Chest Pain in Teen Athletes: Causes and Concerns

Chest pain in adolescents?

The 14-year-old male athlete has been experiencing sharp chest pain recently, occurring both at rest and during physical activity.
Each episode lasts between 5 to 30 seconds.
He underwent an echocardiogram and an electrocardiogram, both of which were normal.
He also completed a 17-minute exercise stress test without any discomfort, although the report indicated signs of hypoxia.
A subsequent nuclear medicine scan showed normal results.
Two doctors have assessed his condition and confirmed that there are no cardiac issues.
However, the child continues to experience intermittent sharp pain, which has caused concern among the coaching staff.
I would like to ask the doctor if this situation could be attributed to autonomic nervous system dysregulation or if it is a normal occurrence during his developmental stage?

Zheng Mama, 30~39 year old female. Ask Date: 2016/10/20

Dr. He Dongjin reply Cardiology

Hello, the tingling sensation does not appear to be a cardiac symptom.
The results from the ultrasound, electrocardiogram (ECG), exercise ECG, and nuclear medicine tests are all normal.
Both doctors have stated that there are no issues with the heart, and it is likely a normal condition related to developmental stages.
Parents and coaching staff need not worry.
Changhua Hospital cares about you.

Reply Date: 2016/10/20

More Info

Understanding chest pain in teen athletes is a complex issue that requires careful consideration of various factors, especially given the physical demands placed on young athletes. In your case, your 14-year-old son, who is an athlete, has been experiencing sharp chest pain that occurs both at rest and during exercise. The pain lasts from a few seconds to half a minute, and despite thorough cardiac evaluations—including echocardiograms, electrocardiograms (ECGs), and a stress test—all results have come back normal, except for some noted hypoxia during the stress test.

Given these findings, it is essential to explore several potential causes for the chest pain. One possibility is that the pain could be related to musculoskeletal issues rather than cardiac problems. Young athletes often experience chest pain due to muscle strain, rib dysfunction, or costochondritis, which is inflammation of the cartilage connecting the ribs to the sternum. These conditions can cause sharp, localized pain that may mimic cardiac pain but is not related to heart function.

Another consideration is the role of anxiety or stress, particularly in competitive sports environments. Athletes, especially teenagers, can experience performance anxiety, which may manifest as physical symptoms, including chest pain. This could be exacerbated by the pressure to perform, concerns about health, or even the fear of injury. If your son is experiencing anxiety, it may be beneficial to consult with a mental health professional who specializes in sports psychology.

Additionally, the possibility of autonomic nervous system dysregulation should not be overlooked. The autonomic nervous system controls involuntary bodily functions, including heart rate and blood pressure. In some cases, young athletes may experience symptoms related to dysregulation, particularly during periods of rapid growth or hormonal changes. This could lead to sensations of chest pain or discomfort, especially during physical exertion.

It is also worth considering the impact of exercise intensity and training volume. Overtraining can lead to various physical symptoms, including chest pain. Ensuring that your son has a balanced training regimen with adequate rest and recovery is crucial. If he is pushing himself too hard, it may lead to physical stress that manifests as pain.

In conclusion, while the cardiac evaluations have ruled out significant heart issues, it is essential to continue monitoring your son's symptoms. If the pain persists or worsens, further evaluation by a pediatric cardiologist or a sports medicine specialist may be warranted. They can provide a more comprehensive assessment and potentially explore other avenues, such as musculoskeletal evaluations or psychological assessments, to determine the underlying cause of the pain. In the meantime, encouraging your son to communicate openly about his symptoms and ensuring he has a supportive environment both at home and in sports can help alleviate some of the concerns surrounding his condition.

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