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Child with chest pains
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Child with chest pains

I posted this on the Dr.'s forum as well and got an answer, but wondered if anyone else knows of a child with similar symptoms and what they found out.

My 4 year old son first told me a few weeks ago that sometimes his "heart hurts" when he runs or walks. I asked how long it had been going on and he seemed to think for a while. I told him to tell me if he ever felt them again. Since then he's had 3-4 episodes of chest pain immediately after running or playing hard (but he has also run and not had pain). I asked him to describe the pain and he said "hard". Later he described it as a tickle feeling. All of these pains were on the left side of his chest. He had one time where he felt it on the right side, and one time he felt pain after lying down. As an aside, he has also been tiring very easily lately, not keeping up at play like he used to, and even unable to do some things (like lift himself out of the pool with his elbows) that he's been doing routinely for a long time. Seems to breathe harder than normal when exerting himself.  

Took him to his doctor who referred him to the pediactric cardiologist (who he saw last year for a heart murmur which was found to be innocent - had an echo) since his doctor heard the murmur again this time and just wants to rule things out re: the chest pains.

Anyone know of other young children who had symptoms like this?

18 Comments Post a Comment
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187666_tn?1331176945
As a very young child I had arrhythmias (my heart would suddenly start pounding at a fast rate for no apparent reason). I didn't mention it to my mom because I didn't understand it was a problem. Now I know what was going on and have had procedures to partially correct it.

But children can have heart problems and his sounds like more than a simple arrhythmia. Perhaps the cause of the murmur has changed. I'm glad you'll be seeing a pediatric cardiologist. That's the best person to check this and rule out anything dangerous. I don't want to guess what it might be because any illness in a child is too scary to think about. I'd rather the doctor give you the facts.
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Avatar_m_tn
I do not, but this definitely sounds like something that should be followed up on.  I would think they should do a holter on him or loop test, something that will monitor him to see his baseline heart rhythm and what rhythm he is in when becomes symptomatic.  I would for sure ask for another echo.  Have his iron levels been checked? Do you think he gets enough from dietary sources?
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Avatar_f_tn
He had complete bloodwork back in March/April following complications from a routine tonsillectomy/adenoidectomy. The day after surgery he came down with a bad cough and became extremely sick and lethargic, not eating and hardly drinking for 11 days (finally was admitted to the hospital). Anyway, his bloodwork on followup was normal. He eats very well and I have him tested annually (last time in April) for Celiac disease since his father has it. So far he's negative for that so it shouldn't be dietary in nature.  

Also, he has had a very hard time the last several months going upstairs, and always has to stop and "rest", saying his legs are weak. I don't know if that sort of thing is related or if he's just not a very athletic child!

I appreciate everyone's responses and insight - it's very helpful!
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187666_tn?1331176945
I don't know of a 4 year old that's not "athletic."  I don't mean in terms of sports and muscles. But most 4 yo kids are on the move wiggling, climbing, moving around. If he's getting winded or achy just walking up a flight of stairs, something odd is going on. I do hope you get answers soon and that it's nothing bad. I have 4 grandchildren now and it always breaks my heart when one of them gets sick. Our oldest grandson, only 2, has had a couple surgeries already and lots of PT because of his spine. It just isn't fair.
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Avatar_f_tn
Hello and welcome to this site (also just wanted to let you know that there is a support forum for parents here on MedHelp called: Pediatric Cardiology Forum, it is not the EXPERT Forum).

When a person is in Medical School, one of the first things he is taught is to always look for the most obvious thing for what is going on along with the : "First, do no harm" and "Listen to your patient, he will tell you what is wrong".

You probably will not be thrilled over this, but what hits me, first and foremost is that your child may be playing you as a parent; kids are so good at doing that. I am NOT saying that is what he is doing, I just telling you that you need to step back and give that some consideration. Why am I saying that? There are a few reasons:1) because of his age. 2) chest pains are very common as a complaint in children and teens 3) and because of the description that you wrote saying sometimes he can do things and not have pain "...but he has also run and not had pain...".4) there could be other health issues going on.

So let me take these problems one at a time.
I have brought up the idea that your child 'could be playing you'. I do not mean for that to upset you in any way, but we all know that young children have that capability and they are good at it. Children are glued to watching their parent's reactions to things going on. You mention the words "chest pain" with a family member and everyone in that family becomes very concerned because we as adults all understand that that means there could be serious problems going on. It could even mean death. It is not uncommon for children to complain about chest pains after Uncle Joe or Grandpa has a heart attack. The child hears everyone talking and it becomes a part of their world. We, as adults, sometimes do not give the children enough credit. When a child complains about something as serious as chest pain, what does it do? It gets his A LOT of attention, because we as adults know what that can mean and as parents we have the instinctual need to protect our children. A child feeds off of that overwhelming attention and a cycle can begin as a result. Is your child doing this? I have no idea, but it is not uncommon.



Children in this age group often times complain of chest pain; usually they feel the hard thumps of premature beats and refer to it as chest pain because it is uncomfortable for them; it is NOT true heart related chest pain caused by a lack of bloodflow to the heart muscle wall. Children who have true chest pain usually have severe forms of cardiomyopathy where the heart muscle, itself, is diseased or have some other form of congenital heart structure issues going on. In almost all of those cases, you would have known about the problem by now.

You wrote about your son being able to run on some days and not on others as well as his issues of trying to go up the stairs and having to rest. If your child had a heart problem severe enough to have chest pain, these activities would cause chest pain EVERYTIME, not just some time or part of the time. At 4 years of age, he would not want to go out and play and run around, instead you would find him doing sedentary activities; he would begin to do this himself, instinctively. He would not be able to keep up with you walking through the toy store or at the amuzement park, things like that. If he is in preschool, your son's teachers would notice all of this even if you did not.

There are a lot of health issues that your son could possibly dealing with, everything from asthma to something as serious as Glycogen Storage Disease where the body cannot break down sugars properly, for energy.

Your son needs to have a GOOD evaluation, not just bloodwork. He should probably have a Holter Test done to see if he is having arrhythmia issues going on. Maybe his blood sugar levels (GTT) should be done as well as genetic testing. Have his Thyroid checked as well.

Above all, follow your instinct. I remember when my daughter was 2 years old both my husband and I made the comment that we did not think our beautiful, healthy looking daughter would live to adulthood and at 4 I told a friend that if I didn't know any better I would swear my daughter had heart disease. At 22 she needed a heart transplant to live.          
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Avatar_f_tn
Thanks for all the thoughts - some I can definitely rule out, and I really don't think it's cardiac-related myself, but maybe will ask for blood test specific to glucose. He had complete thyroid workup last year. I think he's feeling something other than "pain" but doesn't know quite how to describe it. I do think he's aware of something, though. Would an arrhythmia issue present like that?  I guess that's something an echo wouldn't have picked up. So sorry to hear of your daughter's health problems - it sounds like you know what severe symptoms look like. Hope she's doing well now.
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Avatar_f_tn
I'm so glad you have written back. To answer your question: yes, an arrhythmia issue could present like that and usually young children describe palpitations as chest pain. If it were me, I would certainly ask about a 48-72 hour Holter to be done ( not the 24 as it rarely picks up anything). There is also something called the King of Hearts Monitor which is worn for 30 days where the patient pushes a button when he is feeling "off". There is also a Loop Recorder which is implantable. I would also recheck his Thyroid testing just to double check it; you never know if or when something can change. The GTT has to be done over a several hour period of time; blood draws for a period of 4-5 hours, timed out. A simple blood test isn't going to do much good; you need to see how his sugar levels develop over several hours; this is not a simple test and with him being 4 years old, he is not going to be a happy camp[er. Make sure they use a butterfly needle on him any time he gets blood drawn, it's a tiny needle. Thank you for asking about my daughter; at the moment she has started the process of being re-evaluated for a second heart; I guess that speaks for itself, right? Take care and give your baby a huge hug! :)
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Avatar_f_tn
His appointment with the pediatric cardiologist is coming up this Thursday, and I realize he hasn't complained of any "feelings" in his chest since the 15th - 2 weeks ago. I think I'll cancel the appointment - I hate to waste the doctor's time and possibly incur unnecessary expenses with additional testing, etc. if this is just nothing.
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Avatar_f_tn
Meant to post my above comment to you. Curious to see if you'd agree - I appreciate your input if you get a chance...
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Avatar_m_tn
I would keep it, your child's health is priceless.

Children shouldn't be getting out of breath like you mentioned, and the way he describes it could definitely be a rhythm issue.  Just my 2 cents.
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Avatar_f_tn
Thanks!
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Avatar_f_tn
You keep the appointment; we can all tell you what we think on this forum, but we are not there looking at you and your little one. We are not doctors; some of us, myself included, may have worked in the medical field, but it doesn't matter. That PC will see and listen to your son's heart and maybe do some tests on him to rule things out. Chest pain is VERY common in children and teens and can be caused by a number of things; 9 times out of 10, it isn't the heart. He needs to still see the doctor and be evaluated. Bring up all of your fears as well; believe me, the PC has heard them all before. Keep uas posted!
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Avatar_f_tn
Wanted to update this for the sake of anyone who might come upon this thread later w/ the same concerns. My son saw the pediatric cardiologist as scheduled and his Echo and exam were normal. He has not continued having the pains, so I guess I jumped the gun. Next time he has a weird symptom I'll wait more than a month to see if it continues . . .
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Avatar_f_tn
Are you nuts?  Take him to the Cardiologist, or take him to Cleveland
Clinic they are the best in the Country.  I think C.C. is number 1 in
the Country.
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Avatar_f_tn
I'm very happy for you that your little one looks to be okay!! Follow your instincts, it is a part of you as a parent. Did the cardiologist mention the possibility of arrhythmias for your son?
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Avatar_f_tn
No, he didn't. I forgot to mention that he wore a holter monitor, but it was for less than 24 hours. I have wondered about the possibility of arrhythmia, but would think he'd have to wear it for a longer period of time to catch that, and that he'd have to participate in normal activity since his pain came with exertion. They told him to "take it easy". He does have a follow-up in 6 months since he had a complaint of chest pain, but without any more symptoms I doubt they'll do more tests.

Thanks for your concern and advice!
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Avatar_f_tn
Welcome back. A Holter Monitor is always placed for at LEAST 24 hours. Sometimes they will run the test for 48 or better still, 72 hours. It can be very difficult to catch arrhythmias on any of those Holters and it may take having the monitors put on many times before an arrhythmia can be caught. The King of Hearts Monitor is better; it is worn for 30 days and the patient pushes a button to record the heartbeat when something is amiss. I would not let this go, keep on top of it. I would certainly be questioning ANY doctor who told my 4 year old son to "take it easy"!!!!! That is NOT normal behaviour for any 4 year old, especially a boy! Why on earth are they telling you that?? AND exactly what does that mean???
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Avatar_f_tn
Sorry - I wasn't clear on that. The nurse just told him to "take it easy" while he had the monitor on. I had asked if he should run around, since that's when he always complained of pains. She said no exercising with the monitor, and in fact, to "take it easy" while he had it on. He was just a few hours short of 24 hours but still, I felt it wasn't an accurate sample since he just slept and sat around - not normal activity.
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