Substernal Chest Pain with an Abnormal Electrocardiogram in an Adolescent Male Presenting to a Pediatric Emergency Department

We report a case of an adolescent male who developed acute-onset, substernal chest pain and was noted to have electrocardiographic changes concerning for inferior and lateral myocardial ischemia. Although adult emergency departments (EDs) manage cardiac chest pain on a daily basis, pediatric EDs have very little experience with chest pain suggestive of myocardial infarction (MI). In addition, MI is being recognized more frequently in the pediatric age group. Historically, evaluation for MI was initiated in the ED but was completed as an inpatient. Recent laboratory and technologic advances have made ruling out MI an ED skill in low-risk patients. It is helpful for pediatric emergency medicine physicians to be aware of current evaluation techniques and their application to at-risk patients.