, and fluid overload. Edema is present in 65%–90% of patients,
progressing to pulmonary involvement in severe cases. Cardiac dysfunction
secondary to fluid overload is a potentially fatal outcome in the acute setting.
Physicians should consider post-streptococcal glomerulonephritis for patients
presenting with hypertension, cardiac/pulmonary pathology, or symptoms of acute
heart failure in the context of strep infection.
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Affiliation(s)
- Samantha Loza
- The University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Brandon Tallman
- The University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Keith Hanson
- The University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Shane Rainey
- The University of Illinois College of Medicine at Peoria, Peoria, IL, USA
- The University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
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Wang Y, Wang S, Zou R, Chen S, Li F, Wang Y, Xu Y, Wang C. The Relationship Between Unexplained Chest Pain in Children and Head-Up Tilt Test. Front Pediatr 2022; 10:901919. [PMID: 35722475 PMCID: PMC9203148 DOI: 10.3389/fped.2022.901919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To explore the relationship between unexplained chest pain in children and head-up tilt test (HUTT). MATERIALS AND METHODS A total of 825 children with the main symptom of unexplained chest pain were admitted to the Specialist Outpatient Clinic of Children's Cardiovascular Disease from October 2000 to November 2021 at The Second Xiangya Hospital, Central South University. Among them, 473 were male and 352 were female, with a mean age of 10.61 ± 2.21 years. The control group included 58 cases, comprising 35 males and 23 females, with a mean age of 10.26 ± 2.66 years. The detailed history, physical examinations, conventional 12-lead electrocardiogram, chest X-ray, echocardiography, myocardial enzymes, electroencephalogram, and blood series were all examined. Disorders of the chest wall, lung, heart, mediastinum, and esophageal reflux, as well as drug effects, were ruled out. All the children underwent HUTT. Demographic description, univariate analysis, and multivariate logistic regression analysis were used to explore the possible linear or non-linear relationships between the children's unexplained chest pain and HUTT. RESULTS Among the 825 chest pain cases, 301 (36.48%) were HUTT positive and 524 (63.52%) were HUTT negative. HUTT-positive patients were older than HUTT-negative patients (11.04 ± 2.03 vs. 10.34 ± 2.31 years, P < 0.001). The logistic regression results showed that each year of age increased the probability of being HUTT positive by 17.90% (P < 0.000), and females were 91.30% more likely to be HUTT positive than males (P < 0.000). CONCLUSION Clinically unexplained chest pain in children is mainly caused by unbalanced autonomic nervous function. HUTT can help clear the cause of unexplained chest pain.
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Affiliation(s)
- Ying Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Pharmacy, Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Wang
- Department of Neonatology, Xiangya Hospital, Central South University, Changsha, China
| | - Runmei Zou
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Siyang Chen
- The Affiliated Hospital of Xiangnan University, Chenzhou, China
| | - Fang Li
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuwen Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Xu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
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Akdeniz O, Ertaş K. Diagnostic Evaluation of Children Presenting with Chest Pain to Pediatric Cardiology Clinic: Covid-19 Pandemic's Effect to Etiology. Journal of Contemporary Medicine 2021. [DOI: 10.16899/jcm.844873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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