Clinical Significance of Cardiac Screening Tests and Methacholine Challenge Test for Children with Chest Pain

Abstract

Purpose: This study was performed to evaluate the causes of chest pain in children and identify the clinical correlation with cardiac screening tests and bronchial inhalation test with methacholine to measure nonallergic bronchial hyperresponsiveness. Methods: In 180 patients(5-19 years of age, mean 10.3) with chest pain during an 8-year period from Aug. 1995 to Oct. 2003, we analyzed the results of echocardiogram, 24 hour-holter monitoring, treadmill test and methacholine challenge test. Using CPI pulmolab system, the FEV1 was measured after baseline pulmonary function tests. PC20(provocative methacholine concentration which fall 20% in FEV1) was measured and positive response was defined when PC20 was below 25 mg/mL. Results: 96 patients(53.3%) of 180 with chest pain revealed a positive response to methacholine challenge test, and PC20 were from 0.07 to 24.60 mg/mL(mean 8.8±7.8 mg/mL) in the patients with a positive response. Abnormal findings of echocardiogram were found in 7(5.5%) of 127 patients, mitral valve prolapse in 5 patients, and congenital heart diseases in 2 patients. In 4 of 7 patients, methacholine challenge test showed a positive response. 24 hour-holter monitoring and treadmill test results were negative in all tested patients. Conclusion: In children with chest pain, cardiac screening tests do not correlated with the patients’ symptom and could not clearly explain each chest pain. While it is suggested that methacholine challenge test could have a significant role to detect the airway hyperresponsiveness in the patients with chest pain. Airway hyperresponsiveness could be a major cause of chest pain in children.