By Molly Ray, MD
Pediatric Resident at The University of Texas at Austin Dell Medical School
Member, Texas Medical Association
Pediatric Resident at The University of Texas at Austin Dell Medical School
Member, Texas Medical Association
“Do you ever feel like
your heart is beating so hard it wants to jump out of your chest?” If you
tell your doctor you have chest pain, he or she might ask this question.
Sometimes chest pain, chest tightness, or palpitations (a feeling
of pounding/racing heart beat) are an indication of a serious condition such as
a myocardial infarction (a heart attack) or severe allergic reaction
(anaphylaxis).
However, what might seem surprising is that more teenage patients are visiting the
emergency department or their physician complaining of chest pain. The cause of
this pain in this unlikely group of patients? Acute anxiety.
Anxiety is becoming a more common diagnosis in the world of
adolescent medicine. The National Institutes of Health (NIH) reports that nearly
32% of adolescent patients surveyed on the National
Comorbidity Survey - Adolescent Supplement (NCS-A) have an anxiety
disorder, with girls affected more often than boys. Signs and symptoms of an
acute presentation of anxiety (an anxiety or panic attack) include chest pain,
palpitations, shortness of breath, difficulty sleeping, poor academic
performance, and feelings of uncontrollability, among various others.
How will my doctor determine
if there is a serious problem?
If an adolescent patient says chest pain is the main reason
for their visit to the emergency department or other acute-care facility, the
most important thing the doctor will do is get a thorough medical history of
that patient. It is important to know if the adolescent has any underlying
medical conditions that might raise suspicion of something more serious – such
as a history of heart surgery or murmur, a bleeding disorder, any medications
the patient may be taking, a family history of anyone with heart problems – including
sudden death at a young age (less than 50), or if the young patient has a pacemaker. It is
also important to note the factors and timing of the chest pain – time of day
the pain first started; where the patient was; what they were doing; and how
long the pain has been occurring. The answers to these questions will determine
which tests, if any, are necessary for the doctor to perform.
What are some of the
most commonly used tests?
Two of the most frequently used tests to determine the cause
of chest pain in adolescents include:
- Electrocardiogram
(ECG/EKG) – This is a tracing of your heart beat to see how fast, or slow, your
heart is beating and if there are any indications of an abnormal rhythm (an arrhythmia)
such as skipped beats, premature beats, or abnormal communication between the
upper and lower chambers of the heart. This test is performed by placing 12 or
15 stickers containing electrical leads across the chest to capture the
electrical current present in the heart. This creates an interpretable picture
of the electrical activity in the heart.
- Chest X-ray – This is an image of the chest which allows your doctor to look at the size and shape of your heart (cardiac silhouette). We also look at the surrounding structures such as the lungs, ribs, sternum, and portions of your abdomen, which may also contain clues to the source of your chest pain.
In a healthy adolescent with anxiety these tests will likely
be normal.
What can you do to
help prevent acute anxiety?
- Recognize
your triggers – Keep track of what you are doing, what you are thinking
about, who you are with, and where you are when you note feelings of chest pain
or other symptoms of anxiety.
- Develop coping
strategies – This is not an easy thing to do. Finding people, places, and
things that will help prepare you for interactions with your triggers – or
distract you from them – can be helpful.
- Find someone to talk to – All primary care physicians and providers likely use some type of screening tool to help identify patients with signs/symptoms of anxiety early so they can help patients and connect them to the right resources. Your primary care doctor is a great place to start.
In this modern age, there are many internal and external
pressures and stressors that can trigger anxiety in teens; this is something to
note as more of them report chest pain and anxiety disorder diagnoses continue
to rise. This article only briefly addresses one possible cause of chest pain.
If you or your teen are experiencing chest pain alone, or with any other
symptoms, it is important to talk to your physician.
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