American Academy of Pediatrics – Section on Cardiology and Cardiac Surgery

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Released November 2, 2020

Do not order an echocardiogram for the routine evaluation of pediatric chest pain in the absence of a concerning history or ECG abnormalities.

Chest pain is a common presenting symptom in pediatrics but is rarely life-threatening, and the vast majority of cases are not cardiac in origin. Therefore, the addition of an echocardiogram only adds diagnostic value in very limited circumstances and increases the cost of care. If the patient has a concerning personal (exertional chest pain with an abnormal ECG) or family history of sudden or unexplained death or cardiomyopathy or ECG abnormalities, consultation with a pediatric cardiologist is generally recommended prior to obtaining an echocardiogram. Therefore, it is important to obtain a complete personal and family history,* physical examination, and screening ECG, if the treating physician feels that the chest pain is cardiac in nature, prior to proceeding with cardiac consultation and echocardiography.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items
on this list or their individual situation should consult their physician.

How The List Was Created

This list was developed initially by faculty in Pediatric Cardiology at University Hospitals in Cleveland OH. It was then revised and approved by the AAP Section on Cardiology and Cardiac Surgery. After review by other AAP sections, the AAP Executive Committee granted final approval of the list.

AAP’s disclosure and conflict of interest policy can be found at


Campbell RM, Douglas PS, Eidem BW, Lai WW, Lopez L, Sachdeva R. ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 Appropriate use criteria for initial transthoracic echocardiography in outpatient pediatric cardiology: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Academy of Pediatrics, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Coll Cardiol. 2014;64(19):2039-2060

Friedman KG, Kane DA, Rathod RH, et al. Management of pediatric chest pain using a standardized assessment and management plan. Pediatrics. 2011;128(2):239-245
Chamberlain RC, Pelletier JH, Blanchard S, Hornik CP, Hill KD, Campbell MJ. Evaluating appropriate use of pediatric echocardiograms for chest pain in outpatient clinics. J Am Soc Echocardiogr. 2017;30(7):708-713

Nguyen T, Fundora MP, Welch E, et al. Application of the pediatric appropriate use criteria for chest pain. J Pediatr. 2017;185:124-128