Difficulty in Diagnosing Coronary Spastic Angina in a 9-Year-Old Boy

Abstract

Chest pain due to cardiovascular disease is rare in children. It is important to distinguish between angina and myocarditis in the outpatient department. A 9-year-old boy was presented with chest and abdominal pain, which makes it difficult to diagnose coronary spastic angina from clinically relevant myocarditis. The patient was treated for an asthma attack two weeks ago. He had experienced right chest pain for two days. He complained of right-sided abdominal pain at midnight and consulted his family doctor. He was referred to our hospital on suspicion of acute myocarditis because of a high C-reactive protein level and troponin T positivity. During the chest pain, the electrocardiogram (ECG) exhibited ST-segment elevation in the inferior wall leads and V4-6, and a sublingual nitroglycerin spray improved the symptoms and ECG findings. No abnormalities were found on coronary angiography, and no contrast effects were observed on delayed contrast cardiac MRI, leading to a diagnosis of coronary spastic angina. It is difficult to differentiate coronary spastic angina in children from clinically relevant myocarditis due to limitations of the testing methods, so it can be difficult to diagnose and treat according to the guidelines for the diagnosis of coronary spastic angina.