Chest Pain Clinical Pathway – Emergency Department

Further Diagnostic Testing

Laboratory testing is rarely required in children with chest pain. Please discuss indications for labs with Cardiology.

Consider these tests with the following indications:

	History	Physical Exam
ECG	Exertional Acute onset, awakens from sleep Substernal crushing pressure Radiation to shoulder, arm, neck, jaw Syncope, dizziness Palpitations Dyspnea, Orthopnea Risk Factors for PE Suspected drug exposure/abuse Consider with fever	Ill appearance Significant VS abnormality Abnormal cardiac exam Consider with fever
Chest X-ray, 2 View	Fever Respiratory distress Trauma Awakens child from sleep Acute onset Suspected foreign body	Fever Ill appearance Significant VS abnormality Abnormal lung exam Abnormal cardiac exam Crepitations
CBC, ESR, CRP	Concern for myo/pericarditis
Troponin	Concern for ischemia, myo/pericarditis
BMP, Mg	Arrhythmia with abnormal ECG
Drug Screen	Suspected drug use and all adolescents with chest pain
D-Dimer	Concern for PE (see Acute Pulmonary Embolism Pathway for full evaluation) History of connective tissue disorder (e.g., Marfan syndrome) and concern for aortic dissection
BNP	Concern for heart failure

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Chest Pain Clinical Pathway – Emergency Department

Further Diagnostic Testing

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Chest Pain Clinical Pathway – Emergency Department – Further Diagnostic Testing

Chest Pain Clinical Pathway – Emergency Department

Further Diagnostic Testing