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Etiologic Diagnosis and Clinical Characteristics of Chronic Recurrent Chest Pain in Children

Korean Journal of Pediatrics 2004;47(6):628-633.
Published online June 15, 2004.
Etiologic Diagnosis and Clinical Characteristics of Chronic Recurrent Chest Pain in Children
Eun-Jung Choi, Eun-A Lee, Chang-Woo Lee, Du-Young Choi, Yeon-Geun Oh, Jong-Duk Kim, Hyang-Suk Yoon
Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
만성 재발성 소아 흉통의 원인 질환과 임상양상
최은정, 이은아, 이창우, 최두영, 오연균, 김종덕, 윤향석
원광대학교 의과대학 소아과학교실
Correspondence: 
Hyang-Suk Yoon, Email: yhs0520@wonkwang.ac.kr
Abstract
Purpose
: To identify the causes and clinical characteristics, and the efficacy of various diagnostic approaches, we studied, prospectively, pediatric patients with chronic recurrent chest pain.
Methods
: A prospective study of 122 patients with chronic recurrent chest pain from June 1998 to June 2003 was performed. The male and female ratio was 81 : 41, age 9.3?.1 year. A single chart including pain description(histoy) and pain questionaire, with associated symptoms, was used for systematic history taking. The patients were devided in two groups, Group A, before June 2001(n=70), Group B, after June 2001(n=52). Chest X-ray and ECG were checked in all patients. Allergy tests and echocardiography, 24 hour ECG monitoring, exercise tests, pulmonary function tests, and gastrointestinal fiberendoscopy were performed selectively.
Results
: Idiopathic origins were most common(32%). The remaining causes were psychogenic(23%) and exercise-induced asthma(20.5%), hyperventilation syndrome(9.1%), tachyarrhythmia(4.9%), cardiac (4.1%), pulmonary(3.3%), reflux esophagitis(2.5%), in order. The positive rate of allergy tests(24%) was higher than that of cardiac examinations(11-20%). Exercise-induced asthma was more common than psychogenic causes after June, 2001. Various abdominal symptoms accompanied idiopathic and psychogenic chest pains, and hyperventilation syndrome. Headaches were more commonly found in psychogenic pain, but chest tightness and dyspnea were common in hyperventilation syndrome. About half of exercise-induced asthma patients had symptoms of allergic rhinitis.
Conclusion
: In the majority(72%) of exercise-induced asthma, the chest pain was induced or aggravated by exercise, and relieved by rest. Causative antigens were detected in 69.2% of group B patients with exercise-induced asthma. Exercise-induced chest pain might be a first manifestation in allergy patients. So, we recommand allergy tests for patients with recurrent chest pains induced or aggravated by exercise. Hence, cardiac examinations such as echocardiography or 24 hour ECG monitoring could be performed selectively, case by case.
Key Words: Recurrent chest pain, Exercise-induced asthma


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