Pediatric Heart Expert Forum
My little Athlete's Chest Pain
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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My little Athlete's Chest Pain

My 11 year old soccer star has been complaining of chest pain that presents itself when she is in a game or on a 30 minute job.  Seems to radiate from her upper center chest and subsides after a few minutes once she quits the exercise.  She does not appear to have reduced breath at the time these pains kick in.  She is in great shape, so we are baffled.
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Dear Jim,

Not being able to assess your daughter or to ask her the questions that I need to help me diagnose her leaves me somewhat limited in the response that I can give.  I need much more information, including how long it lasts, is it sharp or dull, how severe is it, is it worse with inspiration, and a lot of other questions.  Chest pain with exercise can be due to muscle strains or tears, or can be associated with a true heart problem.  The pain associated with a true cardiac reason, though, is the worst pain EVER.  It is a crushing sensation in the middle of the chest, like an elephant sitting there, with radiation up to the neck, out to the left arm, or down to the abdomen.  These people are sick appearing.  The pain can last 20 to 30 minutes, and they can be very pale, sweaty, nauseated, and dizzy; it is not reproducible by pushing on the chest.  I can say that the vast majority of chest pain in children and teenagers is not due to the heart, but chest pain with exercise is somewhat more concerning.  Therefore, as far as her chest pain goes, I would definitely have your primary care provider go through this evaluation with her and make sure that the history and examination is reassuring.  
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