Episode Transcript
Dr. Miller: Your child has chest pain. Does he need to see a pediatric cardiologist? That's next on Scope Radio.
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Dr. Miller: I'm here with Collin Cowley. He's a pediatrician and a cardiologist and he's a professor of pediatrics and he works over at Children's Primary Hospital. Collin, tell me a little bit about chest pain in kids. Do you see chest pain in kids very often?
Dr. Cowley: It is a very common symptom. We see well over a thousand patients a month in our clinic at Primary Children's Hospital alone. A significant number of those patients are coming in with symptoms of dizziness or fainting.
Dr. Miller: In addition to chest pain?
Dr. Cowley: In addition to chest pain.
Dr. Miller: So the families are worried that oh my gosh, this could be a heart attack because they hear so much about that on the adult side if you're having crushing substernal chest pain.
Dr. Cowley: Absolutely.
Dr. Miller: As an adult you probably should consider that this might be a heart attack and get to the emergency room. Is that right?
Dr. Cowley: Right and that is ingrained in our culture. Even smart, well trained physicians and pediatricians in the community, a kid comes into their office and the kid says, “I have chest pain,” they very quickly say you better go see a cardiologist.
Dr. Miller: And once they get to your doorstep, what do you find?
Dr. Cowley: A normal kid usually with chest wall pain. We will typically do an electrocardiogram as a safety measure. It's probably overkill in and of itself. There are a few providers who might step up the testing to other things that are far more expensive. But the incidence of underlying heart disease in otherwise healthy kids presenting with chest pain is close to zero.
Dr. Miller: It's much different than it is in adults, right?
Dr. Cowley: Absolutely, it's a paradigm shift essentially.
Dr. Miller: So the number one cause of chest pain in kids is something related to the musculo-skeleture of their chest wall, right?
Dr. Cowley: Yes, and especially in teenagers. These teenagers growing, your chest wall is actually a very dynamic part of your body.
Dr. Miller: There's nerves running through the . . .
Dr. Cowley: Exactly. Lots of cartilage and in the normal process of growth sometimes those nerves get . . .
Dr. Miller: Or if they're rough housing . . .
Dr. Cowley: Exactly. Or yeah, their dad sits on them, something along those lines. That's a source of crushing chest pain that we can't treat, when your Dad is sitting on your chest.
Dr. Miller: The bottom line is, if your child has chest pain, and when you say child you mean up to the age of what, 18, 16?
Dr. Cowley: Yeah, yeah 16 to 18. It's pretty common for us to see teenagers in this age group, but oftentimes school aged children as well.
Dr. Miller: The vast majority of the time it's not going to be anything related to heart.
Dr. Cowley: I've actually never seen it be related to the heart in the 20 years I've been working as a pediatric cardiologist.
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