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"Child`s Health" 3 (54) 2014

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The cardiac causes of the chest pain of children

Authors: Pshenichna O.V., Bordugova E.V., Konopcko N.N., Dubova G.V., Parshyn S.O., Koval O.P., UzunK.S. - Donetsk National Medical University of Maxim Gorky, Donetsk

Categories: Pediatrics/Neonatology

Sections: Specialist manual

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Pain in the heart in children is one of the most frequent reasons for the consultation of cardiologist. Interpretation of this symptom often is the cause of medical mistakes: overdiagnosis of heart disease, followed by inadequate treatment and underdiagnosis with lack of proper attention to the complaint.

There aretwo types of heart pain caused by heart disease. They are:anginal pain associated with myocardial ischemia resulting from failure of the coronary circulation; non anginal pain of a cardialgia, which is based on mechanisms other than those that cause myocardial ischemia.

Clinical classification of chest pain, that proposed by A.G. Diamond in 1983 include: typical angina, atypical angina, non-cardiac pain (not associated with myocardial ischemia).

Myocardial disease characterized by pain in heart are divided into: ishemic (myocardial ischemia (angina pectoris; acute myocardial infarction) and noncoronary (myocarditis, pericarditis, cardiomyopathy, congenital diseases of heart and great vessels, arterial hypertension, autonomic dysfunction).

Pain in congenital heart disease (CHD) had usually ischemic nature. It is most common in children with pulmonary artery stenosis - over and subvalvular aortic stenosis, coarctation of the aorta, aorto-pulmonary fistula; anomalies of the coronary arteries.

Important and common cause of chest pain is the syndromeof the ectopic discharge of coronary arteries (Bland - White - Garland, etc.). The most frequent causes of myocardial infarction in children are developmental anomalies of the coronary arteries and inflammatory diseases of the coronary arteries - coronaritis (Kawasaki disease, Takayasu disease, systemic lupus erythematosus, periarteritisnodos, nonspecific aortoarteryitis ). Moreover, the causes of myocardial infarction in children may be injured coronary arteries and heart, pheochromocytoma, supravalvular aortic stenosis.

Carditis is a heterogeneous group of different by the etiology and the pathogenesis of toxic, infectious, allergic, autoimmune and other diseases of the heart, which is the substrate of inflammation of the heart muscle.

Diagnostic criteria of the carditis aremyocarditic syndrome, congestive heart failure, electrocardiographic syndrome instrumental radiological and laboratory confirmation. Clinical symptoms of carditis depends on the etiological factors. Nonspecific initial harbingers of disease can be fatigue, weakness, sweating, low-grade fever, loss of appetite, nausea, and in some cases, vomiting, loose stools , dizziness, arthralgia, myalgia.

Pain in myocarditis is due to an inflammatory lesion infarction, heart failure, cardiac arrhythmias and conduction. Pain in myocarditis is usually oppressive or aching in nature, sometimes - piercing; little to do with the physical and emotional loads, often associated with feelings of outages heart palpitations or fading of the heart; anginal different from no effect on reception nitroglycerin, not accompanied by pathological changes in the ECG.

Pericarditis is an inflammatory disease, an exciting outer shell of the heart. Irritation of the nerve endings in the plurality of the pericardium gives rise to pain. Pericarditis localized pain at the bottom and the left chest - projected apex of the heart, can capture the entire region of the heart, the left half of chest radiating to the right side of the chest, right arm. Not typical for pericarditis pain irradiation to his left hand under the left shoulder, the left half of the neck and jaw. Acute pain, aching, cutting, not increases during stress and intense exercise. Its intensity depends on the position of the patient's body: often in order to reduce the pain, the child takes a sitting position, leaning forward; characterized by pain during inspiration. Cardialgia with pericarditis usually occurs early in the disease, due to the dry friction between the inflamed pericardium sheets, then at least for pericarditis effusion formation fluid in the heart bag friction stops and the pain subsides.

Cardiomyopathy is an idiopathic primary lesion of the heart muscle and not associated with inflammatory, neoplastic, ischemic genesis. Cardiomyopathy has a different genesis, morphological and clinical manifestations.

The pathogenesis of pain in primary cardiomyopathy determined hypertrophy and degeneration of muscle fibers, chaotic arrangement of myofibrils and destruction; damage to the mitochondria, reducing the amount of myosin and actin in the myocardium. The above leads to secondary dystrophic changes walls of the coronary arteries branches and dyscirculatory disorders, which makes the possibility of secondary focal ischemic myocardial injury. It is important to remember that while the majority of primary cardiomyopathy patients who died suddenly have no complaints or they were nonspecific and insignificant. Death is often the first clinical manifestation of the disease. Therefore, even minor clinical manifestations discussed pathology (cardiomegaly, heart failure, heart rhythm disorders) require careful attention physician.

Heart rhythm disorders in children often occur latently without complaints and clinical manifestations. Pain in the heart at the arrhythmia is a nonspecific symptom, often combined with other complaints: at the paroxysmal tachycardia withfeelings of frequent and strong heartbeats, at the heart block with a sense of fading heart, dizziness, weakness, at the extrasystoliawith feelings of disruptions of the heart.

Thus, the pain in heart of children is a symptom that accompanies a number of pathological conditions and diseases, requiring thoughtful, differentiated approach in each case. The timely determine the cause of pain in the heart depends on the tactics of treatment and prognosis.

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