Can chest pain in children and adolescents be caused by a heart attack?

Although chest pain can be frightening, in most cases in children and adolescents, it is not caused by a serious heart problem, such as a heart attack. Adults often associate chest pain with heart attacks, but this concern is much less common in children, as heart attacks are extremely rare in this age group. However, it is always important to evaluate chest pain to determine its cause and provide appropriate care.

Chest pain can arise from a variety of tissues and organs within and around the chest, including the heart, lungs, esophagus, muscles, ribs, tendons, and nerves. Pain can also radiate to the chest from other areas such as the neck, abdomen, and back. Common causes of chest pain in children are often non-cardiac in nature.

Cardiac-related causes of chest pain (rare in children)

For children and adolescents, cardiac causes of chest pain are extremely rare compared to adults. However, some potential heart problems that may cause chest pain include:

• Pericarditis: Inflammation of the sac surrounding the heart, which can cause pain in the center of the chest [1].
• Myocarditis: Inflammation of the heart muscle itself [3].
• Blood vessel problems: Such as a tear in the wall of the aorta, the large blood vessel that carries blood from the heart, which causes sudden, severe pain in the chest and upper back [1].

While these conditions are serious, they are not heart attacks in the common sense that affects adults and are much less common in children. Risk factors for heart attacks, such as a family history of heart disease, smoking, obesity, high cholesterol, high blood pressure, or diabetes, increase the likelihood of heart issues—factors that may be present in some adolescents [1].

Common causes of chest pain in children and adolescents

In most cases, chest pain in children is caused by non-cardiac, non-serious reasons. These common causes include:

• Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone. It causes sharp pain that increases with pressure on the affected area [1].
• Digestive problems: Such as heartburn (GERD), esophageal spasms, or stomach ulcers, which can cause burning chest pain [1].
• Lung problems: Such as pneumonia or pleurisy (inflammation of the membrane surrounding the lungs), which can cause sharp pain that worsens with deep breathing or coughing [1].
• Muscle and tendon strain: Strain of the muscles between the ribs can cause chest pain [1].
• Anxiety and panic attacks: Panic attacks can cause chest pain, often accompanied by rapid breathing [1].

When to seek emergency care?

Although chest pain is rarely serious in children, some symptoms warrant immediate emergency care. Call your local emergency number if your child experiences:

• Sudden, severe chest pain that feels like pressure, squeezing, or heaviness [1].
• Pain radiating to the jaw, left arm, or between the shoulder blades [1].
• Nausea, dizziness, sweating, racing heartbeat, or shortness of breath [1].
• Sudden, sharp chest pain with shortness of breath, especially after a long period of immobility (such as travel or bed rest), or if one leg is more swollen than the other, as this may indicate a blood clot [1].

If any of these symptoms appear, do not hesitate to seek emergency medical help for an urgent evaluation.

Next steps and diagnosis

If your child has chest pain, it is important to consult a pediatrician to evaluate the situation. The doctor will ask detailed questions about the nature of the pain, such as its location, description (sharp, burning, pressure-like), when it started, and whether it worsens or improves with certain activities such as breathing or movement [1]. They will also ask about any other associated symptoms and the child’s medical and family history. The doctor may perform a comprehensive physical examination.

Tests the doctor may request depend on their initial assessment and may include an electrocardiogram (ECG), chest X-ray, blood tests, or other tests to determine the underlying cause of the pain. It is important not to attempt self-diagnosis or home treatment without medical consultation [1]. To learn more about chest pain in children in general, you can visit Chest pain in children and adolescents: When to worry and when not to? (Arabic).

Medical references

• Chest pain
• Heart Inflammation What Is Heart Inflammation?