Pediatric Primary Care (71 page)

Figure 24-7b
Stepwise approach for managing asthma in children 5–11 years of age.

Figure 24-8
Stepwise approach for managing asthma in youths ≥ 12 years of age and adults.

BIBLIOGRAPHY

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CDC fact sheet: pertussis technical information.
Atlanta, GA: Centers for Disease Control and Prevention; 2003.

Klassen T, et al. Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial.
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Principles and practice of pediatric infectious diseases.
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Global burden of asthma
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Practical guide for the diagnosis and management of asthma
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Pickering L.
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CHAPTER 25

Cardiovascular Disorders

Karen M. Corlett

I.  CHEST PAIN

A.  Etiology.

1.  Classes of chest pain.

a.  Severe, acute, unremitting chest pain: Refer immediately to pediatrician or urgent/emergent care facility. Rare and most often due to cardiac, pulmonary, or gastrointestinal causes.

b.  Chronic or recurrent chest pain: more likely.

•  Typically patient has had several episodes of chest pain before medical attention is sought.

•  Many times, physical exam may be normal.

•  Patient history is crucial in elucidating etiology of chest pain although large percentage of chest pain in children will never have etiology determined.

•  Chest pain is distressing to patients, families: chest pain in adult friends, relatives typically signifies cardiac event, most chest pain in childhood is noncardiac in origin.

•  Thorough history and physical can rule out serious causes for chest pain.

2.  Chest pain, cardiac in origin.

a.  Coronary artery disease.

b.  Congenital heart disease.

c.  Typically have murmur.

d.  Acquired heart disease.

e.  Infectious etiologies.

f.  Cardiomyopathy, pericarditis, Kawasaki disease, rheumatic fever.

g.  Myocardial issues, myocarditis.

h.  Cardiomyopathies.

i.  Dysrhythmias.

j.  Supraventricular or ventricular tachycardias.

3.  Chest pain, noncardiac in origin: most common.

a.  Musculoskeletal.

b.  Pulmonary.

c.  Gastrointestinal.

d.  Psychogenic.

B.  Occurrence.

1.  Few studies of overall incidence of chest pain in pediatric population due to wide range of specialists to whom these patients are referred.

2.  Incidence, particularly in adolescents, is significant.

C.  Clinical manifestations.

1.  Chronic or recurrent intermittent chest pain.

a.  Most often occurs in adolescent population.

b.  May or may not limit activities.

c.  Usually chest pain has been long standing before treatment is sought.

d.  Important to elucidate inciting factors and relieving factors.

•  Relationship of pain to activity varies.

e.  Associated symptoms.

•  Syncope, presyncope, dizziness, palpitations.