Pediatric Cardiology

Heart Pain (Chest Pain): Common Causes, Symptoms and Treatment Options

Posted on by Prof. Dr. İbrahim Cansaran TANIDIR

Heart pain in children is rarely caused by the heart itself; these aches felt in the chest are generally directly related to problems involving the muscles, musculoskeletal system, or digestive system. Although this condition can be extremely frightening for parents, it is usually caused by harmless factors such as growth, poor posture, or intense physical activity. Symptoms suggesting a structural heart problem are quite limited, and in most cases, simple diagnostic tests are sufficient to relieve concerns. Correctly interpreting these physical complaints, understanding that there is no permanent underlying problem, and intervening early with appropriate solutions are among the most valuable steps in protecting children’s health.

What Causes Heart Pain in Children?

Chest pain during childhood and adolescence is the second most common reason for hospital visits. The number of children brought to hospitals with this complaint is by no means insignificant. Symptoms most commonly peak during adolescence between the ages of eleven and fourteen. However, they may also appear as a significant complaint as early as four years of age. The frequency is quite similar in boys and girls. Nevertheless, because of intense physical activity, demanding sports training, and minor injuries that may occur during these activities, chest pain may be observed more frequently in boys during certain periods. The greatest concern for families is that the pain originates from the heart. Regular medical evaluations generally prove this fear to be unfounded, providing significant psychological reassurance for parents.

Is It Really Heart Pain or Could There Be Another Cause?

When adults experience chest pain, the first possibilities that usually come to mind are heart attacks or blocked coronary arteries. In children, however, the situation is quite different. On average, only about five percent of pediatric patients presenting to emergency departments with chest pain require further evaluation. Detailed investigations reveal that the vast majority of these children experience pain caused by conditions unrelated to the heart. Pain originating from the heart muscle itself, the coronary arteries, or the heart valves accounts for only one to five percent of all cases. During the diagnostic process, the primary goal is to identify the true cause without subjecting the child to unnecessary tests or increasing the family’s anxiety.

How Does Idiopathic Heart Pain Improve?

One of the most common types of chest pain in children that is unrelated to the heart is idiopathic pain. These cases, in which no underlying organ disorder can be identified despite thorough examination and testing, constitute a considerable proportion of all cases. Although unexplained pain may seem alarming to parents, it is generally regarded as medically benign. The pain is typically described as a sharp stabbing sensation in the chest. It usually subsides spontaneously within seconds or a few minutes without requiring any intervention. There is no known association with physical exercise. Taking a deep breath may temporarily intensify the discomfort. These complaints, usually felt beneath the breast area, tend to decrease significantly as the child grows older.

What Causes Musculoskeletal Heart Pain?

The chest wall is a mobile structure composed of ribs, cartilage, and muscles. A significant proportion of chest pain in children results from strain or injury involving this complex structure. Tenderness of the cartilage connecting the ribs to the breastbone is particularly common during adolescence. Even gentle pressure on the chest may cause localized tenderness. The main factors that can trigger this type of pain include:

  • Carrying heavy backpacks
  • Sudden or awkward movements
  • Severe coughing episodes
  • Sports injuries
  • Sudden muscle spasms
  • Chest wall deformities
  • Poor posture
  • Growing pains

Although none of these factors directly affects the heart, the pain is often perceived as originating from the heart because it is felt directly over the chest.

Can Stress and Psychological Factors Cause Heart Pain?

Mental health directly affects the body, and children often respond to stressful situations with physical symptoms. During adolescence in particular, exam stress, family problems, or difficulties in friendships may manifest as chest pain. This phenomenon is known as somatization. The child’s emotional distress is perceived as though there were a physical problem with the heart. Common complaints associated with psychological factors include:

  • Severe headaches
  • Unexplained abdominal pain
  • A sensation of palpitations
  • Frequent need to take deep breaths
  • Body tremors
  • Excessive sweating
  • Sleep disturbances (difficulty falling asleep or waking during the night)

Once an organic disease has been ruled out, providing psychological support for the child becomes extremely important. While reassuring the child that the body is physically healthy, emotional needs should also be addressed appropriately.

Can Respiratory and Digestive System Problems Affect the Answer to How Heart Pain Improves?

The chest cavity also contains organs such as the lungs and the esophagus. Since the nerve networks of these organs are located very close to one another, a problem originating in the lungs can easily produce the sensation of chest pain. Asthma attacks commonly create a feeling of tightness in the chest. In the digestive system, stomach acid flowing back into the esophagus causes a burning sensation. Factors that may irritate the esophagus include:

  • Carbonated and acidic beverages
  • Highly spicy foods
  • Deep-fried foods
  • Excessive chocolate consumption
  • Caffeinated beverages
  • Heavy meals eaten late at night

Limiting these foods and establishing healthy eating habits can significantly reduce the burning sensation in the chest.

What Causes True Heart Pain and Under What Circumstances Does It Occur?

Although very uncommon, chest pain arising from the heart itself should never be overlooked. Such pain is usually caused by insufficient blood supply to the heart muscle, structural abnormalities, or disorders affecting the membrane surrounding the heart. In children, heart-related pain typically begins as a sensation of pressure or heaviness in the front of the chest. It tends to occur during physical exertion, such as climbing stairs or participating in strenuous activities, rather than while resting. Heart-related pain often extends beyond the chest and may radiate to other parts of the body. This type of pain serves as a warning that the heart is unable to meet its increased demand for blood and oxygen during periods of higher workload. A sudden decrease in a child’s exercise capacity during sports or physical activity is therefore an important warning sign.

Can Coronary Artery Problems and Ischemia Cause Heart Pain?

The arteries that supply blood to the heart muscle are called the coronary arteries. Structural abnormalities affecting these vessels may lead to myocardial ischemia, meaning inadequate oxygen supply to the heart muscle. Congenital coronary artery anomalies are an important example of this condition. An abnormal origin of a coronary artery may result in compression of the vessel during physical activity, reducing blood flow. Another cause of coronary artery disease during childhood is inflammation of the blood vessels following certain illnesses. If left untreated, these diseases may lead to structural abnormalities of the coronary arteries. Such changes in the vessel wall impair blood flow and make it more difficult for the heart muscle to receive adequate nourishment. In addition, congenital narrowing of the heart valves through which blood is pumped into the body forces the heart muscle to work harder. To cope with this increased workload, the heart muscle thickens. When sufficient blood cannot reach the thickened muscle, fatigue and chest pain may develop.

How Does Inflammation of the Heart Muscle or Heart Lining Change the Course of Heart Pain?

Certain viral infections affect not only the respiratory tract but may also spread directly to the heart muscle or the protective membrane surrounding the heart. When the lining of the heart becomes inflamed, sharp pain is felt behind the breastbone. A characteristic feature of this pain is that it changes with body position. The pain becomes worse when lying flat on the back or taking a deep breath but improves when sitting up and leaning forward. This occurs because leaning forward reduces friction between the inflamed layers of the heart lining. Inflammation of the heart muscle presents with a different clinical picture and may even develop after an intestinal infection. In such cases, chest pain is accompanied by a general feeling of illness. The child may appear pale, weak, and have a rapid heartbeat even while resting. Prompt medical attention and adequate rest are generally recommended to promote recovery.

Why Does Heart Pain Occur in Heart Rhythm Disorders and Valve Diseases?

The heart contains an electrical system responsible for maintaining a regular heartbeat. When electrical impulses become excessively rapid or irregular, a heart rhythm disorder develops. During these episodes, the heart may beat so rapidly that it has insufficient time to relax between contractions. Without adequate relaxation, the heart cannot properly receive blood through its own coronary arteries. This may lead to chest pain. Heart valve diseases may also occasionally cause pain. One relatively common condition is valve prolapse, in which a heart valve bulges backward. This stretches the supporting cords attached to the valve and may produce brief episodes of mild chest pain that are unrelated to physical exercise. Although this represents a structural variation, it generally does not interfere with the child’s daily activities.

What Causes Dangerous Heart Pain and Which Symptoms Should Be Taken Seriously?

Although most chest pain is harmless, certain situations require careful attention. Benign pain usually occurs while the child is resting. However, some characteristics may indicate an underlying heart problem. Warning signs that should be taken seriously include:

  • Chest pain beginning during physical exertion
  • A widespread pressure sensation across the chest
  • Pain radiating to the left arm
  • Pain spreading to the jaw or neck
  • Sudden episodes of blurred vision or dizziness
  • Unexplained fainting
  • Unexpected marked paleness of the face
  • Cold sweating while at rest
  • Severe shortness of breath

If these symptoms are observed, the child should be evaluated by a physician as soon as possible. Early diagnosis plays a crucial role in preventing serious complications.

How Is Heart Pain in Children Evaluated and How Is the Correct Diagnosis Made?

When a child is brought to a physician because of concerning symptoms, the primary goal is to determine whether there is an underlying condition that could significantly affect the child’s health. The evaluation begins with obtaining a detailed medical history. The physician asks when the pain occurs, how long it lasts, what time of day it appears, and which factors relieve it. The family’s medical history is also important. A comprehensive physical examination follows. The physician carefully listens to the heart sounds and rhythm, searching for abnormal murmurs or unusual heart sounds. Pulses in the arms and legs are also assessed. If both the medical history and physical examination are normal, the likelihood of a serious underlying condition is greatly reduced. This represents an important step toward establishing the diagnosis.

Can an ECG and Chest X-ray Explain the Cause of Heart Pain?

One of the most fundamental steps in the diagnostic process is performing an electrocardiogram (ECG). An ECG records the electrical activity of the heart. Adhesive electrodes placed on the child’s skin transmit the heart’s electrical signals onto paper. The procedure is painless and takes only a short time. Physicians analyze the recordings to determine whether there are rhythm abnormalities or evidence of strain on the heart muscle. Inflammatory conditions may also produce characteristic ECG changes. A chest X-ray is performed when indicated by the findings of the physical examination. It may be ordered if the heart appears enlarged or fluid accumulation is suspected. The X-ray provides an overview of the organs within the chest cavity. The results of these tests help clarify whether the symptoms are heart-related and guide further treatment planning.

How Does Echocardiography Help Answer the Question of What Causes Heart Pain?

One of the most common methods for evaluating suspected heart-related problems is echocardiography. Many families worry whether the equipment emits harmful radiation. This examination uses sound waves rather than radiation and is entirely safe and noninvasive. A gel is applied to the child’s chest, allowing the heart to be visualized on a monitor. Echocardiography provides valuable information including:

  • The precise size of the heart chambers
  • The thickness of the heart muscle walls
  • Heart valve function
  • The presence of congenital heart defects
  • The origin of the major blood vessels
  • Fluid surrounding the heart
  • Blood flow velocity within the heart

Color Doppler imaging allows physicians to evaluate the direction of blood flow in detail. This examination provides extensive information about the heart and significantly contributes to establishing an accurate diagnosis.

Are Blood Tests Always Necessary When Diagnosing Heart Pain?

When adults present to the hospital with chest pain, blood tests measuring cardiac enzymes are often performed immediately. In children, however, this approach is not routinely recommended. Drawing blood unnecessarily from a child with harmless chest pain may increase fear and cause unnecessary discomfort. Cardiac enzyme tests are only meaningful if there is genuine injury or strain affecting the heart muscle. If the physical examination and imaging findings raise suspicion of heart muscle involvement, these tests become appropriate. Otherwise, routine blood testing may only increase parental anxiety. Whenever possible, diagnostic methods that are easier and less distressing for the child are preferred.

How Is Heart Pain Treated with Medication and Which Drugs Are Used?

Once the underlying cause has been identified, the most appropriate treatment plan is developed. In the majority of cases involving harmless chest pain, thoroughly explaining that the child’s heart is healthy helps reduce symptoms. This reassurance is an important component of treatment. Appropriate medications may be prescribed for digestive or musculoskeletal causes. Respiratory conditions may require medications that help open the airways. When an actual heart condition is diagnosed, the following medication groups may be used:

  • Antiarrhythmic medications
  • Blood pressure-lowering medications
  • Medications that reduce stomach acid
  • Muscle relaxants
  • Diuretic medications
  • Anti-inflammatory treatments
  • Heart-supporting vitamin supplements

The dosage of all medications is carefully adjusted according to the child’s age and the nature of the underlying condition.

Güncellenme Tarihi: 13.10.2026

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