Child Athlete with exercise induced chest pain

[Mommydee]

My 15 yr old daughter with a prior hx of Graves' Disease (dx age 8) and lupus (dx age 12) is currently in a good remission from both illnesses...no symptoms and bloodwork levels are currently great. About 2 yrs ago she had significant chest pain and following one abnormal EKG underwent extensive cardiac testing including repeat EKG, echo, stress exercise test with pulmonary function testing, and wore an event monitor for 30 days....all tests came back within normal limits and the general feeling was that it was chest wall pain related to the connective tissue disease...she was dismissed from the cardiologist.  Later her rheumatologist noted a heart murmur, I called the cardiologist and they checked her file and noted that it was even noted there was no noticeable murmur just a few weeks prior, so it was decided to be a flow murmur and not significant.  She went for several months with no problems, no pain, no shortness of breath...her remissions have been so complete she is off all her medicines, and her labs are remaining good.  However, she is a competitive swimmer and now that she is feeling better is working hard to reduce her times and advance competitively...to this end she is working out five to six days a week, once a day during school and twice a day when school is out, including dry land training with lots of running and several thousand yards of swimming.  She has started complaining that it is getting difficult to decrease her times because she can't "breathe" good while she is swimming fast, and her chest starts hurting....the pain resolves rapidly with rest and there seems to be no lingering effects.  Other than this transient pain and shortness of breath she seems to have no unusual problems dealing with the increased exercise load.  Following all the normal tests about 2 yrs ago she was dismissed from the pediatric cardiologist with no need for further follow up...the only test they had wanted that they didn't get was cardiac enzymes because after they wrote a prescription for this the severe pain never returned.  I have been assuming this is pretty normal for someone exercising at the intensity she is exercising, I have asked her if she feels she needs to see a doctor and she does not want to (the kid has been doctored to death because of her history of chronic autoimmune disease).  I have never been an athlete at these levels so I am not sure if what she is experiencing is normal.  She seems fine outside of these episodes while exercising....I do know of course when you exercise at high levels you get short of breath, but is it normal for chest pain to also occur?  Should it resolve as she continues working out?  Is this something that definately needs reported to either her pediatrician or her former cardiologist immediately, or would a brief mention to any of her doctors at the next scheduled appointment (which is with endocronology in February) be sufficient?  I appreciate the care and concern you give to patients in the forum....especially when something is not quite right with your child, it is easy to worry, sometimes unnecessarily.
Dee

[Cleveland Clinic, MD]

It's a bit difficult to tell someone over the internet not to see a doctor due to chest pain so I can't really do that.  However, I would talk it over with her coach and try to determine if her symptoms are in line with the level of activity she is undergoing and are similar to what the other girls are experiencing.