Angina living in children

Overview

Angina is a type of chest pain that happens when the heart muscle does not get enough oxygen-rich blood. While angina is common in older adults, it is very rare in children. In children, chest pain is usually caused by other things like muscle strain, breathing problems, or anxiety. Still, it is important to take any chest pain seriously and have it checked by a doctor.

Angina is not common in children. It affects fewer than 1 in 10,000 children each year. Most children who complain of chest pain have non-cardiac causes that are not serious.

Angina in children can affect those with underlying heart problems present at birth (congenital heart disease) or acquired later, such as after Kawasaki disease. It is more common in children with risk factors like obesity, diabetes, or high blood pressure, though still rare.

Symptoms

Common symptoms

• Chest discomfort, pressure, or squeezing sensation
• Pain that may spread to the arms, neck, jaw, or back
• Shortness of breath
• Nausea or indigestion
• Feeling dizzy or lightheaded

Symptoms in children

• Chest pain that happens during exercise or physical activity (exertional chest pain)
• Feeling like the heart is pounding or skipping beats (palpitations)
• Fatigue or tiredness more than usual
• Fainting (syncope) during or after activity

Symptoms in older adults

• Chest pain that often occurs with exertion and goes away with rest
• Pain may be described as tightness, pressure, or heaviness
• Shortness of breath, sweating, or nausea

Causes

Main causes

• In very rare cases, a child may have a congenital heart defect that reduces blood flow to the heart.
• Kawasaki disease can inflame the arteries that supply the heart, leading to angina later in childhood.
• Other heart conditions like coronary artery anomalies (abnormal structure of the heart arteries) can cause angina.
• In most children, chest pain is due to non-heart causes such as costochondritis (inflammation of rib cartilage), asthma, anxiety, or muscle strain.

Risk factors

• Being born with a heart defect (congenital heart disease)
• Having had Kawasaki disease with heart complications
• Obesity, high blood pressure, or diabetes (rare in children)
• Family history of early heart disease
• Certain genetic conditions like familial hypercholesterolemia (very high cholesterol)

When to see a doctor

See a doctor urgently if:

• Any episode of chest pain with fainting, trouble breathing, or blue lips – call emergency services immediately.
• Chest pain that comes on suddenly and is severe.
• Chest pain with a very fast or irregular heartbeat.

Book a routine appointment if:

• If your child has chest pain that occurs during exercise and goes away with rest, make an appointment with your child's doctor within a few days.
• If your child complains of chest pain that is mild and brief, but you are concerned, schedule a routine check-up.
• If your child has a known heart condition and develops new chest pain, see the specialist soon.

Diagnosis

To diagnose angina in a child, a doctor will take a detailed history, ask about symptoms during activity, and do a physical exam. They may refer the child to a paediatric cardiologist (heart specialist) if heart disease is suspected.

Tests that may be done

• Electrocardiogram (ECG/EKG) – measures the heart's electrical activity at rest and sometimes during exercise (stress test).
• Echocardiogram (ultrasound of the heart) – shows heart structure and function.
• Blood tests – to check for heart muscle damage or other conditions.
• Holter monitor – a portable ECG worn for 24–48 hours to record heart rhythms.
• Cardiac MRI or CT scan – detailed images of the heart and arteries.
• Stress test – child exercises on a treadmill while ECG is monitored.

What to expect at your appointment

The doctor will explain each test before it is done. Many tests are non-invasive (no needles or cutting) and painless. It may take several visits to get a clear diagnosis. The doctor will keep you and your child informed every step of the way.

Treatment

Treatment for angina in children depends on the cause. If a heart condition is found, treatment may involve medicines, lifestyle changes, or procedures. For non-cardiac chest pain, treatment focuses on the underlying cause, such as managing asthma or anxiety. Always follow the treatment plan given by your child's doctor.

Self-care at home

• Encourage your child to rest if they feel chest pain during activity.
• Make sure your child stays active but avoids overexertion if heart condition is present.
• Help your child manage stress with relaxation techniques or talking to a counsellor.
• Keep a diary of chest pain episodes, noting what the child was doing before the pain started.

Medical treatments

If a child has true angina from a heart condition, doctors may prescribe medicines that help relax or widen blood vessels, or reduce the heart's workload. These may include nitrates, beta-blockers, or calcium channel blockers – but no specific names or doses are given here. Treatment is always tailored to the child's specific condition and monitored closely by a paediatric cardiologist.

When is surgery considered?

In rare cases, a child may need a procedure to fix a blocked artery or correct a heart defect. This could involve a heart catheterization (a thin tube inserted into a blood vessel) or open-heart surgery. The decision for surgery is made only after careful evaluation by a heart team.

Living with this condition

Most children with chest pain from non-cardiac causes can live normally. For those with true angina, daily life may need adjustments. The doctor will give guidance on safe activity levels. Your child can attend school and play, but may need to avoid very strenuous sports or activities that trigger symptoms.

Lifestyle tips

• Follow any activity restrictions advised by the heart doctor.
• Make sure your child takes all prescribed medicines exactly as directed.
• Encourage a heart-healthy diet (low in saturated fats, high in fruits and vegetables).
• Maintain a healthy weight for your child's age.
• Avoid smoking exposure – do not smoke around the child.

Diet and exercise

A balanced diet with plenty of fruits, vegetables, whole grains, and lean protein is good for all children. If your child has a heart condition, the doctor may recommend limiting salt and unhealthy fats. Exercise is important, but the type and intensity should be based on your child's health – always ask the doctor which activities are safe.

Mental health and emotional wellbeing

Living with chest pain or a heart condition can be stressful for a child and the family. Children may feel anxious, fearful, or frustrated. Talk openly with your child about their feelings. Consider speaking with a child psychologist or counsellor if needed. Reassure your child that they are safe and that the medical team is taking good care of them.

Prevention

Most cases of angina in children are not preventable because they are due to rare birth defects or acquired conditions. However, you can reduce the risk of heart disease later in life by encouraging healthy habits from a young age: a balanced diet, regular activity, and avoiding obesity. If your child has Kawasaki disease, prompt treatment can lower the chance of heart complications.

Vaccines

No specific vaccine prevents angina. However, keeping up with routine childhood vaccines protects against infections that could affect the heart, such as influenza or COVID-19.

Screening programmes

Children with a strong family history of early heart disease or known risk factors may need screening with cholesterol tests or other evaluations. Talk to your child's doctor about whether screening is right for your child.

Complications

If left untreated

• If true angina is left untreated, it can lead to a heart attack (myocardial infarction) – extremely rare in children.
• Untreated heart conditions may worsen over time, affecting the heart's pumping ability.
• Severe undiagnosed heart defects can cause life-threatening complications.

Long-term outlook

The outlook for children with angina depends on the underlying cause. For the vast majority of children with chest pain, the cause is not heart-related and they have a normal, healthy life. For children with true angina from a heart condition, modern treatments are very successful. With proper medical care, most children can lead active, fulfilling lives. Your child's doctor will guide you on the best path forward.

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