Chest pain due to heart disease in children

Though rare, some cardiac causes of chest pain in children are worth noting. Pericarditis or inflammation of the covering of the heart can cause chest pain in children. Most cases of pericarditis are self limited, but can rarely become a serious problem. It causes a shart pain which may be relieved by sitting and leaning forwards. Fever may be associated with pericarditis. Abnormalities of the coronary arteries which supply oxygenated blood to the heart can occur as a congenital anomaly or secondary to conditions like Kawasaki disease. Thickening of heart muscles due to heritable conditions like hypertrophic cardiomyopathy have also to be thought of. Mitral valve prolapse of bending backwards of the mitral valve between the left atrium (upper chamber) and the left ventricle (lower muscular chamber) can also cause chest pain, more often in adolescent females. Most often it is only a minor abnormality though rarely it can cause a leakage of the valve which can be significant. Another rare cause of chest pain could be an aneurysm of aorta (swelling of the great vessel which arise from the left ventricle). This is quite rare in children and can occur due to a condition known as Marfan syndrome. Rarely fast heart rate due to abnormal heart rhythms may also be felt as a chest discomfort by some children.

Supraventricular tachycardia is seldom fatal and can often be terminated easily in a cardiac care set up. Sometimes it can be terminated even without medications by a cough, strain or a gag reflex or a splash of ice cold water over the face as well. Another method which emergency personal use to terminate the episode is by giving a pressure over the carotid sinus in the neck. But this should not be attempted by a lay person as it has its own risks. Carotid sinus massage should be done carefully, with ECG monitoring in an emergency care set up. If the disorder is left untreated for a long period,it can cause weakening of the heart muscle causing a fall in blood pressure and heart failure. Recurrence can be prevented by medications taken on a long term basis. Some with very infrequent episodes also opt for a “pill in the pocket” approach by taking a tablet as soon as the symptom occurs. Definitive treatment these days is in the form of identification of the site by cardiac electrophysiology studies and radio frequency catheter ablation. In this procedure, small multi electrode catheters are introduced into the heart, monitoring the electrical signal from each location. One the exact site of the abnormality is localized, a radiofrequency signal is delivered to cause a tiny controlled superficial burn which stops the abnormal electrical activity within the heart. This procedure has a fairly high success rate and few complications and hence is being resorted to by most persons to avoid the problems of taking long term medications.

Atrial fibrillation is an electrical disorder of the upper chambers of the heart in which regular electrical pulses from the sinus node are replaced by fast disorganized electrical activity which causes the upper chambers (atrial) to stand still and quiver. This can lead to blood clot formation in these chambers which can move along the blood vessels to regions like the brain and cause disorders like stroke or paralysis.

There could be multiple roles for a pacemaker in patients with atrial fibrillation. In those with recurrent rather than persistent atrial fibrillation, pacing the atrium (upper chamber of the heart) simultaneously from multiple sites can reduce the recurrence of atrial fibrillation. Another role is to have a pacemaker when atrial fibrillation is refractory. In drug refractory atrial fibrillation, radiofrequency current is used to cut off the pathways which conduct the atrial pulses to ventricles using specially designed electrode catheters. This produces a complete heart block and requires a pacemaker to give regular electrical pulses for the ventricles to contract regularly.