complaint of "my heart hurts"

[mc3, ASN, RN]

Hello, I am new at this, and ran into this situation today. Elementary school student came to clinic c/o "my heart hurts". Sx started while they were on the computer - said it hurt so much it "caught my breath" and worsens upon inspiration. VS were 97.8 60 irr 18 and 90/60. Student denied SOB/tightness in chest, H/A, N/V or pain anywhere else. Only other complaint is that they were hungry (it was just before lunch). The irregular HR threw me as student said they never had that before, or chest pain, and they could feel the irregularity. It was a very consistent "bump bump, bump-bump-bump". Student said they had never felt this kind of pain before but did not appear in any acute distress. They did also have a very flushed face and looked worried. Mom/family were immediately contacted and denied student had any PMX of cardiac issues. They declined my offer to call 911 and wanted to come pick student up right away, which was done. The irregularity, pain and flushed face continued the whole time I was with the student - for about 45 minutes or so. I strongly suggested (we are not allowed to recommend, only suggest for reasons that I won't get in to...) that student be seen by MD TODAY.

My question is, did I over/underreact? Should I have called 911 despite what the family wanted? As I said, student did not appear in acute distress and was breathing and talking fine. How can it be that a student suddenly develops chest pain and a previously unidentified arrythmia? P.S. They are not a frequent flyer..........

Oh, and a second question. Another student had a temp of 95.5. I've noticed a few kids have low temps in the 96's but they seem fine. I'm used to the elderly having low temps - can kids get them too? What would cause it?

Thanks in advance for your help!

mc3:nurse:

[Flare, ASN, BSN]

I would have done exactly the same thing in the case of the "heart issues". As far as the temps - that's not uncommon - especially early in the morning. If you are using a tympanic thermometer, cerumen may affect results.

[mc3, ASN, RN]

i would have done exactly the same thing in the case of the "heart issues". as far as the temps - that's not uncommon - especially early in the morning. if you are using a tympanic thermometer, cerumen may affect results.

ding! the bell goes off...of course, that's what it is!!!!!

mc3

[mustlovepoodles, RN]

I agree with the way you handled it. A child in no distress, except an irregular heartbeat, does not need 911. He does need to be evaluated by a doctor though. If he had been shocky, altered, dyspneic,or diaphoretic, that would be a 911 call. It will be interesting to see what they find. I had a girl last year who had mitral valve prolapse and she would get these random "heart pains" with and without exertion. When it would start up she was actually weak, nauseous, pulse racing and irregular. She has a prn heart med in the clinic(oh,heck,I can't remember~) which I would give her and call her mother. Usually mom would pick her up but a few times I just had to keep her with me until she felt better, about 30-40 minutes of quiet rest did it.

Good call~

[bergren]

Ditto - I'd have handled it the same.

[Wishinonastar, BSN]

I have had a lot of the same complaint. Having worked in telemetry I know that there is a lot more to the picture than just one symptom conveys. I did find a student who ended up seeing a cardiologist and having extensive testing. He has major blockage issues in a coronary artery at age 17! He had a BP of 78/60, HR about 100, irreg. as I recall, and he was pale. He got dizzy and almost fainted in class. Initially I thought maybe dehydration/ electrolyte imbalance but he stated that he had been eating and drinking well, no sports or other activities that might have triggered excessive sweating. I was glad I called his dad to pick him up.

I also had a student with flushing, diaphoresis, tachy irregular heartbeat but normal blood pressure and resp. status. It was diagnosed as anxiety. Sometimes kids on stimulants or other meds can also have these symptoms. And in high school it is seen with energy drinks. As long as cardiac output seems adequate, vitals are within normal limits and the child is not in distress I think a parent taking him to the doctor is appropriate. I think you did the right thing.

From what I have seen both kids and the elderly can have atypical symptoms and both are equally as challenging to assess! I think unless a kid had consistently subnormal temps I would not worry, so much can depend on what they were doing right before they came in and the time of day. A very sick child with a low temp can be a sign of sepsis, and a consistently low temp can be a sign of hypothyroid. That is the two things that come to mind, but we are talking lower than just one reading of 95.5.