Diehl A M
Postgrad Med. 1983 Jun;73(6):335-7, 340-2. doi: 10.1080/00325481.1983.11697888.
The primary care physician can often delineate the cause of chest pain in a patient under 21 years of age after a thoughtful, careful, and thorough history and physical examination. Occasionally, an ECG and a chest x-ray film may be helpful. Noncardiac causes for the chest pain should be explored, and if found, the child and the parents should be assured that the problem is not serious. Occasionally, psychotherapy may be indicated. A pediatric cardiologist should be consulted when a strong family history of coronary artery disease or a personal history of coronary risk factors is present or a murmur is detected that may not be innocent. The specialist also should evaluate children who have organic cardiac disease. Finally, although the primary care physician may strongly suspect that the chest pain has little or no significance, reassurance by a pediatric cardiologist is frequently helpful to the child and the family.
经过深思熟虑、仔细且全面的病史采集和体格检查后，初级保健医生通常能够明确21岁以下患者胸痛的病因。偶尔，心电图和胸部X光片可能会有所帮助。应探究胸痛的非心脏病因，若发现此类病因，应向患儿及其父母保证问题并不严重。偶尔可能需要进行心理治疗。当存在冠心病的强烈家族史或个人有冠心病危险因素，或检测到可能并非无害的杂音时，应咨询儿科心脏病专家。该专家还应对患有器质性心脏病的儿童进行评估。最后，尽管初级保健医生可能强烈怀疑胸痛意义不大或没有意义，但儿科心脏病专家的安抚通常对患儿及其家庭有帮助。
