Göğüs ağrısı ile Kırıkkale Üniversitesi Tıp fakültesi çocuk kardiyoloji polikliniği ve çocuk acil servisi'ne başvuran vakaların etiyolojik ve epidemiyolojik özelliklerinin incelenmesi
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Tarih
2020
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Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Göğüs ağrısı çocuk popülasyonunda, özellikle adölesan dönemde yaygın görülen bir şikayettir. Çocuklarda erişkinlerden farklı olarak; kalp hastalıklarından kaynaklanan göğüs ağrıları nadir olarak görülmektedir. Çocuk hastalar ağrıyı tam olarak tarifleyip, lokalize edemedikleri için kardiyak nedenli göğüs ağrısını dışlamak amacıyla daha fazla test yapılabilmektedir. Özellikle kalp kası hasarı belirteci olarak kullanılan Troponin (Tn), Kreatin Kinaz (CK) ve Kreatin Kinaz Miyokardiyal Band (CK-MB) ve ekokardiyografi (EKO) kullanımının ne sıklıkta olduğunu belirlemek, pozitiflik oranını saptamak ve bu tetkiklerin hangi koşullarda istenmesi gerektiğinin belirlenmesi önemlidir. Bu çalışmada, göğüs ağrısı şikayeti ile başvuran hastaların etiyolojik ve epidemiyolojik özelliklerini geriye dönük inceleyerek, göğüs ağrısı vakalarının sıklığını belirlemek, göğüs ağrısı ile başvuran hastalarda, muhtemel kardiyak hasar göstergesi olarak kullanılan CK, CK-MB, Tn seviyelerinin ve ekokardiyografi tetkikinin kardiyak nedenli göğüs ağrılarındaki anlam ve önemini araştırmaktır. Gereç ve Yöntem: Bu çalışmaya, Kırıkkale Üniversitesi Tıp Fakültesi Hastanesi Çocuk Kardiyoloji Polikliniği ve Çocuk Acil Servisi'ne 01 Ocak 2014 – 01 Ocak 2019 tarihleri arasında göğüs ağrısı şikayeti ile başvuran 10-18 yaş aralığındaki çocuklar alındı. Hastaların yaş, cinsiyet gibi demografik verileri, göğüs ağrısına yönelik yapılmış olan; elektrokardiyografi (EKG), ekokardiyografi, tam kan tetkiki (CBC) ve biyokimya değerleri değerlendirildi. Sonuçlar istatistiksel yöntemlerle karşılaştırıldı. Bulgular: Çalışmamızdaki bireylerin yaş ortalamasının 12,9±2 yıl, kızlarda 13,1±2 yıl, erkeklerde ise 12,6±2 yıl olduğu belirlendi. En fazla başvurunun şubat ayında (%12,1) en az başvurunun ise temmuz ayında (%5,3) olduğu görüldü. Göğüs ağrısı nedenleri; idiyopatik: %45,8, kas iskelet sistemi ilişkili: % 14,5, gastrointestinal sistem ile ilişkili: %6,8, psikojenik: %9,5, solunum sistemi ilişkili: % 13,5, kardiyak: %9,9 olarak bulundu. 1164 hastanın %87,9'una EKO yapılmış olup; en sık oranda, %16 Mitral Valv Prolapsus'u (MVP) saptandı, ikinci sıklıkta %11,3 Mitral Valv Prolapsus+ Mitral Yetmezlik (MY) saptandı. Kardiyak göğüs ağrısı nedeni olarak kabul ettiğimiz MVP+MY olan hastalar ile normal EKO bulgusu olan hastaların tam kan sayımı, biyokimya, tiroid fonksiyon testleri (TFT), C-Reaktif Protein (CRP), Eritrosit Sedimantasyon Hızı (ESH), CK, CK-MB, Tn, Pro-B-tipi natriüretik peptit (Pro-BNP) değerleri karşılaştırıldığında istatistiksel olarak anlamlı sonuçlar bulunamadı. CK ve CK-MB yüksekliği saptanan hastalarda erkek cinsiyet oranının kız cinsiyete göre anlamlı derecede yüksek olduğu bulundu. EKO bulgularında MVP saptanan hastalarda kız cinsiyet (%71,4) anlamlı derecede yüksek olarak bulundu. Sonuç: Bu çalışma ile, çocuklarda göğüs ağrısının kalp ile ilişkili olma oranının düşük olduğu gösterilmiştir (%9,9). Ayrıca göğüs ağrısı yakınması ile başvuran hastalarda ilk aşamada ayrıntılı öykü, dikkatli fizik muayene ve elektrokardiyografik değerlendirme ile kardiyak göğüs ağrılarının ekarte edilebileceği ve Tn, CPK, CKMB, ekokardiyografi gibi tetkiklerin muayenemizin rutin bir parçası olmaması gerektiği, testlerin yüksek olma oranlarının çok düşük ve maliyetlerinin fazla olması nedeniyle bu tetkiklerin maliyeti ve kaynak kullanımının da biz çocuk hekimleri tarafından önemsenmesi gerektiği vurgulanmıştır.
Objective: Chest pain is a common complaint in the pediatric population, especially in adolescence. Unlike adults in children; Chest pain caused by heart disease is rare. Since pediatric patients cannot fully describe and localize the pain, more tests may be performed to exclude cardiac chest pain. It is especially important to determine the frequency of use of Troponin (Tn), Creatine Kinase (CK), Creatine Kinase Myocardial Band (CK-MB) enzymes and echocardiography, to determine the positivity rate and todetermine under which conditions these tests should be requested. In this study, we retrospectively examine the etiological and epidemiological features of patients with chest pain and we aimed to determine the frequency of chest pain cases, also investigating the importance and meaning of echocardiography examination and CK, CK-MB, Tn levels which are used as indicators of possible cardiac damage in patients who presenting with chest pain, in cardiac chest pain. Materials and Methods: Children between the ages of 10-18 who applied to Kırıkkale University Medical Faculty Hospital Pediatric Cardiology Clinic and Pediatric Emergency Service between 01 January 1 2014 and 01 January 01 2019 with the complaint of chest pain were included in this study. The demographic data of the patients such as age and gender, also electrocardiography, echocardiography, whole blood test and biochemistry values which was made for chest pain, were evaluated. Results were compared by statistical methods. Results: The mean age of the individuals in our study was determined to be 12.9 ± 2 years, 13.1 ± 2 years in girls and 12.6 ± 2 years in boys. It was observed that the highest number of applications were in February (12.1%) and the least was in July (5.3%). Chest pain causes; idiopathic: 45.8%, musculoskeletal system related: 14.5%, gastrointestinal system related: 6.8%, psychogenic: 9.5%, respiratory system associated: 13.5%, cardiac: 9.9% was found. ECHO was performed in 87.9% of 1164 patients; MVP was the most common with 16%, and the second most common was 11.3% MVP + MY. When the complete blood count parameters, biochemistry, thyroid function tests, CRP, ESR, CK, CK-MB, Tn, Pro-BNP values of the patients with MVP + MR, which we considered as the cause of cardiac chest pain, and those with normal echo findings were compared, no statistically significant results were found. . Male gender ratio was found to be significantly higher than female gender in patients with high CK and CK-MB levels. Female gender (71.4%) was found to be significantly higher in patients with MVP in ECHO findings. Conclusion: In this study, it was shown that the rate of chest pain associated with the heart is low in children (9.9%). In addition, in patients presenting with chest pain complaints, cardiac chest pains can be ruled out with detailed history, careful physical examination and electrocardiographic evaluation at the first stage, and tests such as Tn, CPK, CKMB, and echocardiography should not be a routine part of our examination, also it was emphasized that the cost and resource use of these examinations should be taken into consideration by us pediatricians as the rates of high tests are very low and their costs are high.
Objective: Chest pain is a common complaint in the pediatric population, especially in adolescence. Unlike adults in children; Chest pain caused by heart disease is rare. Since pediatric patients cannot fully describe and localize the pain, more tests may be performed to exclude cardiac chest pain. It is especially important to determine the frequency of use of Troponin (Tn), Creatine Kinase (CK), Creatine Kinase Myocardial Band (CK-MB) enzymes and echocardiography, to determine the positivity rate and todetermine under which conditions these tests should be requested. In this study, we retrospectively examine the etiological and epidemiological features of patients with chest pain and we aimed to determine the frequency of chest pain cases, also investigating the importance and meaning of echocardiography examination and CK, CK-MB, Tn levels which are used as indicators of possible cardiac damage in patients who presenting with chest pain, in cardiac chest pain. Materials and Methods: Children between the ages of 10-18 who applied to Kırıkkale University Medical Faculty Hospital Pediatric Cardiology Clinic and Pediatric Emergency Service between 01 January 1 2014 and 01 January 01 2019 with the complaint of chest pain were included in this study. The demographic data of the patients such as age and gender, also electrocardiography, echocardiography, whole blood test and biochemistry values which was made for chest pain, were evaluated. Results were compared by statistical methods. Results: The mean age of the individuals in our study was determined to be 12.9 ± 2 years, 13.1 ± 2 years in girls and 12.6 ± 2 years in boys. It was observed that the highest number of applications were in February (12.1%) and the least was in July (5.3%). Chest pain causes; idiopathic: 45.8%, musculoskeletal system related: 14.5%, gastrointestinal system related: 6.8%, psychogenic: 9.5%, respiratory system associated: 13.5%, cardiac: 9.9% was found. ECHO was performed in 87.9% of 1164 patients; MVP was the most common with 16%, and the second most common was 11.3% MVP + MY. When the complete blood count parameters, biochemistry, thyroid function tests, CRP, ESR, CK, CK-MB, Tn, Pro-BNP values of the patients with MVP + MR, which we considered as the cause of cardiac chest pain, and those with normal echo findings were compared, no statistically significant results were found. . Male gender ratio was found to be significantly higher than female gender in patients with high CK and CK-MB levels. Female gender (71.4%) was found to be significantly higher in patients with MVP in ECHO findings. Conclusion: In this study, it was shown that the rate of chest pain associated with the heart is low in children (9.9%). In addition, in patients presenting with chest pain complaints, cardiac chest pains can be ruled out with detailed history, careful physical examination and electrocardiographic evaluation at the first stage, and tests such as Tn, CPK, CKMB, and echocardiography should not be a routine part of our examination, also it was emphasized that the cost and resource use of these examinations should be taken into consideration by us pediatricians as the rates of high tests are very low and their costs are high.
Açıklama
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
