Kids & chest pain

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Specializes in School Nurse, past Med Surge.

Don't you just love it when you get that complaint? I had a 3rd-grade kiddo a couple of weeks ago tell me "It feels like a chunk of my heart fell off into my chest," when describing chest pain he was having. Vitals were all WNL, but I did hear an irregular heartbeat that I did not feel was related to his breathing pattern. Kid wasn't really goofing off in the clinic but he wasn't looking distressed either. I felt like he was most likely fine, but there's always the "what if" in the back of your mind. I called mom, suggested she call his doctor and let them know what was going on with him. They told her to take him to the ER. Everything was OK, they did an EKG & chest x-ray. Doc heard the irregularity but said it was normal (so I assume he thought sinus arrhythmia?). Fast forward to today and kid is back saying he has the exact same feeling. Vitals still WNL & I still hear an irregularity that IMO is not related to breathing. I called mom & she isn't overly concerned. She asked me to give him Tylenol & send him back. Cool. I feel like he's fine. I've done what I need to do. But I'm annoyed because I feel dumb. I'm neither a cardiologist nor do I have an EKG machine nor do I feel like I had much exposure to listening to arrhythmias back in my hospital days. Does SA sound different? Does anyone have any really good resources for heart sounds?

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Specializes in kids.

Can you get a release to talk to MD? Any chance he has symptoms of GERD? Maybe costochondritis, pectus excavatum or pectus carinatem?

http://www.childrenshospital.org/conditions-and-treatments/conditions/c/chest-wall-deformities

Curious to see what the end result will be.

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Specializes in ICU/community health/school nursing.

Or harmless PVCs (I have 'em.) The thing is... I don't feel them. So, you've done what you can with what you have. Don't overthink. You have EMS in your corner if needed. Document the pants offa "Mom said to give him Tylenol and send him back." Hugs to you.

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I had a fifth grade kid come in last week with right sided chest pain. Vitals were fine but he was both guarding and clenching the upper pec. This was also a child I never see. I was pretty sure it was some sort of GERD or gas issue. Since he was so uncomfortable, I called the parent who came and got him. The child was back in school the next day and fine according to his teacher. But let me tell you....over the next few days, "chest pain" was the cause of a lot of visits for fifth grade flyers. ?

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Specializes in ICU.

My first thought -- I have crippling anxiety. As an adult, I'm on medication but as a child, I was on my own and my symptoms were entirely unmanaged. My anxiety specifically manifests itself in heart palpitations, high blood pressure, and dizziness. I can recognize my anxiety now, but I remember how scary it felt as a child. Potentially it's psychological? It may be nothing, but it's very real to him. That's something an EKG wouldn't show ?‍♀️

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Specializes in kids.
19 hours ago, beekindRN said:

My first thought -- I have crippling anxiety. As an adult, I'm on medication but as a child, I was on my own and my symptoms were entirely unmanaged. My anxiety specifically manifests itself in heart palpitations, high blood pressure, and dizziness. I can recognize my anxiety now, but I remember how scary it felt as a child. Potentially it's psychological? It may be nothing, but it's very real to him. That's something an EKG wouldn't show ?‍♀️

I truly believe their pain is real. I often think the cause is non physical.

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Specializes in school nursing, ortho, trauma.
On 7/4/2019 at 12:50 AM, beekindRN said:

My first thought -- I have crippling anxiety. As an adult, I'm on medication but as a child, I was on my own and my symptoms were entirely unmanaged. My anxiety specifically manifests itself in heart palpitations, high blood pressure, and dizziness. I can recognize my anxiety now, but I remember how scary it felt as a child. Potentially it's psychological? It may be nothing, but it's very real to him. That's something an EKG wouldn't show ?‍♀️

i had a student who came to me just about every day in third or fourth grade with chest pain. I'd put her through the paces - vital signs, call parent every day - no distress, everything wnl, etc... By about the 6th or 7th time, mom just stopped answering the phone when I would call. My best guess is that it was something anxiety related and that there was something afterschool she didn't want to contend with, as this pain would usually start at the end on the day. The following school year, the child came back in september without complaints of chest pain, but a bad attitude and a lot of behavior problems. ?

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