Chest pain in teens is uncommon, and it can be due to cardiac or non-cardiac diseases (1). Fortunately, chest pain in teens usually occurs due to non-cardiac conditions. In most cases, it can be due to conditions such as asthma or chest wall pain from muscle or bone injuries or inflammation. However, chest pain is a concerning symptom at any age, and health care providers should evaluate it to diagnose the underlying cause. Read on to know the causes, accompanying symptoms, diagnosis, and treatments for chest pain in teens and when to seek medical care.

Signs And Symptoms Associated With Chest Pain In Teens

Signs and symptoms present, along with chest pain, may depend on the underlying cause. The pain can be felt as a burning, sharp, or throbbing sensation in the chest, depending on the cause. The following are some of the signs and symptoms that may occur along with chest pain (2). Chest tightness or pressure with crushing pain is a classic symptom of a heart attack. Chest pain due to heart attack may last for a few minutes to a few hours. However, the above-listed symptoms can be seen in cardiac and non-cardiac chest pain. If your teen had chest pain for a few days or weeks, then it could be due to non-cardiac causes (3). However, it is important to seek doctors’ attention for diagnosis and early treatment.

Chest Pain In Teens: When To Worry?

If your teen has chest pain with other symptoms such as shortness of breath, rapid heart rate, syncopy or loss of consciousness etc., then seek immediate medical care (4). Acute onset of chest pain due to trauma can often indicate conditions causing accumulation of fluid or air in the pleural cavity (cavity around the lungs) or pericardial cavity (cavity around the heart). It can be fatal in a short time if left untreated. Seek emergency care if your teen has an acute onset of chest pain.

Causes Of Chest Pain In A Teenager

Chest pain can be grouped into cardiac chest pain and non-cardiac chest pain. Non-cardiac chest pain is usually more common in teens (5).

Non-Cardiac Chest Pain

Non-cardiac chest pain may account for 98% of chest pain experienced in adolescents and children. This can be mainly due to musculoskeletal pathologies, gastrointestinal problems, or pulmonary problems. The following diseases can be the reason for non-cardiac chest pain (5).

1. Musculoskeletal chest pain

Chest wall or musculoskeletal pain can be the most common cause of chest pain in teens. Various diseases and conditions can cause pain in the thoracic (chest) area.

Costochondritis: This is also known as costosternal syndrome and may cause stabbing pain on one side of the chest. Costochondritis is the inflammation of cartilages of the rib cage that are attached to the sternum (breast bone).

Tietze syndrome: It is the inflammation of the cartilages attached to the ribs. The syndrome often occurs due to excessive coughing during an upper respiratory tract infection.

Non-specific or idiopathic chest wall pain: It is a sharp pain lasting a few seconds to minutes without the signs of inflammation.

Slipping rib syndrome or lower rib pain syndrome: This can be due to trauma or dislocation of lower ribs.

Muscle strain and injuries: Chest wall trauma or muscle strain mostly occurs due to weightlifting, gymnastics, or other sports activities. Chest wall injuries can present localized tenderness and pain. However, teenagers who experience chest pain with breathing trouble or rapid heartbeat after trauma, such as fall, road accident, etc., may require immediate medical care to rule out pericardial or myocardial damages.

Texidor twinge or precordial catch: It is a sudden sharp pain on the left side of the chest. It can be due to a pinched nerve or a poor body posture.

Xiphodynia or hypersensitive xiphoid syndrome: It is a pain in the part of the breast bone called the xiphoid process.

Around 2 to 11% cases of chest pain can be of pulmonary origin. Bronchial asthma is one of the major causes of airway-related chest pain in teens. Pulmonary embolism (blockage of arteries in the lungs) can be associated with intense chest pain and shortness of breath. The respiratory causes of acute chest pain can be due to bronchial or lung infections that include:

Pneumonia Empyema Bronchitis Bronchiectasis Lung abscess

If your teen has sickle cell disease, then seek immediate medical care for chest pain. They may have chest pain due to acute chest syndrome or pulmonary infarction.

3. Chest pain due to gastrointestinal conditions

Gastrointestinal causes of chest pain can often be associated with other digestive problems, such as:

Gastrointestinal reflux disease (GERD) Peptic ulcer disease Esophageal spasm Esophagitis Cholecystitis

Food intake can increase or decrease chest pain in some gastrointestinal conditions.

Chest pain can be a physical symptom of anxiety in teens. Psychogenic chest pain can often be felt in teens who experienced a stressful situation in their life. Anxiety or panic attacks may cause hyperventilation. It may lead to chest pain resulting from heavy breathing and distention of the stomach from swallowing air (aerophagia).

Breast-related chest pain can be commonly seen in some teenage girls. This can be a throbbing or burning pain on one or both sides of the chest. Post menarchal chest pain can be due to mastitis, pregnancy, or fibrocystic changes of the breast. Teenage boys with gynecomastia may have breast-related pain.

6. Skin conditions

Herpes zoster infection may often cause pain on the chest wall, followed by the appearance of blisters (skin rash) after a few days.

7. Scoliosis or other deformities

Teens, who have scoliosis or other vertebral or postural deformities that cause compression of the spinal cord and nerves, may have chest pain.

Cardiac Chest Pain

Rarely, teenagers can have chest pain due to heart problems. It accounts for less than 6% of chest pain cases among teens. Conditions affecting the oxygen supply of the cardiac muscle can cause chest pain due to lactic acidosis. This type of chest pain is called angina. The following conditions can cause heart-related chest pain in teens (5) (6).

Pericarditis and pericardial effusion: Inflammation of the pericardium and accumulation of excess fluid in the pericardial cavity. It can cause sharp retrosternal pain.

Myocarditis: Inflammation of the heart muscles.

Endocarditis: Inflammation of the inner lining of the heart.

Structural heart defects: Chest pain can be the first symptom of many anatomical heart defects such as mitral valve prolapse (Barlow syndrome), aortic valve stenosis, etc.

Coronary artery diseases: Teens with coronary artery disease can have myocardial ischemia (coronary heart disease), resulting in exertional chest pain.

History of cardiac surgeries: Coronary heart disease can be a cause of chest pain in teens with a history of cardiac surgeries.

Aortic dissection: It is severe chest pain radiating to the back and often seen in teens with connective tissue disorders, such as Marfan syndrome. Teens with Turner’s syndrome, Ehlers-Danlos syndrome, and homocystinuria can also be at an increased risk of dissection.

Arrhythmias:Pediatric chest pain can be due to slow or fast heart rhythms.

Drug use: The use of certain decongestants, methamphetamine, marijuana, or cocaine can cause irregular heart rhythm and ischemia that may result in chest pain.

Kawasaki disease and giant coronary artery aneurysms: These conditions could lead to stenosis (narrowing of blood vessels) and thrombosis (clot inside a blood vessel), thus causing ischemia and chest pain.

Diagnosis Of Chest Pain In Teens

Your teens’ doctor may order a few tests after evaluating symptoms and physical examination. These tests help identify the exact cause of chest pain. The following examinations may be conducted based on clinical findings (7).

Electrocardiography (ECG) helps identify the electrical activity of the heart.

Echocardiography can identify structural and functional abnormalities of the heart. 

Exercise stress or treadmill test monitors ECG while exercising. It can help identify any abnormalities in heart rate or rhythm during exertion.

Chest X-ray may help identify lung pathologies.

Endoscopy is done to asses gastroesophageal reflux disease and other upper gastrointestinal conditions.

Blood tests can be useful in identifying any inflammatory markers.

Lung function tests can be useful in the diagnosis of asthma.

The tests are often ordered based on the history of symptoms and findings on physical examination. The doctor may refer the teen to a pediatric cardiologist or other specialists based on the results of the evaluation. It is recommended to restrict physical activities until the cardiac evaluation is completed. Some teens have to use a Holter monitor or transtelephonic monitor for two days or up to the suggested time to find the sudden onset of irregular heartbeat (arrhythmia). If the teen has chest pain without any physical reasons, then referral to a pediatric psychologist may be recommended for the evaluation of anxiety-related chest pain.

Treatment For Chest Pain In Teenagers

Treatment varies depending on the cause. Various treatment methods include (8)

Cardiologists may prescribe medications and procedures as required. Heart problems such as endocarditis, myocarditis, etc., are treated with medications, whereas a few structural anomalies may require cardiac surgeries.

NSAIDs are given for non-cardiac chest pain due to musculoskeletal problems after the diagnosis.

A pulmonologist may treat asthma or other lung pathologies.

Gastroenterologists may prescribe proton pump inhibitors or histamine blockers for GERD.

Psychotherapies and medications may be prescribed for anxiety chest pain, by a psychiatrist.

Orthopedic evaluation and treatment are required for scoliosis and other deformities.

Deaddiction therapy may be required in the case of drug abuse.

Antibiotics are prescribed for infectious diseases that cause chest pain. Analgesic medications are often given in some causes of chest pain.

Home Remedies To Cure Chest Pain In Teens

Most teens with chest pain require prescription medication for pain relief or to treat the underlying conditions. You may ask your teen to follow the following home care measures, along with the treatment (9). Anecdotal home remedies and over-the-counter medications may not be helpful in managing chest pain.

Risks And Complications Of Chest Pain In Teens

The following factors may be associated with a higher incidence of chest pain in teens (4).

A family history of heart diseases.

Stress may increase the risk of panic disorders and other anxiety disorders.

Cigarette smoking increases the risk of asthma and other respiratory diseases.

Substance abuse may cause chest pain due to heart rhythm changes and may result in myocardial damages.

Dietary factors can be associated with GERD.

These risks may vary based on the causes of chest pain. Cardiac chest pain or angina may result in a heart attack. Air pollution and exposure to smoke may lead to exacerbation of asthma and may cause chest pain due to severe bronchospasms.

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