Etiology of chest pain in children and adolescents referred to cardiology clinic.

OBJECTIVE To determine the proportion of children referred to pediatric cardiology clinic for chest pain diagnosed with a cardiac cause for the pain. DESIGN Medical records of patients evaluated for chest pain at the University of Wisconsin Children's Hospital from 2004 to 2006 were reviewed, including the studies performed and final diagnosis. RESULTS A total of 135 patients, including 78 boys, ranging from 4 to 17 years were evaluated. Eighty-four (62%) patients had pain for at least 1 month. All patients had an electrocardiogram (ECG), and most had an echocardiogram performed. Only 1 patient (0.7%) was found to have a cardiac cause for the pain. In 6 patients (4.3%), there was possible supraventricular tachycardia based on history, but no evidence of abnormality on subsequent testing. Ninety-five percent of the patients were diagnosed with noncardiac chest pain. CONCLUSION The incidence of cardiac chest pain in our study population is less than previously reported. Many patients were referred to cardiology clinic despite having had normal testing by the referring physician. Primary care physicians should be reassured when patients have a normal history, physical examination, and testing. Referral to pediatric cardiology usually is not necessary under these circumstances.