When we are infants, developing in the womb, our heart starts out as a tube that folds into what will eventually become our chest. By the 28th day of development, it has folded into two pouches, and by the 40th day the valves between chambers are starting to form. If you ever get a chance to watch a video representation of a slowly forming heart, take a look. It is a fascinating process with twists and turns. It is crazy to think how those tiny cells and shapes turn into what will later pump oxygenated blood around, and around and around for a lifetime.
Our hearts work through several different mechanisms. There is muscular tissue that does the heavy lifting of the heart, collecting “used” blood from the body and pumping blood that doesn’t have full oxygen to the lungs. Then it receives that blood, now oxygenated, from the heart. Then it pumps the oxygenated blood to the rest of the body to be used. And this process happens, beat by beat, over and over. In infants, the heart beats at 100-160 times a minute under normal circumstances, and in children and adults it slows down a little bit as its volume increases.
When children complain of chest problems, there are a lot of different things that we have to consider. I wrote about some of the congenital problems that can occur in infants/children and how those would be detected. For serious problems, the child gives us signs of concern, and it is usually picked up long before the child can say “my chest hurts.” When the child gets older, though, they begin to express pain, discomfort or just abnormal sensations.
Chest pain is a red flag complaint for adults, but it is less clear in children. Whereas in adults, chest pain is frequently cardiac, most of the causes of chest pain in children are not heart-related. The possibilities of chest pain more often include muscle/chest wall pain, acid reflux or lung-related issues (coughing causing pain, pneumonia, asthma issues, etc.). Studies in children presenting to the ER with chest pain demonstrate that, unlike adults, the most effective approach, in addition to a complete history and physical, is to perform an EKG. If vital signs and EKG are normal, and the child does not have other red flags, children can usually be discharged from the ER with close follow up.
So, what does that EKG look for? For most children, it is a screening test to look less for a heart attack, and more for signs that there could be an arrythmia. An arrhythmia is abnormal electrical activity in the heart. The heart may skip beats, or it may have a pattern of electricity that does not go through the normal circuits and, therefore, can cause pumping problems. If a child is having chest pain or palpitations, an EKG may help determine the problem, which can be referred to a cardiologist. If there is no sign of problems on the EKG, the child has normal heart rate and blood pressure, and there are no red flags, watchful waiting is usually recommended, with a possible referral to cardiology if red flags develop or if the child has persistent symptoms. Be flexible, be smart and be patient. You can do this.
“The heart of man is very much like the sea, it has its storms, it has its tides and in its depths it has its pearls too.” -Vincent Van Gogh
Katie Jackson, M.D., is a pediatrician with Utica Park Clinic Claremore.