Infective endocarditis (IE) presenting as hyperventilation and chest pain in an adolescent female

What is it about?

Chest pain is a common complaint in both children and adolescents. It accounts for 650,000 medical visits annually in patients age 10-21yrs. Chest pain in children and adolescents is often chronic, is rarely of cardiac origin, and is often benign .Anxiety and hyperventilation are common causes of chest pain in adolescents, but can also be the consequences of pain. . A careful history and physical examination are essential and should include: characteristics of the pain, recent activity (eg. chest wall strain), trauma, recent infections or systemic illnesses (asthma, sickle cell, fever), medications or drugs (cocaine, oral contraceptive pills), associated symptoms such as paresthesias, tingling (suggesting hyperventilation syndrome), family history of heart disease, and a detailed psychosocial history for recent stressors, fears and concerns of the patient. A through physical examination should include; general state (anxiety, hyperventilation), cyanosis, vital signs for tachypnea, tachycardia or fever, chest wall palpation for localized tenderness, cardiopulmonary examination for rales, pleural friction rub, breast examination and abdominal examination. Laboratory evaluation depends on the findings of the history and physical examination.

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