Contact: Curt Daniels, (614) 293-8962
Written by: Holly Wagner, (614) 292-8310
CHEST PAIN IN ADOLESCENTS IS COMMON, BUT RARELY SERIOUS
COLUMBUS, Ohio -- When a teenager feels sudden chest pains or other symptoms of heart troubles, it can cause a lot of concern for both the teen and his or her parents.
Yet nearly all the supposedly heart-related symptoms that adolescents experience are benign and, in fact, not related to the heart, according to Curt Daniels, clinical instructor of internal medicine at Ohio State University.
"It is common for adolescents to have chest pains," Daniels said. "Probably 10 percent or fewer of the teenagers coming to our clinic each year have significant heart disease."
Daniels and Wayne Franklin, clinical associate professor of pediatrics at Ohio State, co-authored a paper published in a recent issue of Pediatric Clinics of North America that examines common cardiac complaints of teenagers.
Chest pain is one of the most common complaints in this age group. Daniels said 90 percent of chest pain cases are related to changes in the musculoskeletal system.
"In very rare instances is chest pain related to the heart in a teenager," he said, adding that a thorough exam or an electrocardiogram (EKG) is recommended to rule out potentially serious cardiac problems.
Exams can usually rule out major problems in a patient with heart palpitations, or feelings of the heart beating forcefully. Daniels said palpitations are not a serious problem for most adolescents. An EKG or heart monitoring equipment used at home can generally determine the reason for the palpitations.
Of slightly more concern to the patient are fainting spells. Daniels said his clinic sees about 50 patients each year who suffer from frequent passing-out spells.
"Frequent fainting in this age group usually isn't a sign of serious disease," Daniels said. "Fainting could be serious when it is directly associated with exercise or is sudden, without warning."
He added that most cases are caused by vasodepressor syncope, fainting induced by the dilation of blood vessels.
"There is an increased incidence of vasodepressor syncope in this age group which may be due to a lifestyle change," Daniels said. "When kids hit adolescence, they tend to become more active in sports and usually start leading a teenage lifestyle, characterized by not eating much or drinking enough fluid while staying very active."
Treatment includes a fairly aggressive fluid regimen -- patients with vasodepressor syncope are required to drink at least 64 ounces of fluid each day and to stay away from caffeinated beverages. Doctors often use the incentive of improved sports performance to get teens to change their habits.
"In a small percentage of patients, medications may be needed to control vasodepressor syncope," Daniels said.
While the majority of teenage cardiology complaints fall into the benign category, there are more serious heart problems that may require a more extensive evaluation.
Supraventricular tachycardia (SVT) is a common heart problem found in adolescents. It is defined as a faster-than-normal heartbeat caused by an abnormal connection in the heart's electrical system.
Daniels said SVT is a fairly common finding and can be treated with medications or cured with cardiac catheterization procedures.
"This disorder seldom causes serious complications and is more of a nuisance to the patient," he said.
Although rare, Daniels said he sees some adolescent patients with structural heart diseases, including atrial septal defect (ASD) and mitral valve prolapse (MVP).
ASD is a hole in the upper chambers of the heart. If undiagnosed, ASD can lead to serious problems in mid-life, such as enlarged heart chambers, elevated blood pressure in the lungs and heart rhythm problems.
Daniels said if ASD is diagnosed early in a patient's life and surgeons patch the hole, that patient can have a normal life expectancy.
Mitral valve prolapse is the buckling of the mitral valve during contractions of the heart's main pumping chamber. MVP has a variety of potential symptoms, including chest pain, shortness of breath, anxiety and heart palpitations. MVP is usually a nuisance rather than a serious problem. In some instances, however, the valve may start to leak or thicken, in which case it could be surgically replaced.
"Physicians tend not to be very aggressive in treating MVP," Daniels said. "Unless there's a significant leaking of the valve in addition to the buckling, patients will never have anything serious happen."
While most symptoms aren't signs of major problems, there are serious heart diseases that can afflict adolescents, Daniels said. Concerned parents should take their teenager to a physician.
"The majority of patients coming to the clinic with complaints are very anxious about possible afflictions," he said. "However, after taking a careful history, performing a physical exam and an EKG, we usually end up telling the patient there is no heart disease."
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