Chest Pain Clinical Pathway — Emergency Department | Children's Hospital of Philadelphia

History	Physical Exam	Non-Cardiac Past Medical History	Family History
Exertional Acute onset Substernal crushing pressure Radiation to shoulder, arm, neck, jaw Syncope, dizziness Palpitations Dyspnea Orthopnea Pulmonary Embolism Risk Factors Drug use Medication use COVID-19 mRNA Vaccination within 1 Week Recent COVID-19 Illness or Concerning Exposure	Cyanosis Tachypnea, shortness of breath, work of breathing Abnormal heart rhythm Hypotension New or significant murmur Gallop Friction rub Abnormal 2nd heart sound Decreased femoral/peripheral pulses	Rheumatologic disease, lupus Aortopathy, such as: Marfan syndrome Loeys-Dietz syndrome Turner syndrome Sickle cell disease	Sudden death or myocardial infarction under 50 years old Unexplained sudden death in young relative Cardiomyopathy

Posted: January 2014
Revised: February 2023
Authors: M. M'Farrej, MD; P. Stephens, MD; J. Lavelle, MD; M. Elias, MD

Evidence

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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.

Emergency Department Clinical Pathway for Evaluation/Treatmentof Children with Chest Pain without Known Cardiac Disease

Risk Factors for Cardiovascular Etiology

Evidence

Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Chest Pain without Known Cardiac Disease