14 y.o boy w/chest pain, intermittent blue hands/feet

[LD963]

Hello Dr., my 14 y.o. son began experiencing chest pain this past Mon. night and into Tues. a.m.  Saw his doctor Tues., who sent him to ER for evaluation.  EKG, chest x-ray, ultra sound, and blood work appeared normal.  Diagnosed as possibly having viral infection (e.g. influenza) that "landed" near his heart.  Had slight fever (100.2) off and on Tues.  Normal temp. since then.  Son continues to have chest pain, no matter what he does.  Feels somewhat better when he leans forward, and with a dose of Motrin.  However, continues to have intermittent circulatory issues; either both feet and hands are pale and bluish, or, as of last night, right foot was red, warm, normal, left was pale blue and cold.  He is taking Concerta, 36 mg./day.  Has been on meds for 5 years for ADHD, but increased from 27 mg. to 36mg in Dec. 2010.  No history of heart problems; he is very thin, always has been; 5'3" and 90 lbs.  Just don't understand the intermittent change in color of his feet when he is not feeling especially cold or warm.   Thanks for your help.  LD

[Marie M Gleason, M.D.]

Influenza and other viruses can inflame the heart and the sac in which the heart sits (called the pericardium).  If the pericardium is inflamed (pericarditis) then the patient can experienced significant chest pain, that is worse when laying down, and better when leaning forward.  This is usally treated with anti-inflammatory medications like ibuprofen on a regular basis for a week or two.  If the ECG, echocardiogram chest x-ray and lab work earlier this week were thought to be normal, then that is a good thing.  however, pericarditis can be a subtle finding.  If your child is still symptomatic, it would be worthwhile repeating the ECG to see if there are typical changes seen with pericarditis, and another echo to look for accumulating fluid in the pericardial sac.  As far as the changes in the coloring of the extremities, there is no physiologic reason why one leg would be a different color from the other.  However, if the heart is affected by a virus, then the perfusion to the body may not be normal, and the extremities could appear bluish and cold. I think he should be re-evaluated by your physician soon.  Continue the ibuprofen in the meanwhile if it helps him.  The ADHD medication is not likely to play a role here.

[LD963]

Thank you Dr. Gleason.  Your response helped me tremendously!

After a good night's sleep (finally!), my son saw a cardiologist this morning who repeated all the tests, which continued to be negative.  He noted that the extremity coloration seemed more likely to be part of my son's normal body reactions and just recommended that we watch this to see if it gets worse or causes pain over time.